Permit (22) CITY OF TIGARD ELECTRICAL PERMIT
•
a COMMUNITY DEVELOPMENT Permit#: ELC2016-00443
-FIG A r.r) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/01/2016
T
Parcel: 25111 DB05100
Jurisdiction: Tigard
Site address: 15249 SW ALDERBROOK PL
Project: Stanley Eischen Properties LLC Subdivision: SUMMERFIELD NO.7 Lot: 409
Project Description: (1)200 amp panel and(3)branch circuits for interior remodel.
Contractor: LIGHTING ELECTRIC LLC Owner: STANLEY M EISCHEN PROPERTIES LLC
PO BOX 890 15755 SW OAK HILL LANE
WOODBURN, OR 97071 TIGARD, OR 97224
PHONE: 971-338-8989 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/27/2016 $100.70
Specifics: amps or less
3 crt Branch Circuits w/Purchase 05/27/2016 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 05/27/2016 $14.76
Electrical
Type of Const:
Occupancy Grp:
Total $137.72
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 ob f ttirules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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 1 OR 01I1( F I (1\1.1
2iCE1VEI) Received
City of Tigard DateB : , , t0'Ty-- Permit No.: ` - h ,
13125 SW Hall Blvd.,Tigard,OR Plan Review M�r
_ Phone: 503.718.2439 Fax: 503.598.1960 DateB : Other Permit: M + • i'.
t ,It 1 Inspection Line: 503.639.4175 h ,V Date Ready/By: ® See Page 2 for
Internet: www.tigard-or.gov 2 6 2 016 Notified/Method: IlirMI Supplemental Information
TYPE oFerposoF TIGARD PLAN R 1EW 'r
❑New construction ®Addition}It� I � Please check all that apply(submit 2 sets of plans w/items checked below):
lA\ 17 LD �lj 015 0 Service or feeder 400 amps or more 0 Building over three stones.
❑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
® I-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 ❑Emergency system. larger separately derived system.
0 Addition of new motor load of ❑"A","E","1-2","I-3",
Job no.: Job site address: 15249 SW Alderbrook place Six or 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 thanrye( �p ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ` _`O Ec i S[HPn/ pID�PIr 0 Service or feeder 600 amps or more.
r FEE SCHEDULE
Cross street/directions to job site: Description 1 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 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75 00 2
Interior remodel/new 200 amp panel residential(with above sq.ft.)
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
® PROPERTY OWNER ❑ TENANT 200 amps or less 1 100.70 /(ja,-713 2
201 amps to 400 amps 133.56 2
Name:Stanley Eischen 401 amps to 600 amps 200.34 2
Address: 15755 SW Oak Hill Lane 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:( ) r location
or less mit ---. r
Owner installation:This installation is being made on property that I own which is not 201 amps to 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
0 APPLICANT , C..4 CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 3
7.42 O1�
w>i 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)
y g Each manufactured or modular
Phone:(503)9842783 Fax::( )
dwelling,service and/or feeder 67.84 2
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
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Woodburn,OR 97071 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.: 6019S specifically listed(/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: i). ,2p
Print name: Agty L basyuk ` Date: 5/26/16 — Plan review(25%of permit fee): "--
L State surcharge(12%of permit fee): iii_ '
Authorized signature: TOTAL PERMIT FEE: I 137.7,4.
Print name: Konstain Lobasyuk Date: 5/26/16 This permit application expires if a permit is not obtained within 180
w 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
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
15249 SW ALDERBROOK PL, TIGARD, OR,
97224
Residential - Electrical
199 Electrical final
FAIL
ELC2016-00443
David Young
Provide access for inspection.
Lock box code left with message not working.
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
15249 SW ALDERBROOK PL, TIGARD, OR,
97224
Residential - Electrical
199 Electrical final
PASS - No C of O
August 30, 2016 at 9:08:45
AM
ELC2016-00443
David Young
Violation Summary:
Inspector Contractor