Permit (91) CITY OF TIGARD ELECTRICAL PERMIT
1N1 - , COMMUNITY DEVELOPMENT Permit#: ELC2019-00068
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/07/2019
T r c ;t I<.C7 g Parcel: 2S106DA11700
Jurisdiction: Tigard
Site address: 16668 SW SNOWDALE ST
Project: River Terrace East,Lot 116 Subdivision: RIVER TERRACE EAST Lot: 116
Project Description: Adding(1)branch circuit for A/C unit.
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: 602-494-4031
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 02/07/2019 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/07/2019 $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 952-001-0090. You may obtain a copco'of the rules or direct questions to OUNC by calling 503.232.1 7 or 1.800.332.2 ,
Issued By: �i/�/G1/Ir�����Permittee Signature:
...,71-,e.
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.
Electrical Permit Application FOR OFFICE USE ONLY
Cityli ®f Tigard g ,1 44 Received
t, w. '' fie '••• Date/B
• 13125 SW Hall Blvd.,Tigard,OR.9i"
Plan Review
1 Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 r-r••4 'I 0 i Ready Date/By: Iuris: is See Page 2 for
TIGARD Internet: www.tigard-or.gov r I._ 1_l Notified/Method: Supplemental Information
.,.: kr ,x,: ..., M:, .T A OF j° `I. 1, .. . - s Pl lsT K#84'4(r
®New construction ❑Addittoni te4i4Al1`lricit tt 't i.) Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over titter stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
„ , s,_, ,08)mEC OR 1l,OF,Cot S'TItITCTI`O1V vexceeds 10,000 amps at 150 volts or ❑floating buildings.
®1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building fess to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other instanatloos. buildings.
❑Multi-family - 0 Master builder ❑Other: ['Fire pump. 0 Installation of 150 KVA or
JOB'SITE INFORMATION AND X OCATION 0 Emergency system. larger sopa ately derived
❑Addition of new motor load of system.
Job#: Job site address: 1 VV4,8 SW S/.Jolt> kir Sr,
City/State/ZIP: A-Va,}J, a_ 41 ,1-00} ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Polygon at ko-E1t` TjQACG 0 Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: , PEE SM1),14E ": '
Description I Qty. I Each I Total f.-
New residential single-or multi-family dwelling unit.
Subdivision:Polygon'Ep&i"River Terrrace Lot#: t t, Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
gainienaiNSKOI:1110.MAICNOWK.tniZ4.*SHNOW!'2:;::::: :',li, Limited energy,residential
/� � (with above sq.ft.) 75.00 2
!'I!�1 AC, Vki �� Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
K_ ,P1RQ ` Tlf 01W14R,_„ a ^sr 4, aa` ., luTF1VA1)7J< . . Services or feeders installation,alteration,and/or relocation
Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:7600 E Doubletree Ranch Road
401 amps to 600 amps 200.34 2
City/State/ZIP:Scottsdale,AZ 85258 601 amps to 1,000 amps 30L04 2
Phone:(602)694-4031 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 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
)�( �TlL1 A1+1 C ' , „.,•, Qr OONTACT>yE t dl Branch circuits—new,alteration,or extension,per panel
,::,.... . I;St ,.. ,tI _TM, ..g ,.... A.Fee for branch circuits with
Business name:William Lyon Homes,Inc. above service or feeder fee,
742 2
each branch circuit '
Contact name:Angela Grajewski B.Fee for branch circuits without
Address:109 East 13th Street service der
fee,first
ci
branch crcuit 56.18 2
City/State/ZIP:Vancouver,WA 98660 Each 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
dwel
se
Email:Angela CN R.tS1' _f SE/4 @ -po1GO1.1L 1'btµt3• cam Reconnect
rvice and/or feeder 67.84 2
only 67.84 2
l a a ..,.,., '.rgO,1aI0Kka08 _r.. ` R-..:: .,?. ::: ; . K. : ,.,..' 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 ❑ See Page 2 2
Address:6101 NE St Johns Rd panel,alteration,or extension. _
City/State/ZIP:Vancouver WA 98661 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(253)320-1657 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:bdaniels@gweusa.com Industrial plant(l!tunic) 78.18/hr
Inspections for which no fee is
90.00/
hr
CCB Lie.: C1158 Electrical Lie.: 208174 Suprv.Lic.: 44965 specifically listed(%hr min)
• _ .EI ECTRJGAL,t PERMIT EEES .
Suprv,Electrician signature,required: fq l �•� � � Subtotal:
L Print name: Joan P Albert Date: 4/26/2016 ❑Plan Review Required(25%of permit fee):
e"-----77.-.., State surcharge(12%of permit fee):
"- TOTAL PERMIT FEE:
Authorized signature:
,..,./------- ,
'•— -
i "� — This permit application expires if a permit is not obtained within 180
Print name: Bill Daniels ( Date: 4/26/2016
* Number of inspections allowed per pencil_
IAA uilding\PermiteeRLc permitApp_ELR ERE_doc Rev 06/1712015 440-46151(11/o5/COM/WEB el
r:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16668 SW SNOWDALE ST, BEAVERTON, February 8, 2019 at
OR, 97007 8:40:50 AM
Record Type: Record ID:
Residential - Electrical ELC2019-00068
Inspection Type: Inspector:
199 Electrical final Jeremy Burrows
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor