Permit (112) CITY OF TIGARD ELECTRICAL PERMIT
. COMMUNITY DEVELOPMENT Permit#: ELC2017-00933
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/20/2017
Parcel: 2S106DB16400
Jurisdiction: Tigard
Site address: 13174 SW AUBERGINE TER
Project: River Terrace Northwest, Lot 164 Subdivision: RIVER TERRACE NORTHWEST Lot: 164
Project Description: Adding(1)branch circuit for A/C.
Contractor: GARNER ELECTRIC WASHINGTON LLC Owner: ADLV LAND HOLDINGS LLC
402 VALLEY AVE NW, SUITE 106 BY FORSUM, MICHAEL
PUYALLUP,WA 98371 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE, AZ 85258
PHONE: 253-872-6051 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/20/2017 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/20/2017 $6.74
Type of Use: Electrical
Class of Work:
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 R 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: •11 Permittee Signature: SZ- 4.- ./.�e.-�-�G�-c._
OWNER INSTALLATION ONLY /j
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 Perrmit Application . �i.. —4 1,.
r,.-
'� �{t�'��,b477 1�J♦�{.Sr JJ� ,711 Tiihrti,-. '::,-,:,..-,.:,.':(.:.:.,;* j
City U Tigard Q� Received C l.C.,SOI?"t/C1 /
F--
" g DEC1 9 2 017 Received
Permit#.
13125 SSV Hall Blvd.,Tigard,OR 97223Plan Review
;d 1 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#: S e ] /'r/� 4
Inspection Line: 503.639.4175 ( GA �ady Date/By; loris: `I See PPage 2 forW
'TIGAR Internet: www.tigard-or.gov ¢ $ OF i i Jri9 doUfied/Method: Supplemental Information
4-- '•'•9 _i _he...EMt; t .X;::j, -- 'Ct1;:..,. _
®New construction 0 Addition/alteration/replacement Please cheek all that apply(submit 2 sets of plans w/itein,checked):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
�., it}-' ti:,.. where the available fault current ❑Marinas and boatyards.
°Gt'EP
D -LV
,.��. , -..Q._..G�._.. .._., ._Oh ,. . - exceeds 10 000 amps at 150
- .�. ..,...:., ..: . ........ ... volts or ❑Floating buildings.
®I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 Cl Commercial-use agricultural
0 Multi-family • 0 Master builderamps for all other installations, •buildings.
Other:
:.,; ;;s• a .:a:_tr:.::=«:;.,....=i`�i.:..,_.-,.:,. ,:. ;....:•,:.::•.... ,•-..:,.:.., Pirepnmp. _
:.;:asc:.:�:a::,..-;.:.+.::•:.::;.� .,:, Installation150KVA
0 0 t oor
:::::r.,: �a;•>..;a:.i::;.,Od1-� IT .,1N1 O,R IWATT(JN:AND4.4°A'I7O1i(.;;;r; _ ❑Emergency system. larger separately derived
❑Addition ofttew snorer load of system.
Job#: Job site address: wit/ t.to rt uG 100HP or more. ❑'A",'✓">"1-2",�1-s",
City/State/ZIP:Tigard,OR 97224 1
CJ Six or more residential mils. occupancy.
0 Heallh-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name ['Hazardous locations. ❑Supply voltage for more than
��� T��4Ce, N W
El Service or feeder 600 amps or more. 600 volts nominal,
Cross street/directions to job site:
Description 1 Qty. 1....-Each 1 reed 1 *
N 'hNew residential single-or multi-family dwelling milt
mat Subdivision: goer it t a /IAA)es-}- Lot#:I'W Li Inchrdes attached garage. •
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
:.....:...,,.... Ea.ndd'l 500 sq.
::::a.,,:.,. .�,.�.;,.:,;,".T"`�,.;•::._ .;. n 33.92
;u:: •�� ft.or1
.,.. ................:::....r;,.:'::.::;,:>';..':•;:".: ;::.:• Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75,00 2
residential(with above sq.ft.)
