Permit CITY OF TIGARD ELECTRICAL PERMIT
111
COMMUNITY DEVELOPMENT Permit#: ELC2020-00073
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/05/2020
T I G 1 R.E.-) g Parcel: 2S108DB04200
Jurisdiction: Tigard
Site address: 15277 SW THAMES LN
Project: Polygon at Bull Mountain,Lot 40 Subdivision: POLYGON AT BULL MOUNTAIN Lot: 40
Project Description: Adding(1)branch circuit for addition of NC.
Contractor: ALAMEDA ELECTRIC Owner: POLYGON WLH LLC
3415 NE 44TH 109 E 13TH ST, STE 200
PORTLAND, OR 97213 VANCOUVER,WA 98660
PHONE: 662-694-4031
PHONE: 503-319-2192
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 02/05/2020 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/05/2020 $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 t follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OA 2-001-0090. You may ain a copy of e rules or direct uestions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Ymittee Signature: />" _
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 ApplicatioBECEI V ED FOR OFFICE USE ONLY
City of Tigard �,f 0 Received }}--- _ /y 3
g J A N 3 2020 Date/By: �i •Permil#Z C ��C) V��
- a 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review �. ��_„__
Phone: 503.718.2439 Fax: 503.598.196�Y OF TIGARD Date/By: ✓7�`¢' j�.7
Inspection Line: 503.639.4175 Er Date/By: 1nr,s: See Page 2 for
TIGARA Internet: www.tigard-or.gov BUILDING DIVISION 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 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling ❑Commercial/industrial to ground,or exceeds 14,000 ❑Commercial-use agricultural
industrial ❑Accessory building
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑ Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
AddJob#: Job site address: l 52�1"1 St-4) O.vlt1ve S tt t h 0 100H ion of new motor load of system.
� P or more.
—
100H ❑•'A„ "E,•"1.2„ •,1.3„
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:^� 'yam ❑Hazardous locations. 0 Supply voltage for more than
•�VQ�� � ❑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: East River Terrace Lot#: J.,p Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00 2
ackd- Pr(C V\ tS2--- (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER ❑ 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 ❑ 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, 7.42 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 56.18 2
branch circuit
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: (360)695-7700 Fax: :(360)693-4442 Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:permitsubmittals@polygonhomes.com 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 44th Ave. Signal circuit(s)or limited-energy ❑ 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(1 hr min) 78.18/hr
- Inspections for which no fee is 90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 1 Suprv.Lic.: 48715 specifically listed(Y.hr min)
fj ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: �,;� ��.-� Subtotal:
Print name: Kirk Rood I Date: 05/09/2019 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: k t 1 Aio pe,-,(, 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 permit
I:tBuildine\Permits\ELC PemitAoo ELR ERE.doc Rev 06/17/2015 440.4615111 lmc,rt1M/WFR