Permit (100) CITY OF TIGARD ELECTRICAL PERMIT
F COMMUNITY DEVELOPMENT Permit#: ELC2019-00508
T i,GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/30/2019
Parcel: 2S107AA23600
Jurisdiction: Tigard
Site address: 16870 SW ROCKHAMPTON LN
Project: Polygon at Roshak Ridge Subdivision: ROSHAK RIDGE Lot: 236
Project Description: Temporary power for sales trailer across(2)lots at site addresses: 16870&16882.
Contractor: ALAMEDA ELECTRIC Owner: POLYGON WLH LLC
3415 NE 44TH 703 BROADWAY ST STE 510
PORTLAND, OR 97213 VANCOUVER,WA 98660
PHONE: 503-319-2192 PHONE:
FAX:
FEES
Quantity Description Date Amount
Specifics: 1 ea Temp Services or Feeders- 07/30/2019 $59.36
200 amps or less
1 ea 12%State Surcharge- 07/30/2019 $7.12
Type of Use: COM Electrical
Class of Work: NEW
Type of Const:
Occupancy Grp:
Total $66.48
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent . .ose rules are set forth in OAR
f ij
952-001-0010 through 0 952-001-0090. You may obtain a copy of the rules or direct questions to U by ca in 503.232.19; or 1.; . .2344.
Issued By: Permiftee Signature: g^
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application' FOR OFFICE USE ONLY
City of Tigard Received
Permit#: � i"l_ \Z `\
III `� 13125 SW Hall Blvd.,Tigard,OR 97223 J w 3 `' Date/B: �3
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:(,mCC.,; e1
TIGARD Inspection Line: 503.639.4175 Ready Date/By: Juris: H See Page 2 for
c Internet: www.tigard-or.gov ... . .: Notified/Method: Supplemental Information
TYPE OF WORK , PLAN-REVIEW _ ''
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Other: ❑Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
- CATEGORY OF-CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑ Other: 0 Fire pump.p 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ' 0 Emergency system. larger separately derived
%'^a 1 n , ,\` ^,�.�,-
O Addition of new motor load of system.
Job#: Job site address: V b� �W O1 D r` 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97224 ` + ❑Six or more residential units. occupancy.
❑Health-care facilities. Er Recreational vehicle parks.
Suite/bldg./apt.#: _ Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: 2. 4) Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:William Lyon Homes,Inc. 200 amps or less 100.70 2
Address:703 Broadway St Suite 510 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver,WA 98660 601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 Fax:(360)693-4442 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less Li.„....
1 J 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps ------��� 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
® APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
7.42 2
each branch circuit
Contact name:Nichole Thorpe • B.Fee for branch circuits without
Address:703 Broadway St Suite 510 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)695-7700 Fax: :(360)693-4442 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:permitsubmittals@polygonhomes.com
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Alameda Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:3415 NE 44th panel,alteration,or extension. D See Page 2 2
City/State/ZIP:Portland,OR 97213 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)319-2192 Fax:( ) Investigation(1 hr min) 90.00/hr
•
Email:solarpdx@me.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 4871i s specifically listed(i/a hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Kile Rood Date: 03/08/2019 ❑Plan Review Required(25%of permit fee):
- - State surcharge(12%of permit fee):
Authorized signature: /,--c......� TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Kile Rood Date: 03/08/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Buiidins\Permits\ELC PermitAnn ELR ERE.doc Rev 06/17/2015 440-4615T(11/05/Cr1M/WPR