=:<,.:f :.1:. <.<<;: - Renewable Ener See Pa e 2
. Off,
i� s.
� ,Pa1�l..... .:.. ?.tel�.
�, ..�. ....t`t�?:.. '"Tye: `i
' Services or feeders installation,alteration,antler relocation
Name: Py Psi L �X1C� ttokat n~ S `` 200 amps or less 100.70 2
Address: 11 V!,t 00 l io LLh1 to „ n n G, 201 amps to 400 amps 133.56 2
1 G \vw `�• 401 amps to 600 amps 56
2
City/State/ZIP:' S C®- i ' ' 5 5 601 amps to 1,000 amps 301.04 2
Phone4 02 ..In(4 4 —L O2 !i Fax:( ) Over 1,000 amps or volts 552.26 2
�11 Temporary services or feeders installation,alteration,and/or
Email: Ni C Yr �j b V
N (Y1e5 relocation
Owner installation:This installation its bein tldde on prdperty 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
itgr?idi,^>'*..tf$C s.,S ,t.. ;.4- .�"i:r -s;:;j a rte,;;,�_: - _...i,. - -
_ :'Yo. .';`s,.,F:i�:,..:-:i.-q:::i;;:, } # :"` s Brancheirenits—new,alteration or extension,per panel
=%;any?Sji;,c_;��, �...,?,':-'!�-t�::.:•:..,::.:.r;a•.,.3:,.:. ...:Si';;,CI.,�O1V'I.�'�};C�.,�,'�'r�,��U1Y<'';� ,
A.Fee for bmnclr circuits=ration,
Business name:Polygon WLH,LLC above service or feeder fee, 7 42 2
vvvYYYfff000 each branch circuit
Contact name. (\ 1 Celt,,, (),yc B.Fee for branch circuits without
Address l" 1 service or feeder fee,first 56.18 2
1 t7 wb6i S . S tuft Sl D branch circuit •
City/State/ZIP:Vancouver,WA 98660 4 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: . dwelling,service and/or feeder 67.84 • 2
y:_;..ail:zcp..,:k
3i c,
. ' �;'''r+; ,: r• :.r,�;�r.���, ',`,„:F.Y:,t; •!!y1.5 Reconnect only 67.84 2
'�' , •: +.::?."•�:'�'_s '� i';;pz:>i;a; Ptunp or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC Sign or outline lighting 67.84 2
-.
Address:402 Valley Ave NW Ste 106 • Signal circuit(s)or limited-energy E) See Page 2 2
panel,alteration,or extension.
City/State/ZIP;Puyallup WA 98371 Each additional inspection over allowable in any of the above
Additional inspection(1 hr mitt) 66.25/hr
Phone:(253)872-6051 Fax:(253)872-1801 Investigation(1 hr min) 90,00/hr
Email:bdaniols@gweusa.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: C1158 Electrical Lic.: 208I74 ( Suprv.Lie, 4496S specifically listed(i6 hrmin)
:Te(� :.. .,,. .,. . .� .. ::...i : s'.a
Suprv.Electrician signature,required: k Mil/Y.l/ •., A4 h.i.. F,I. IL1Gv`Lx' ' rPSt nS `'
Subtotal:
Pratt name: Joan P Albert 1 Date: Cl Plan Review Required(25%of pennit fee):
State surcharge(12%of permit fee):
Authorized signature: ./I"� -,� _` TOTAL PERMIT FEB: (u, _`j 2
This permit application expires If a permit is not obtained within 180
Print name: Bill Daniels Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:1Building\Parmits'ELC_PermilApp_BLR nREdoo Rev 06/17/2015 440.4615T(tl/OS/COMMEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13174 SW AUBERGINE TER, SHERWOOD, December 21 , 2017 at
OR, 97140 9:31 :22 AM
Record Type: Record ID:
Residential - Electrical ELC2017-00933
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor