Permit (187) CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2018-00060
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2018
T Ilan#It. 9 Parcel: 2S106DB14000
Jurisdiction: Tigard
Site address: 17477 SW FOREST HOLLOW ST
Project: River Terrace Northwest,Lot 140 Subdivision: RIVER TERRACE NORTHWEST Lot: 140
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 01/23/2018 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/23/2018 $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 OAR 952-0 1-0090. You ma obtain a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee 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.
,
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" 13125 SW Hall Blvd.,Tigard,OR 97220• .' 1. '0 ti..'d'+0 Plan Review
Phone: 503,718.2439 Fax: 503.598.1960'' Date/0 :
1:1215, .. :NIP
Inspection Line: 503.639.4175 - ' ',..,'- -' Ready Date/By: Ione SS.See Page 2 for
t1A11,D;
i•_ • -.4, Internet: www.tigard-or.gov t.,i, 1, , ,- ,- Notiffed/lvIelltod:
Supplemental Information
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•airteaMtgleakilattAW/#44.A.KgE44#4."..IRI.M.: inK;:,911:.:n .-:•... AINP.
0 New construction 0 Addition/alteration/replacement Please check all that apply(submit/sets of plans Ay/Heine cheelced):
. °Service or feeder 400 amps or more El Building over three stories.
0 Demolition 0 Other:
where the available fault current C]Iv/ulnas and boatyards.
mtegakyikyt.ra,).:Ne iIttitait(WAVitiAFAUggalt•gi.?...c exceeds 10,000 amps at 150 volts or 13 Floating buildings.
less g
El I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building toround,or exceeds 14,000 0 Commemial-use agricultural
_
amps for all other installations. -buildings. '
0 Multi-family • 0 Master builder 0 Other:
°Fire pump. 0 installation of 150 KVA or
'41::35;:4MigNigR-:;10:1110g.*;Vg.00iNtRi.i9,WW-lAtattO:g.4';i):::...i:',A.::::.'.' .:..........1.-f::-::,:'; 0 EmoillenoY system larger separately derived :.--
0 Addition of new motor load of system.
fob#: I Joh site address:,'Iti 11
) SW FDrest timllow. St taailF or more. 0"A","E","1-2"i-3 •-,-.
0 Six or more residential units. occupancy,
City/State/Z1P:Tigard,OR 97224
ClRecreational vehicle path.
o Health-care facilities.
0 Supply voltage for more than
Suite/bldg./apt.#: i Project name:River Te,pen ee... ori,v,tAxc.4_
, El SHerv2iorde°o7feleticaetti.°1601s0 amps or more. 600 volts nominal.
Cross street/directions to job site:
.',I,I..;..:,Ig.fg.0;:•••11.M' lfgt.f.f.0-.0Viag:R.V:Vgn:;t:'•.!'Y
Description
1 Qty. I Each i Total 1 .
New residential single-or multi-family dwelling unit.
Subdivision'la illeAr T-P_MY'nirey_e itki oftinwes+- 1 Lot//: I Li 0 includes attached garage.
1,000 sq.ft.or less168.54 4
Tax map/parcel#:
La.add'I 500 sq.R.or portion 33.92 1
iggl;i2,\?::Vgagfaiii,jaillV4Y.004ti(*.t.:***CiAg*!: ;:::,•• ., : ; :•;': : Limited energy,residential
75.00 2
(with above sq.ft)
MSt1,0 rt-000lt.p
Limited energy,multi-family
75.00 2
residential(with above sq.IL)
FiliatigaRiebitkalilyntAttaqiilSiMilana*MANTii.t42,,WGZa sReernvielLasboj,e.ft
deregYrs installation,alCiteraSteioenP,aagned/2or relocation
Name;
\DV L I,4 r‘rk en idillMS 200 amps or less 100.70 2
Address:—1(p 00E 0 cWote 1-ve-. czax\d . (24 ad 201 amps to 400 amps
401 amps to 600 ainps 210033-3.546 2
City/State/ZIP: SQ Misektt. PO., /2E,--Ect2) 601 amps to 1,000 amps 1 I 301.04 2
2
Phone:Leo 2. ,ei ty_ty 03 I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
• relocation
1
Owner installation:This installation is being made on property that I own which is not 200 amps or less
iI 125.0859.36 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps
Owner signature:
Date: 401 amps to 599 amps I 168.54 I 1 2
reitaffiglik Wilikaingigeanli Eg?.teiririAifitifit0010:**35fgi;,".* AprFeeenelfloreibrmeen:-0-..eel,elittherellee'r or
extensio
n
' er panel
Business name; Ki i I barn f_Lion itimf r rtc, above service or feeder fee.
7.42 2
/ each branch circuit
Contact nameiQ(cy'ku,te:RADOed B.Fee for branch circuits without
service or feeder fee,first
Address: inStAAAe_. SID branch circuit 56.18 2
City/State/ZIP:Vancouver,WA 98660j Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone;(360)695-7700 I Fax::(360)693-4442
Bach manufactured or modular
67.84 • 2
dwelling service and/or feeder
Bmail:p(*1..olp -,-k‘Qrat. ryou46400a.ofyieE 6((xi) Reconnect only 67.84 2
gang'.•01:40EMMAYAIVIVA-itt 6.11:1P11;k4:740tinacr,IVI:riga,' Pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC
Sign or outline lighting 67.84 2
-,
Signal circuit(s)or limited-energy
Address:402 Valley Ave NW Ste 106
. Panel,alteration,or extension. 0 See Page 2 2
City/State/ZIPEach additional Inspection over allowable in any of the above
:Puyallup WA 98371
Additional inspection(1 hr min) 66.25/hr
Phone:(253)872-6051 I Fax:(253)872-1801 Investigation(1 hr min) 90.00/hr
Email:bdaniels@gweusacorn Industrial plant(1 lir inin) 78.18/hr
.
Inspections for which no fee is III
90.00/h
1111111
CCB Lie.: C1158 Electrical Lie.: 208174 I Supry.Lie.: 44968 ificall listed(II hr min r
-•-. • :ili,`..T;•TV%.. :.'d.''4XIA;.:'" 441101Ntt WAD Wir9:1.E.&
Suprv.Electrician signature,required: ': 01 4 ..D. A . 4 / .,: :'" '
Subtotal: MM.
Print name: Joan P Albert • I Date: 13 Plan Review Required(25%of permit fee):
.,-- ___, State surcharge(12%ofpermit fee);
Authorized signature: TOTAL PERMIT FEE:, —.------ -,_------_
This permit application expires If A permit is not obtained within ISO
Print name: Bill Daniels Date:
days after it has been accepted as complete.
---------..— * Number of inspections allowed per pennit.
1:1BuildinglPennit.MC Permit/Willa Eilt.E.doo Rev 0611712015 440-461ST(MOS/CObfAVEM