Permit (44) CITY OF TIGARD ELECTRICAL PERMIT
11 . COMMUNITY DEVELOPMENT Permit#: ELC2019-00169
TI(;A R F.) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/01/2019
Parcel: 2S 107AA23300
Jurisdiction: Tigard
Site address: 16790 SW ROCKHAMPTON LN
Project: Polygon at Roshak Ridge,Lot 233 Subdivision: ROSHAK RIDGE Lot: 233
Project Description: Temporary power for model complex.
Contractor: Owner: POLYGON WLH LLC
703 BROADWAY ST STE 510
VANCOUVER,WA 98660
PHONE: 360-695-7700
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Temp Services or Feeders- 03/19/2019 $59.36
Specifics: 200 amps or less
1 ea 12%State Surcharge- 03/19/2019 $7.12
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $66.48
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 copy of the rul or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 'e"Ti. 7
i .1e/' Permittee Signature: l"/�/��/a�
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.
, .
. 1,:::-
Electrical Permit ApplicationA 2 .)
FOR OFFICE USE°NEI"
tc: i
City of Tigard Received
ISTAIIMill -YINIMIME
li . 13125 SW Hall Blvd,Tigard,OR 97223 ' '•'''..
1 ''' Phone: 503.718.2439 Fax: 503.598.196 -,i: '-; .,:.:,i. k Related Permit#:;;•,, .;,:3 liEfilli
Ready Date/By: inns: 0 See Page 2 for
TIGARD Inspection Line: 503.639.4175
Internet www.tigard-or.gov Notified/Method: Supplemental Information
el:Xt'::6...3'3V?.t. ':..i.tl ; '1'`'ik:t117g..;.0140)1*4-'4:Xtr:1-?:1:::.*: ,'t,,f.:2:,...J:':-; ',': 'A.:',:::q.-.!.5f..7:=1:44t.;:::,:;kt.0 :81"t**- 141.f.,1,4:,Mil4-.. .
El New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Etulding over three stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
f,;;;;i:...:;i:: ;;!:-5:.:. il-RZTA:liciiitgclit4WOrPOinittle4101!It".: fAt l' exceeds 10 000 amps at 150 volts or 0 Floating buildings.
12g 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.
o Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
? : 401iAii:'.kt4Ft$070;1-.01:•'Wa).ariciii!rkt:',: 5. r.".: :.: .:7.-:-:! :.i °Emergency system' larger separately derived
0 Addition of new motor load of system.
Job#: Job site address:MI 0 SW•Rockharnpt6i4 1-n 100EP or more.
0 Six or more residential units. occupancy.
City/State/ZIP:Tigard,OR 97224
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt#: Project name:Polygon At Roshak Ridge 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: .
.• '.. '-....1.:' -' -:.::''Itt••: ditOtii-,E,.--:::1:::',..'.'...!..'s.•!:','•.-:',....-.:!-.,:',..,-,i,'-:.,
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision:Polygon at Roshak Ridge Lot#: 283 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'!500 sq.fl.or portion 33.92 1
Iitg. lifrticerit.:1;Ot*Okit::,!:fi:::-...,:;::::::::.!'-..:::::.,':;,,-:•;-:::':-,:,-.'::::'. .'-':i, Limited energy,residential
75.00 2 .
vvvodituzaa.A.9 ., bviA,L9Li
"--- rxxle.R. (with above sq.ft.) I
mited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
';:-,...•i:i' !.12:1:4116.r.ERtY:i..:ONOtRO-...j.11:. t.:3:•*!:!•'. .'2_',?:'•: f.'.7,:?:•,.:1:3•JtNikNt':-i':'...'':= "7.1.7.:: Services or feeders installation,alteration,and/or relocation
Name:William Lyon Homes,Inc. 200 amps or less 100.70 2
Address:703 Broadway St Suite 510 201 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:(360)693-4442 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 1 59.36 69.Ur 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
APi1ie.,AI•lt„:- •,.. .,,::..:-'.,...-,:::::''',..:CYCO ---,.
NTA ri' ••
- :PERSON':.••,..„::: .•.; ABrFaeenchforcibrtcanuichts;newt;alteration,or extension,per panel
Business name:William Lyon Homes,Inc. eaablvebservichce;orufieteder fee,
742 2
Contact name:Nichole Thorpe B.Fee for branch circuits without
service or feeder fee,first
Address:703 Broadway St Suite 510
branch circuit 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 Fax::(360)693-4442 Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:permitsubmittals®polygonhomes.com
Reconnect only 67.84 2
-:4';';:.i',i,:;:--..:'.:'.-,.-4;1';',; .':! ?::J:.'j±!'-!.i,r.,-7:1:7;L:-T ,COIt1140.01 :-:: ::-,':- 1Z3'.4.2.;.:','.1.'-:;'..:••••:::'.7-'7;.'T-.','.71'i,7':.!:','.15,..-'-':...,,:.-,..:'•
Pump orirrigation circle 67.84 2
Business name:Alameda Electric Sign or outline lighting . 67.84 2
Signal circuit(s)or limited-energy
Address:3415 NE 44th
panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:Portland,OR 97213
Additional inspection(1 hr min) 66.25/hr
Phone:(503)319-2192 Fax:( ) Investigation(I hr min) 90.00/lir
Industrial plant(1 lir min) 78.18/hr
Email:solarpdx@me.com
• Inspections for which no fee is
90.00/hr
CCB Lic.: 199188 Electrical Lic.: c923 Suprv.Lic.: 48715 specifically listed CA hr min)
..; -.•...'s::: .-.17:tripac.k.,-tgArviivAts: ,:41.5*,.::':',•::•:::.,'-:,:,:.
Suprv.Electrician signature,required:
Subtotal:
Print name: Kile Rood I Date: 03/08/2019 0 Plan Review Required(25%of permit fee): _
. State surcharge(12%of permit fee):
Authorized signature: /---e-''.:. ...----- -------- TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Kile Rood Date: 03/08/2019 days after it has been accepted as complete.
* Number of inspections allowed per peamit.
I:NBuilding\Pelmits\ELC PermitAppELP.ERE.doc Rev 06/17/2015 440-46151K11/05/COMAYEB