Permit 1111 CITY OF TIGARD ELECTRICAL PERMIT
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8 COMMUNITY DEVELOPMENT Permit#: ELC2014-00684
T EGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/03/2014
Parcel: 2S 111 CC23000
Jurisdiction: Tigard
Site address: 10420 SW GREENLEAF TER
Project: Eischen Subdivision: SUMMERFIELD NO.5 Lot: 288
Project Description: New panel and(12)branch circuits.
Contractor: LIGHTING ELECTRIC LLC Owner: STANLEY EISCHEN
PO BOX 890 10445 SW GREENLEAF TER
WOODBURN, OR 97071 TIGARD,OR 97224
PHONE: 971-338-8989 PHONE: 503-440-2095
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 12/03/2014 $100.70
Specifics:, amps or less
12 crt Branch Circuits w/Purchase 12/03/2014 $89.04
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 12/03/2014 $22.77
Electrical
Type of Const:
Occupancy Grp:
Total $212.51
Required Items and Reports(Conditions)
This permit i d subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will
be d in accordance 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
d . ATTENTION: Oregon -w 'res you to follow the rules adopted by the Oregon Utility Notification ent Those rules are set forth in OAR
2-001-0010 through OAR 952-0.1-0090 may obtain a copy of the rules or direct questions to OUNC by calling 503 .11 87 or 1.800.332.234
Issued By: A._ . , �� / / Permittee Signature: /-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:
CONTRACT',R INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' -� ' �� � Date:
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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 Applicatio I t BIZ t tl I It I I I t t�l
City of Tigard ` Received Date/B /jZ / /Y % Permit No.:f teet/ -.4006 13125 SW Hall Blvd.,Tigard,OR 9BECERIE
_ Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960D L L 0 1 2014 Date/B : Other Permit:
i ,i\l Inspection Line: 503.639.4175 Date Ready/By: 42 / Juris ® See Page 2 for
I Internet: www.tigard-or.gov CI YOF MARL) Notified/Method: y Supplemental Information
TYPE OF �lgtt�I CITY OF I {+/� u o1'11-e- PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current
❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1- 2-family dwelling less to ground,or exceeds 14,000 ❑Commercial-use agricultural
y g ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address rr� n ,, ),, 1 10OHP or more. occupancy.
11 S . 17��1 1 lQ ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Greenleaf ❑Service or feeder 600 amps or more.
FEE SCHEDULE
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
Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
75.00 2
New panel/12 circuits residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
® PROPERTY OWNER ❑ TENANT 200 amps or less 1 100.70 /e TO 2
201 amps to 400 amps 133.56 2
Name:Stanley Eishen 401 amps to 600 amps 200.34 2
Address: 15665 SW Oak hill 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 I ® CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, , irt- 742 ?`,.2.`'l/ 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'I branch circuit 7.42 2
City/State/ZI'• take Oswego,OR 97035 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phon=.(503)9842783 Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: • • odel @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
I 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.: C904 Suprv.Lic.: 3535S specifically listed(1/4 hr min)
ELECTRICAL PERMIT FEE_S
Suprv.Electrician signature,required: Subtotal: f____
fje7.7 •e Print name: John Christensen Date: 10/8/14 Plan review(25%of permit fee):
State surcharge(12%of permit fee): 02 a• 77
Authorized signature: TOTAL PERMIT FEE: 02/a,57
Print name: Konstain Lobsyuk q Date: 10/8/14 This permit application expires if a permit is not obtained within 180
J4/ ,.,/ days after it has been accepted as complete.
` * Number of inspections allowed per permit.
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