Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2020-00030
Date Issued: 01/17/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106DA17700
Jurisdiction: Tigard
Site address: 16799 SW APPLEDALE RD
Project: River Terrace East No.2, Lot 216 Subdivision: RIVER TERRACE EAST Lot: 216
Project Description: (1)branch circuit for A/C installation.
Contractor: ALAMEDA ELECTRIC Owner: WILLIAM LYON HOMES INC
3415 NE 44TH BY POLYGON WLH LLC
PORTLAND, OR 97213 ATTN BAKER, JASON
703 BROADWAY ST STE 510
VANCOUVER,WA 98660
PHONE: 503-319-2192 PHONE: 602-694-4031
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 01/17/2020 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/17/2020 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 Center. Those rules are set forth in OAR
952-001-0010 through OA 995-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ` . p� Permittee Signature: e-47 %it;�.;.
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 ED FOR OFFICE USE ONLY
Cityri
ofTigard Received r��/
- g Date/By:1 /1 jt"t .ti' / Permit# �C�� -t t G/ �
'I 13125 SW Hall Blvd.,Tigard,OR 97223 1 4 2020 Plan Revtew
Phone: 503.718.2439 Fax: 503,598.1960JAN Date/By: Related Permit#:
TIGAKD Inspection Line: 503.639.4175 �r F r ReadyDatelBy: loris: 10 See Page 2 for
e Internet: www.tigard-or.gov l/� t V� �'AR Notified/Method:
APING„ CASI,y Supplemental Information
TYPE OF ti (� PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
_ CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
E 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
A4P .ls.. R m
❑Addition new motor load of system.
Job#: Job site address: 1 VIC%
ked
slilooHP or more. ❑"A","E","t-z^,••l-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: East River Terrace 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 l Qty. l Each ] Total I
New residential single-or multi-family dwelling unit.
jSubdivision: East River Terrace Lot#: ‘ks 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 75.00 2
r d f [- Wn—r 2 7 31 (with above sq.ft.)
11 t J ` t1 �„O0 d _ Limited energy,multi-family 75.00 2
��+, - �� residential(with above sq.ft.)1-4",?c t / i�' c L ,e‘,4*----
Renewable Energy ❑ See Page 2
®'PROPERTY OWNER 1 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Polygon WLH,LLC 200 amps or less 100.70 2
Address: 703 Broadway St,Ste510 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: ( ) 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 59.36 1
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: Polygon WLH,LLC above service or feeder fee,
7A2 2
each branch circuit
Contact name:Tonja Morris B.Fee for branch circuits without
Address: 703 Broadway St,Ste.510 service or feeder fee,first r 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
Email:permitsubmittals@polygonhomes.com dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Alameda Electric Sign or outline lighting 67.84 2
Address:3415 NE 44"'Ave. Signal circuits)or limited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Portland,OR 97213 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503)319-2192 Fax: ( ) Investigation(1 hr min) 90.00/hr
Email:solarpdx@me.com Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 I Suprv. Lic.: 48715 specifically listed('A hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:. Subtotal:
Print name: Kirk Rood ( Date: 05/09/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: �C,de. AO04 , TOTAL PERMIT FEE:
This permit application expires If a permit is not obtained within 180
Print name: Kirk Rood Date: 05/09/2019 days after it has been accepted as complete.
* Number of inspections allowed per pennit.