Permit (8) p CITY OF TIGARD ELECTRICAL PERMIT
1111 0 ' COMMUNITY DEVELOPMENT Permit#: ELC2016-00158
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/02/2016
Parcel: 25111 DB03700
Jurisdiction: Tigard
Site address: 9160 SW SUMMERFIELD CT
Project: CAMPBELL Subdivision: SUMMERFIELD NO.8 Lot: 423
Project Description: (2)branch circuits for kitchen remodel.
Contractor: LIGHTING ELECTRIC LLC Owner: CAMPBELL,VIRGINIA UDAVID
PO BOX 890 9160 SW SUMMERFIELD CT
WOODBURN, OR 97071 TIGARD, OR 97224
PHONE: 971-338-8989 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 03/01/2016 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 03/01/2016 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 rues or direct questions to OUNC by calling 503.232.1987 or 1.8000,332.2344.
Issued By: ermittee Signature:
VV '
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 il1i 1111 1( 11 ,1 tu.1City of Tigard
ç ' S
� ROCe" 3 Permit No.: _ --p
13125 SW Hall Blvd.,Ti OS`
Plan Re �� _ �--OCV �C50.114 g gond,OR 97 1`p Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 1 t-� Date/By: Other Permit/yn gl a0/6 (3/
I c -�h[� Inspection Line: 503.639.4175 �P� ate Ready/By: Jura. ! El See Page 2 for
Internet: www.tigard-or.gov v�y v��`5�` Met tro Supplemental Information
TYPE OF WORK 0,11 CI v l� PLAN REVIEW
❑New construction ®Addition/altecation/ -, - 'i t Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
o Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14.000 0 Commercial-use agricultural
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION
0 Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","l-3",
Job no.: Job site address:9160 SW Summerfield Ct IooltP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97224 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldgiapt.no.: Project name:Campbell 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
I)eseriptloa I Qty. I Fee. I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'!500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
75.00 2
kitchen remodel,two new circuits residential(with above sq.ft.)
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
® PROPERTY OWNER 0 TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:David&Virgina Campbell 401 amps to 600 amps 20034 2
Address:9160 SW Summerfield Ct 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Tigard,OR 97224 Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel 1
0 APPLICANT ® CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:TL Remodel&Construction Inc each branch circuit
B.Fee for branch circuits without
Contact name:Tim Labnnsky service or feeder fee,first 1
branch circuit 56.18 2
Address:PO Box 1996 Each add'l branch circuit 1 7.42 2
City/State/ZIP:Lake Oswego,OR 97035 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)9842783 Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:TLRemodel@yahoo.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Lighting Electric LLC Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address:PO Box 890 Each additional inspection over allowable in any of the above
City/State/ZIP:Woodburn,OR 97071 Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(971)338-8989 Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90,00/hr
CCB Lic.: 198682 Electrical Lic.: 904 Suprv.Lic.: 60/C/3 specifically listed(%z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: i K //--c.rsey-L-%( Subtotal: 23', ‘10
Print name: Andrey Lobasyuk Date: 2/2 /16 Plan review(25%of permit fee):
State surcharge(12%of permit fee): —7. 473
Authorized signature: -p.- TOTAL PERMIT FEE: 7/).3
f This permit application expires if a permit is not obtained within 180
Print name: Konstain Lobasyuk Date: 2/29/16 days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 05/21/2013 440-4615T0l/05/COM/WEB
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9160 SW SUMMERFIELD CT, TIGARD, OR,
97224
Residential - Electrical
120 Electrical rough-in
PASS
ELC2016-00158
Jeff Grove
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9160 SW SUMMERFIELD CT, TIGARD, OR,
97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2016-00158
Jeff Grove
Violation Summary:
Inspector Contractor