Permit (244) CITY OF TIGARD ELECTRICAL PERMIT
2: , COMMUNITY DEVELOPMENT11114
Permit#: ELC2018 00028
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/16/2018
T [ �/#kt' g Parcel: 251060001500
Jurisdiction: Tigard
Site address: 13470 SW BEACH PLUM TER
Project: River Terrace Northwest,Lot 202 Subdivision: RIVER TERRACE NORTHWEST Lot: Multiple
Project Description: Adding(1)branch circuit for NC.
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 01/16/2018 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 01/16/2018 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 2-001-0090. Y u may obtainaiina copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /i!� %<�Z'G Permittee Signature: �i7—r l��/�J�LGc�c�
OWNER INSTALLATION ONLY ��
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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- Received
X111 E) TLi a�tfQilPenmt$:
;—: .P' gr t >antatl�y. « % ZLC',zvl D
r, `'"t 13125 SGV Hall Blvd.,Tigard,OR 97223 I AIN 1 4 1.,u u Plan Review
Phone: 503,7I8.2439 Fax: 503.598.1960 Dale/By: Related Permit✓F:
inspection Lino: 503.639.4175 i, 7' , Ready Date/iiy: saris f See Pagc2 for
``1`141ATj P cry r ,r �#
i , .� IntemeG: wwcv.tigatzl or.govlio , I"iviS ,t�)`rotitied/rvlethod; Supplemental Information
; a E` ..',`7«' . } ' t OF,•Va. 1,. . ,PI414.'"0V1E
0 New construction ❑Addition/alteration/replacement Please check alt that apply(submit 2e sets of plans w/itemOahecked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current 0 Marinas and boatyards,
H Yc„r„ rCATFf Og_:,:,O) Ct NS'1RfJC`I`IOIY exceeds 10,000 amps nil50 volts or C l Floating buildings.
t : so � g less to ground,or exceeds 14,000 0 Commercial-use agricultural
1-and 2-family dwelling 0 Commercial/Industrial [)Accessory building
amps for all other installations. -buildings.
0 Multi-family - 0 Master builder 0 Other: LI Sire pump. 0Installation o€150 KVA or
' 3'0,13 $SITE .NT ORJlr4T'I.014 ANi;',T.iOC<.TLON QEmergency system. larger separately derived
Job#: Job site address: � 0 Addition of new motor load of system.
� t Be -r, oofw snore. ❑"A„"5" "1.2”"1.3",
CI /State/ZIP:Tigard,OR 97224 C7 Six or more residential units. occupancy
City/State/ZIP: g ' ❑health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 1 I, . Project name: I ❑Hazardous locations. ❑Supply voltage for more than
4Trace- { 0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site; •';.<
�— Description I Qty. I Each I Total 1 ^
New residential single-or multi-family dwelling unit.
Subdivision:{ 'Je '- fQxra(e, 0 tr" '1wesk- Lot#: L .m Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea add',500 sq ft or portion 33.92 i
.� . .i PESQRIPT[,ON OR,.WORK:
Limited energy,residential 75.00 2
(with above sq.ft.)
Limited energy,multi-family 75.00 A 2
residential(with above�cs .ft.)
Renewable Energy 0 See Page 2
w,,,: �zi' I R+I Il?C71�`1VFIt:.. ` ] 1Lt�jAiYl -:. Services or feeders installation,alteration,and/or relocation
Name: Rgv Lx iftkoA L,C, 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: }ko(Go +L• LI{1,�,,> r 401 amps to 600 amps 20034 2
City/State/ZIP:' jJ", 601 ams to 1,000 amps 301.04 2
Phone:On, L
..1 OILI • 4j 1 Fax:( ) Over 1,000 amps or volts 552.26 2
�l t 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 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 70I. 201 amps to 400 amps 125,08 2
Owner signature: Date: 401 amps to 599 amps 168,54 2
om "'PeA 1'I,CCAblT _ , .:❑'CO,NfA,CT i'TI2SON, . Brandi.circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Polygon WLH,LLC above service or feeder fee, i
7.42 2
each branch circuit
Contact name:V'% Vfp
" )1e, 1t - B.Fee for branch circuits itWantt
�it ' 1' service or feeder fee,first 56.18 2
Address: ;) y-oikadisk� _• S\-- al},� c"10 branch circuit
City/State/ZIP:Vancouver,WA 98660 Bach add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included) _
Phone:(360)695-7700 I.Fax::(360)693-4442 Each manufactured or modular 67.84 • 2
Email: �r dwelling,service and/or feeder
C ■A s pot I A .SAL.. .. Atik Reconnect only 67.84 2
• 3-fi'T,,_ .r.4AtIg.. A. ; 1G .. .!44 .. ,lt a:. ...M , .,6' Pump or irrigation circle 67.84 2
Business name:Garner Electric Washington,LLC Sign or outline lighting = 67.84 2
Address:402 ValleyAve NW Ste 106 Signal alteration,or extension.
Q See Page 2 2
parcel, or extension.
City/State/ZIP:Puyallup WA 9$371 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(253)872-6051 Fax:(253)872-1801 Investigation(1 hr trill) 90.00/hr
Industrial plant(1 lir min) 78.18/hr
Email:bdaniels@gweusa.cottt Lrspectivns for which no Peers
CCB Lie,: C1158 Electrical Lie.: 208174 ( Suprv.Lie.: 44965 specifically listed(i4 hr min) 90.00/hr
�.,,� 1� .'.' *p- c T1ud- ,L, 'T?i12MIf[ r+17r8
Suprv.Electrician signature,required: x` i r"1 't/ e _ Subtotal:
Print name: Joan P Albert • I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: door . TOTAL.PERMIT PEE: (r�7 Z
This permit application expires if a permit is not obtained Ivithin 120
Print name: Bill Daniels Date: days atter it has been accepted as complete.
* Number of inspections allowed per permit.
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