Permit (153) CITY OF TIGARD ELECTRICAL PERMIT
tri 2:'- COMMUNITY DEVELOPMENT Permit#: ELC2018-00798
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/05/2018
T[ �}°� 9 Parcel: 2S106DA10500
Jurisdiction: Tigard
Site address: 16904 SW BIRDSONG ST
Project: River Terrace East,Lot 105 Subdivision: RIVER TERRACE EAST Lot: 105
Project Description: (1)branch circuit for NC installation.
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: 602-694-4031
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/05/2018 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/05/2018 $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 iss .-ce, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio e - Those rules are set forth in OARs
952-001-0010 through OAR 952-001-0090. Yo obtain a cop hrc rerl or direct questions to OUNC by c- ' •" • . -87 or ' 800.332.2344.
Issued By: � �! �. PermitteeSignatur,: .t'1 1 t._
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 503.639.4176 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
___,,,,, ,,. „,„i .? Date/By: 44 fs-tir 6.2_, -Permilli: riCc-i-eilf—ii— 7
, ..I 13125 SW Hall Blvd.,Tigard,OR 97241-* * '' _ -:, '' "-- '- Plan Review
ill
.', Phone: 503.718.2439 Fax: 503.598.1960 7 , , Date/By: Related Permit ii: plac,A)11-al '
O A
Inspection Line: 503.639.4175
ri;r, !,, 2018 ReadyNotieciirvDatrd:eBethyo: Suds: Pi See Page 2 for
1 RTY
-., Internet: www.tigard-or.gov
2'" 6 . Supplemental information
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1S1 New construction 0 Addition/alteratibnYieP14`einent-% ' Please cheek all that apply(submit g sets of plans Iv/kerns checked):
0 Service or feeder 400 amps or more 0 Building over three stories,
0 Demolition 0 Other:
where the available fault current El Marinas and boatyards.
',...-.'''':::'':.:.',.... ..N:::::•.;',,.:.i.h,,',:.'‘,-,=:: C40.00,V*,e-0*M14,C,11017,,r',;:::'-: :::.::..:' :-;:r1,,'',:',:- :;. exceeds 10,000 amps at 150 volts or (]Floating buildings.
. 0 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground.or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations, buildings.
0 Multi-family • 0 Master builder 0 Other: 0 Fire pump, 0 Installation of 150 KVA or
40'.$0t;::***4:Atioisr`404i.-004000:.:',.::. .• ..::•': •-- •,'.:: ,!.:-, 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: 1 CACAO c.-k, 5\-.) 1,-- k.v.A.G.evn SI 1001-1P or more.
City/State/ZIP:Tigard,OR 97224 El Six or more residential units. occupancy,
__
°Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Polygon at 1,2 .5-e_..,- 7-r....AfttQc _ 0 Hazardous locations, 0 Supply voltage for more than
0 Service or feeder 600 amps or more. volts"Ini"al'
Cross street/directions to job site: '.:.' '.:;'::::!...,:.. -:...:'.:f.-, 'P-,Eli.kO.Fittlt)4
lkstription Qty. Each Total T7- New residential single-or multi-family dwelling unit
Subdivision: etPolygon ' Q_- -7.-eArC-.42_ Lot if: I 0 c.)--- Includes attached garage.
_
__,
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
----
„ Fa.add'I 500 sq.ft.or portion 33.92 1
:: ., ...-.1' -..: "..-i: .'2'711a.0a.' ..-.: '1::,:1(0.0.40110.0'0.0..'.**0#1(. -1.::: - „::,:. 1:.. . .::.: . .:' :11. ' Limited energy,residential
75.00 2
(with above sq.J.1)
(_/) 74-er 77/e" ii-VjY-4,// :.7t)C,P-'-', Limited energy,multi-family
75.00 2
residential(with above sq.ft)
•. ReneiyableEttei 0 See Page 2
., °7''..1:1:00....C1*:40iSiEIR:--:-.,;',-: ';'1' ::'::.:- :',...-:'::' ,1!.::-:...-'1''...13;;T:fill4Astr'..',.,,-:',....', Services or feeders installation,alteration and/or relocation
Name:Polygon WIII,LLC pZ&t-kon-.3 i1. c.c-)a 200 amps or less II 100,70 2
Address:109 East 13'h Street
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Vancouver,WA 98660
601 amps to 1,000 amps 301.04 2
Phone:(360)695-7700 Fax:( ) Over 1,000 amps or volts 552.26 2
- — ' 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 701, 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps — 168.54 ' 2
weotio.,014.a: !.i.::,,.,::1.:;:. ,;7.,:,::::Efit001 --.-j,,,,,:;::::: Al3rprieenehfocribrerattnichts-c-irenievit,;:alteration,or extension,per panel
Business name:Polygon WL11,LLC above service or feeder fee,
' 7A2
9
each branch circuit
Contact name:Angela Grajewski
B.Fee for branch circuits wiihota
service or feeder fee,first
Address:109 East 13th Street
brand'circuit 1 56.18 sz i) 2
City/State/ZIP:Vancouver,WA 98660 Each add'l branch circuit 7.42 2
_Miseellaneotis(service or feedernot included)
Phone:(360)695-7700 Fax::(360)693-4442 Each manufactured or modular
•
dwelling,service and/or feeder 67.84 2
Email:A ngela.Grajewski@polygonh om es.com
—
Reconnect only 67.84 2
r: %g:U'... .',r:: :-':::!'.-M14.14:00,1C:?;;T.1? '' fl'::1'-;.'r:::.:'.'.. .''': -::'.;: ... ..,':'. .; 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/ZIP:Puyallup WA 98371 Each additional inspection over allowable in any of the above
Additional inspection(1 hr nun) 66.25/In
__
Phone:(253)872-6051 Fax:(253)872-1801 Investigation(I hr min) 90,00/hr _
— _
Emabdaniels@gweusaIndustrial plant(1 hr mm) 7818/hr
il: .com
•
— ---
Inspections for which no fee is—
90.0W hr
Cal Lie.: C1158 Electrical Lie.: 208174 1 Suprv.Lic.: 4496S _specifically listed(14 hr min))kitte.14404g'044.4f.0..0. :.:::- .!•2'.,.:"...,-;:.:::...'i,
Suprv.Electrician signature,required: :44*.?ill '3. 1 , heC;6- : -
Subtotal: sT,.it
Print name: Joan P Albert •, I Date: 0 Plan Review Required(25%of permit fee):
- State surcharge(12%of permit fee): (. 77 '
Authorized signature: .:.------------ ____
---7-,..---- -_7=-----2- TOTAL PERMIT FEE: 6,,,-,Z,v, .,
1 This permit adpapyslic,arttieTtiteixiapiszeinf a acceptedpertriitis.ncootmobptlaeitneed within 180
Print name: Bill Daniels Date:
* Number of inspections allowed per permit.
IftHuildittOermitAPIC_PerotitApp_ELR EitEdoc Rev 06/17/2015 440-4615T01105/COMAVES