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Permit (14) CITY OF TIGARD ELECTRICAL PERMIT Ili11 '. COMMUNITY DEVELOPMENT Permit#: ELC2016 00522 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/05/2016 Parcel: 2S106DB23700 Jurisdiction: Tigard Site address: 17390 SW SABRINA AVE Project: River Terrace Northwest Swim Center Subdivision: RIVER TERRACE NORTHWEST Lot: X Project Description: Electrical for new neighborhood swim center. Contractor: ALAMEDA ELECTRIC Owner: ADLV LAND HOLDINGS LLC 3415 NE 44TH BY FORSUM, MICHAEL PORTLAND, OR 97213 7600 E DOUBLETREE RANCH RD STE 1 SCOTTSDALE,AZ 85258 PHONE: 503-319-2192 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 07/05/2016 $100.70 Specifics: amps or less 11 crt Branch Circuits w/Purchase 07/05/2016 $81.62 Type of Use: COM Service or Feeder Class of Work: ALT 4 ea Signal circuit or Limited 07/05/2016 $300.00 Energy Panel Type of Const: 1 ea Plan Review Electricial 07/05/2016 $120.58 Occupancy Grp: 1 ea 12%State Surcharge- 07/05/2016 $57.88 Electrical Total $660.78 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Y• ••- •btain a •• • .-rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. N. Issued By: Q ' _ Permittee Signature: 2 /20 OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. tleetrica Permit Appliratit / n ,. t w()1 d u d i tit i i\1,1 City of Tigard 1 ' ' ri + a � 13125 SW/laid Blvd,.Trgard,OR 97223 DataBv / /'/I rill tali„' ar r �. 503 718.2439 Fax 5€i3.5r�►$wI � Zn��' 4. l,� Inspection Line 503.639,4175 .1� r i ` , Internet tM1t lk Y3 lttd Ot 1 v _:a , 4 'tA ,.+ i �� � r ' EFEEigiMMI ''ro ter I �w, xi n x ,.yam rare . ._. „4:::: :''' .. .t.,. :70 N 2 k : 721. : ;''': . :4:.,,,, ., �-. %N : NeW t�tTnstruction 0 Addition!altcr Olt, ' e,n t J „_ Please dick dim { it 2 senor planswhims+ ka3) QDemolition 0 Qther, `� a Service or feeder 400 maps or more ©Building over dere alone* , ,�, where die availablerumforma ©Main orad boatyart§. � ,, ;��w,� ,;',27:1";, �e..a meads 10.000 cps at 150 volts or a Mating buildings- • 1-and 2-family dwelling ommercialfindustrial 0 Accessory building leas to Wend,or excel 14,000 0 Conimeiviikinie agricattural E3 Multi-family ]Master builder 0 Other amps for all other installations build nags. ❑Fire pump ❑Intension of)So KVA or :: `, 77:: ' „„ ` `,,.r.7.1-927:,,;,0,717-42...7:- : :1,2 0 Emergent”?oaten linger sePlealelY derived Addition of new motor low of Job#: Job site address: 11-y10 S Ill S a be k iln mow or more. sA".'E"."1-2","1<3" City/State/ZIP:State/ZIP:Tigard,OR 97224 ',l Cl Six or more tesidentud units s�Y W1/ 0 Heatthoui facilities. 0 Raaeeheel l vehicle parks. Suite/bldg./apt.#: I Project name:Polygon at glf River Ter Ci hazardous locations. 0 Supply voltage fru more Dino ©Stavi«or fender 600 amps or more. 5 &moat Cross street/directions to Job site: .-,, 7 '''.'i:::-7-7,„ Zr Description Qty. reek j Tedi. New residential single-or multi-family dwelling unit. ' Subdivision:Polygon at'Nvd River Terrrace I Lot#:-rr'aC • 4-X Includes attached garage. Tax map/parcel 4 S l ej i , Gr 1,000 sq,n,or less 163.54 4 ,, . r°i ': _ Eadd' 500 sq.a or portion 33.92 1 Limited energy,residential 15.Oo 2 ' (with above sq.n..} Limited energy,multi-family ' ` ') ,:'7 v residential(with above sq.ft) 75.00 2 Name:ADVL Land Holdings,LLC Renewable Energy 0 See Page 2 Address:7600 E Doubletree Ranch RoadServices or feeders installation,alteration,and/or relocation 200 amps or less N 100.70 2 City/State-411P:Scottsdale,AZ 85258 Phone:(602)694-4031 I Fax:( ) 201 amps to 400 amps 133.56 2 Email: 401 amps to 600 rumps 200.34 2 Owner installation:This installation is being made on property that i own which is not 601 amps to 1,000 amps 301.04 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Over 1,000 amps or volts 55216 2 Owner Signature: Date: feta ry services or rs installation,alteration,and/or --::`.47,5P:::::::.::;; �„": $ 7 Vis may `'x. Fd .,:;rg`. Temporary T'elo[aYrOn Business name:William Lyon Homes,Inc. 20o amps or less I 59.36 1 Contact name:Angela Grajewski y 201 amps to 400 amps 125.08 Address:109 East 13th Street 401 amps to 599 amps 168.54 2 City/State/ZIP:Vancouver,WA 98660 Branch circuits new,alteration,or extension, panel Phone:(360)695-7700 I Fax::(360)693-4442 A.Fee for branch circuits with above service or feeder fee, ` l 7.42 2 Email:Angela.Grajewski polygonhomes.com each branch circuit 1 - ' ' . � 4::4;,:::::, � � :. B_Fee for brooch circuits w th°w � ���.,�����,�� service or fear fee.Eirse 56.i 8 2 Business name:aimed*electric branch circuit Address:3415 rat 44th Each add'ibranch circuit 7.42 2 Miscellaneous(service or feeder not included) City/State/ZIP:AMPd / 1 L6 1,x/2. _//00, 7 ..l3 Each manufactured or modular 67.84 2 Phone:(503)3192192 I Fax:( ) dwelling seduce ami"or feeder Reconnect only 67.84 2 Email:solarpdx@me.cont Pump or irrigation circle 67,84 2" CCB Lie.: 199188 I Electrical Lie.: c923 Suprv.Lie.: y d7 S o Sign or outline lighting 67.84 2 Suprv.Electrician signature,required: ICI i/AP r j� Signal eircuu(s)'or limited-energy Print name; k 1,. 71.42„...tDate: J? �{.d1 /sane/,alteration,or extension 'oPage 2 L{ - ` Each additional inspection over allowable in any of chin above Authorized signaaaturee: / / Additional nnspxtion t t hr min? 66.23;ire IPrint name: s� -l!"'' Date /14 , investigation(I hr mm) 90 00,hr t, , ustc_ _ ERE.doc Re,tnin72015 440-461ST{II/05dCOM'WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information $ Limited Energy Permit Fees: Renewable Energy Permit Fees: _ Fee for all residential systems combined: $75.00 Description Qty. I Each I Total I * Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 ❑ Garage Door Opener* 50.01 to loo kva 552.26 2 >100 kva(fee in accordance with OAR 918-309-0040) 552.26 2 ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr s -cifically listed(1/2 hr min) Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): (SEE OAR 918-309-0000) * Number of inspections allowed per permit. Check Type of Work Involved: 1- 1/Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Data Telecommunication Installation ❑ Fire Alarm Installation HVAC ❑ Instrumentation ❑ Intercom and Paging Systems -V Landscape Irrigation Control* (7, poll V_. ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 06/17/2015