Permit (98) CITY OF TIGARD ELECTRICAL PERMIT
F'''_ : COMMUNITY DEVELOPMENT Permit#: ELC2017 00240
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/10/2017
Parcel: 2S 111 CA01500
Jurisdiction: Tigard
Site address: 9625 SW SUMMERFIELD DR
Project: Jordan Subdivision: SUMMERFIELD NO.7 Lot: 338
Project Description: Replace 200 amp panel,modify/add(7)branch circuits.
Contractor: LIGHTING ELECTRIC LLC Owner: DEL JORDAN
PO BOX 890 9625 SW SUMMERFIELD DR
WOODBURN, OR 97071 TIGARD, OR 97224
PHONE: 971-338-8989 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/07/2017 $100.70
Specifics: amps or less
7 crt Branch Circuits w/Purchase 04/07/2017 $51.94
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 04/07/2017 $18.32
Electrical
Type of Const:
Occupancy Grp:
Total $170.96
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. ATTE N: Ore n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 0 through OAR 9 - - 90 u may obtain a copyy of the rules or direct questions to OUNC by call' • c.-. .1987 or 1.800.332. 344.
Issue By: ,:t Permittee Signatu •: / i !i' ' /CaL–---'
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' lik_ — - ,Y / Date: 0,1(/7
LICENSE NO. TO/ 9
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 Applicati , . FOR OFFICE I SE Oy Lv
City of Tigard Received Date/B : lo
Permit No.: Ljl� �! lr��
41 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' ■ Phone: 503.718.2439 Fax: 503.598.00R 6 :20 I( Date/B : Other Permit: M tCd6/7,ana/
t-i Cl A R I) Inspection Line: 503.639.4175 Date Ready/By: loris: 0 See Page 2 for
Internet: www.tigard-or.gov ��r7 w`�'y , yI 'y , #1' Notified /Method: Supplemental Information
'V3
TSE1G Iv! i _ "LAN � .
e � �
❑New construction ®Addition/alteration/replacement Please check all that apply(submit a sets of plans w/items checked below):
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.
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
E 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
larger separately derived system.
JOB SITE INFORMATION,�LOCATION ❑Addition
system.
0 Aof new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address:9625 SW Summerfield Dr 100HP or more. occupancy.
❑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/bldg./apt.no.: Project name: 0 Service or feeder 600 amps or more.
I SCH DULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
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'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESUU TION OF WORK (with above sq.ft.) 75.00 2
f, ,
� .
Limited energy,multi-family 75.00 2
New 200 amppanel/full interior remodel/add 7 branch circuits residential(with above sq.ft.)
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Ci PROPERTY OWNER tE1VANI
200 amps or less 1 100.70 /pd.7 7 2
201 amps to 400 amps 133.56 2
Name:Del Jordan 401 amps to 600 amps 200.34 2
Address:9625 SW Summerfield Dr 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
APPLICANT" , „ - >AA CONTACT
PERSON A.Fee for branch circuits with
above service or feeder fee, 7 7.42 57,5!/ 2
Business name:TL Remodel&Construction Inc each branch circuit
B.Fee for branch circuits without
Contact name:Tim Labunsky service or feeder fee,first 56.18 2
branch circuit
Address:PO Box 1996 Each add'l branch circuit 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
�CNTAO 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:( ) iv////
g Industrial plant(1 hr min) 78.18/hr
4 Inspections for which no fee is 90.00/hr
CCB Lic.: 198682 1 la b 9 Electrical Lic.: C904 Suprv.Lic.: 6019S specifically listed(%z hr min)
ELECTIUCAL,'PE MIT
/O .
Suprv.Electrician signature,required: /440/11 -r Lgt
e45 ..4— Subtotal: /tea.
Print name: Andrey Lobasyuk Date: 4-3-17 Plan review(25%of permit fee):
State surcharge(12%of permit fee): /g.-3?
Authorized signature: P�aG e ,4- yLA TOTAL PERMIT FEE: /70, 9
Print name: Konstain Lobasyuk r YDate: 4-3-17 This permit application expires if a permit is not obtained within 180
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 440-4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9625 SW SUMMERFIELD DR, TIGARD, OR,
97224
Record Type: Record ID:
Residential - Electrical ELC2017-00240
Inspection Type: Inspector:
120 Electrical rough-in Jeff Grove
Result:
PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9625 SW SUMMERFIELD DR, TIGARD, OR,
97224
Record Type: Record ID:
Residential - Electrical ELC2017-00240
Inspection Type: Inspector:
195 Misc. inspection Jeff Grove
Result:
PASS
Comments:
Floor heat
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9625 SW SUMMERFIELD DR, TIGARD, OR,
97224
Record Type: Record ID:
Residential - Electrical ELC2017-00240
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor