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Permit (255) CITY OF TIGARD ELECTRICAL PERMIT 1,4 COMMUNITY DEVELOPMENT Permit#: ELC2016-00885 Date Issued: 11/17/2016 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S10/201 6100 Jurisdiction: Tigard Site address: 15192 SW 154TH AVE Project: Polygon at Bull Mountain,Lot 59 Subdivision: POLYGON AT BULL MOUNTAIN Lot: 59 Project Description: (1)branch circuit for A/C. Contractor: ALAMEDA ELECTRIC Owner: NGUYEN, HUNG THANH 3415 NE 44TH BUI,TRINH THUY PORTLAND, OR 97213 15192 SW 154TH AVE TIGARD,OR 97224 PHONE: 503-319-2192 PHONE: FAX: FEES Quantity Description Date Amount 1 crt Branch Circuits wo/Purchase 11/17/2016 $56.18 Specifics: Service or Feeder 1 ea 12%State Surcharge- 11/17/2016 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Or-eon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through ••' 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: ery 4 '/'4'e 77 OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. RECEIVE I Nc it•hhal Permit Application 1 ,w()1 l l( 1 1 ,1 ()01 N . .. N 0 V 14 2016 ltea City of Tigard tea,. // t ' 13125 S5 711 Blvd_,Tigard OR 97223 ; „ . Phone'. ?18 439 pax: 503.598.1 ITY OF 116AR L ma t 6(' 16-1) 7,- A I Line: 503,1394175 ILDING QIVISI(i1 : Internet: www.tigard-or.guv rotilled ed: y , "'„2,..7'.:—,:,:s11,4,' oy 3' w �..:.-a, z'.v',. -� , m', ;a . , ... , , :11,'r2:::::"±-147:,. 1=::;!:::::: Xi' , ,, . : Ea New construction 0 Addition&alteratiorl/replacement Please check all that BO*(ateit 2 sets o(plans wittems meed) ©Service or feeder 400 amps or more Cl Building over three stones 0 Demolition ❑Other stones where the available fault ernrent (3 Maness and bareyacds. < r exceeds 10,000 amps at 130 volts or 0 r1001111$b°114111$6 .4 I..and 2-family dwelling 0 Commerchdfindustrial 0 Accessory building leas 10 ground,or exceeds 14,000 0 Commescial.ess itstimiltund amps for all other installations build. 0?Auld-family 0 Master builder 0 Other: ❑Fire pump, 0Installation of 1$0 KVA or ¢ ", ti � ,';':',<W2117:777,:'�� ,"...:',,,21';,2,;`:,-.1�� a ,, '�n e ;,'��':�;`� �. O�F.t»ag f 3ystar+s load of lsytrgLt *lived Mee on omotor r. Job Cr Job site address:( 1g 2-V4IS LI thPrVe. 100}IP or mese. 0"A",' ','1-2","1-s. City/State/ZIP:Tigard,OR 97224 ©Six or more t dential units, 0 Recreational vehicle parrs. 0 Healthcare fatalities. Suite/bld .ts 4: # F rti' name: / ❑liarardous locanoas a Supply voltage for more than $ Pt + J �Q 1,ygnn 6t-esti "1 I o Service sir feeder 600 amps or mare 6fi0 Vohs nomioat Cross street/directions to job site: ✓ m g 7.71 Description Q?. Leak Tats • . New residential single-or multi-family dwelling unit. Subdivision' 8° �Bit /VW tri ' ! Lot#:b9 Includes attached garage. Tax map/parcel#; 1,000 sq.R.or less 168.54 4 ''5771,7g7;.:77'7.:. 1< "'sfi > ; r`. ..'..77,„;114:i3,17;:, Ea.aid'l 500 sq:R or portion 33.92 1 /4— Limited energy,residential 75.00 2 (with above sq.ft.) Limited energy,multi-family 75.00 2 -- '2. ,, a _-. .- residential(with above sq.R.} Name:ADVL Land Holdings,LLC Renewable Energy. 0 See Page 2 Address:7600 E Donbktrzee Ranch Road Services or feeders installation,alteration,and/or relocation 200 amps or less 100.70 2 City/State/ZIP:Scottsdale,AZ 85258 Phone:(602)694-4031 I Fax:( ) 201 amps to 400 amps 133.56 2 Email: 401 amps to 600 amps 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 552.26 2 Owner signature: Date: Temporary services or feeders installation,alteration,and/or t a " A :< f a s relocation Business name:William Lyon Homes,Inc. 200 amps or less 59.36 1 Contact name:Angela Grajewski 201 amps to 400 amps 125.08 2 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,per panel Phone:(360)695-7700 Fax (360)6934142 A.fee for branch circuits with above service or feeder fee, 7.42 2 Email:Angela Grajewskiigpoiygonhomes.cora each branch circuit -,,,,:41•:,:••—•�.,<r `� t B.Fee for circuits without I . ."; ." " .�, , �,a„ serve ala febranch te fee first 56.18 2 Business name:*lamed*electricbranch circuit Each add'lbranch circuit 7"42 2 Address:3415 ne 44th j Miscellaneous(service or feeder not included) City/State/ZIP: f ?Iain bn ®/Z / ' 7.2-/3 Each manufactured or modular 67.84 2 dwelling,service andior feeder Phone:(503)3192192 Fax:( ) Reconnect only 67.84 2 Email:solarpdx@tne,coru Pump or irrigation circle 67.84 2 CCB Lic.: 199188 Electrical Lie,: c923 Suprv.Lie.: 9,(7 j,, Sign or outline lighting 67.84 2 Suprv.Electrician signature,required: Signal circttigs)or limited energy 0 See panel„alteration,or extension. Page 2 2 Print name: k,i,v. vc- , ! Date: r/23,�1 Each additional inspection over allowable is any of the above Additional inspection(1 hr min) " 66.251 hr Authorized signature: f ' Investigation(1 hr min) 90001 la Print name: ,,/lam' DatCJ � * n''. VIt.C_ eta,,Ea.EAoc Des 06470115 440-4615111I/05/C0MMEB