Permit (167) ELECTRICAL PERMIT
Permit#: ELC2017-00125
CITY OF TIGARD
■ COMMUNITY DEVELOPMENT Date Issued: 02/27/2017
T I( A u r 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2/27/2 A10600
Jurisdiction: Tigard
Site address: 16355 SW WOODCREST AVE
Project: Singley Subdivision: COPPER CREEK STAGE 2 Lot: 59
Project Description: (5)branch circuits for laundry room/kitchen remodel
Owner: HAMMERQUIST, RICHARD C
Contractor: LIGHTING ELECTRIC LLC SINGLEY, KARIN L
PO 16355 SW WOODCREST AVE
WOODBURN, OR 97071 TIGARD, OR 97224
PHONE:
PHONE: 971-338-8989
FAX: FEES
Quantity Description Date Amount
5 crt Branch Circuits wo/Purchase 02/27/2017 $85.86
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/27/2017 $10.30
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 inr.i-rTan - ith 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. AT NTION: Oreg•' law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-8810 through OAR 9'- :81-00• You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198 0 .800.33
Issued - • — / Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
Date:
OWNER'S SIGNATURE
CONTRACTOR INSTALLATION ONLY
� i_' Date: 7 /
SIGNATURE OF SUPR.ELEC' _, ,_ ��:.�J , i
LICENSE NO. (12:,/ 95
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,„ ; fi-1 INS FOR OFFICE t SI:ON1,1
City of Tigard ���. �� `�� Received Aran. /?Oal�
DateB Permit No.:
's 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit:
' 11 Phone: 503.718.2439 Fax: 503.598.1960- o r Date/B :
Date Ready/By: Juris: ® See Page 2 for
LI
1 16
I
Inspection Line: 503.639.4175
Internet www tigard-o[gov Notified/Method: Supplemental Information
c‘ ti-ilksvit r rel REVIEW
h , . �. Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction ®Addition/alt a i plac�e'nient�' ''
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'0 `toWiRu 1ON exceeds 10,000 amps at 150 volts or 0 Floating buildings.
' ess 0 r t l-use gncultural
„.h..,". _•. _: - - ;�, l to ground,or exceeds 14,00 ❑Comme c a a "
N 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
Emergency system. larger separately derived system.
' J � A 0 ANI) )i 101 0 Addition of new motor load of 0"A", -
"1-2",•�73"
,
100HP or more. occupancy.
Job no.: Job site address:16355 SW Woodcrest Ave ❑Six or more residential units. 0 Recreational vehicle parks.
0 Health-care facilities. 0 Supply voltage for more than
City/State/ZIP:Tigard,OR 97224 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: 0 Service or feeder 600 amps or more.
_E SCREDIJLE'
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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
' ':1*S� li)N OF"WORT (with above sq.ft.)
Limited energy,multi-family 75.00 2
move circuits for new laundry location/kitchen remodel residential(with above sq.ft.)
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
tom® 1*(400 Y iI I>R
201 amps to 400 amps 133.56 2
Name:Karin Singley 401 amps to 600 amps 200.34 2
Address:16355 SW Woodcrest Ave 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
relocation
Phone:( ) Fax:( ) 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
A.Fee for branch circuits with
7 Yui F ' - above service or feeder fee,
� f each branch circuit 7.42 2
Business name:TL Remodel&Construction Inc B.Fee for branch circuits without
Contact name:Tim Labunsky service or feeder fee,first 1 56.18 56•/f 2
branch circuit
Address:PO Box 1996. Each add'l branch circuit 4 7.42 ,Z9.lig 2
Miscellaneous(service or feeder not included)
City/State/ZIP:Lake Oswego,OR 97035 Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Phone:(503)9842783 Fax::( ) Reconnect only 67.84 2
E-mail:TLRemodel@yahoo.com Pump or irrigation circle 67.84 2
CO CTOR 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(%2 hr min)
- E� "A:.' =Rl0#ti'
Suprv.Electrician signature,required: Subtotal: �5.g(.0
PPrint name: Andrey Lobasyuk � � l �� 2-12-17 Plan review(25%of permit fee): _ ------
State surcharge(12%of permit fee): 0. 3b
Authorized signature: I TOTAL PERMIT FEE: C 110,/‘0
f This permit application expires if a permit is not obtain within 180
Print name: Konstain L+a asyuk Date: 2-1247 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC PennitApp 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:
16355 SW WOODCREST AVE, TIGARD, OR,
97224
Record Type: Record ID:
Residential - Electrical ELC2017-00125
Inspection Type: Inspector:
199 Electrical final David Young
Result:
PASS - NoCofO
Comments:
Contractor on site finishing drywall at panel.
Violation Summary:
Inspector Contractor