Permit ‘., CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00441
DEVELOPMENT SERVICES DATE ISSUED: 6/23/2005
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 1S134CC-04300
SITE ADDRESS: 12318 SW WINTER LAKE DR ZONING: R - 4.5
SUBDIVISION: CAPSTONE LOT : 010 JURISDICTION: TIG
Project Description: A/C circuit, reconnect furnace, outlet.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
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Owner: Contractor:
GEBERT, LEISSA DOUBLE E ELECTRIC INC
12318 SW WINTERLAKE DR 2626 SE SPRUCE ST
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503 - 590 - 2397 Phone: 503 - 807 - 5156
FEES Reg #: LIC 152985
Description Date Amount ELE 34-267C
SUP 4620S
[ELPRMT] ELC Permit 6/23/2005 .$60.15
[TAX] 8% State Surcharge 6/23/2005 $4.81 REQUIRED ITEMS AND REPORTS
Total $64.96
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 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'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. •
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.
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4 ' Electrical Permit ' ; ; > a VED I. I. I '-I. t t\l ,
City of Tigard h�aat w.. _ , 03 OC�
13125 SW Hall Blvd., Tigard, OR 97223 I Plan Rcv'ca
Phone: 503.639.4171 NI %; 503,598,1960 2 2 2005 A"` i i ti�ten • IltherPennit
O TIGARD - Nprified/ )ari
!lisped Line: 503.639.4175 » 'I I bi i Kct y . - a. Nee Page 2 for
Internet: www.ci.ugunl.ur.us CITY OF T
"rI C T I ® Supplemental !affirmation
Buhl eitiint/ulterution/replacement DI, a >4 ION
_ __ _ _ PLAT( REVIEW
❑ Nev. construction Please check all that apply'
E] Demolition ❑ Other ❑Service over 225 amps. comnl•I ❑I lacurdous location
❑Service over 320 amps - rating ❑ltnildng over 10.000 sq. f ,
1:ATECORY OP CONKI'RUCI'ION or I- and 2- Ihmily dwellings 4 or more new residential
1 - mad 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑tiystem OvL:r 600 volts nominal units in one slnu:lure
❑ Multi-family ❑ Master builder ❑ Other:
❑EttodinK eve, tau« (bliss ❑fceders 400 amps or more
❑(kcupunt load over 99 persons ❑Marufacturud structures: or
.108 Kl'I'E INFORMATION AND LOCATION ❑F..gmss/l Wiling plan RV park
Job no. I Job site address: 12315 SW of (...aEQ A v4. 0(2,0 lealth•cac facility ❑I>fhcr: . . __-
Suhmtl 2 sets of plans with may attic aMwc
City/State/LIP: 71 bej20• The above ate not applicable to temporary construction service
Suite/bldg. /apt. no.: i Pmject Warne FEE* t5C11EDUL6
- - -- ---... • - -.. M+ngdlva I VI,. FR. 1 - T°111 l ..
Corti~ street/directions In job site: New residential single- or muld•family dwelling unit.
Includes attached garage.
--- 1.000 sq. n. to less 145.15 4
Subdivision I I .ot nn. _£u. udd'I 500 sq. ft. or portion 33.41) I
Limited energy. residential 75 (10 2
•I •Ax map /parcel no•: — —• - -- _ _ -
... - — , _..... -..— Limited energy, non- residential 75110 2
DESCRIPTION OF WORK liuch munuluelured or modular
ix ( C c t t2Cu t-r (wo RK. of ru l J Revco IAJC dwelling, service and/or llati 90.90 2
tie rvic ca fir f eeders{ installation, allcratiun, and/or relocation
J 4214I.CC . 200 amps or less ' 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 tulips 1116.85 2
401 :mops to 6110 amps 160 60 2
Name: - L - 1 S S A — 601 amps to 1,1101) amps 240.60 2
Address: ► _ Over I,00(1 amps or voila 454 65 2
Reconnect only — 66.1(5 2
City /state!zlP' Temporary services or feeders installation, alterallnn, and /or
Phone: I ) relocation
3) �4 G -Z3q 7 I'a'` ( _ 200 amps or less 66.85 1
Owner installation: this installation is being made on property that I own which is not ill( amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447. 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature — Date: Branch circuits - new, alteration, or extension, per panel
CI APPLICANT h-•. - . ❑ CONTACT PERSON A I'm for brunch circuits with
- — -
— ° service or feeder tee. each 6.65 2
Business name: branch circuit
B. Fee for brunch circuits •
Contact name: ,without service or feeds! fee. / ��°
each branch citcuil 46 8S ,r 2
Address Each add'I blanch eirtati 6.65 ' 3- 2
City/State /ZIP: Miscellaneous (service nr feeder not Included)
Pump or irrigation steels 53.41)
2
Plme::( lax::( )
- • , __ . Sign or outline lighting 53 40 2
P: mail: Signal cirwit(s) or limited- •
-...
CONTRACTOR cnctgy panel, alteration, or
s , Q extension. Describe: Page 2 2.
�Husincss name: 6LL -.cT12 / C iNC._.
Address: Z bu $F, SPQVcE ST, Loch additional Inspection over allowable in any of the above
Per inspection ^ 67 50
City/State/ZIP: /,) ILL 5 6070 , OR chi 23 . investigation per hour t I lir min) 62.50 ...
IP Maw: ( ) W? - SI S(o I Ens. ( ) 4i —c966 _Industrial pant per hour — 73 75
,.. LrLE TRICAI. PERMIT FEW
c'c'13 Lie.: 5235 iileclric�d I ,ie.; _ • -Z'1 supra. i,it.: '6 � _ Subtotal ( if —
Soprv, }. Iectrieigrt signature. ►vyuired: t Plan review (25 %ol'pcmtrt tic) Si
Print name: EI.(S (20 Al . Dille: -- - • • State melange (8% of permit Ice)
- TOTAL PERMIT I41: 40; �`t.t
Authorized signature_ Tbi, pearll appnranon espirm if permit is not obtained within ISO
days after It has been accepted as complete
Print name. I f)ute: '. fee meihodntngy ray by Tri- Cuutily Building InehirPy Service Board
Z e5Ea 9965- 0£6 -£OS •ouI oT'43e1a a eIgnoI 80:91 SOOZ'ZZ Nl1P
lift-
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CITY OF TIGARD : - "" . -
BUILDING DIVISION PERMIT #: ELC2005 -00441
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/23 /2005
Phone: (503) 639 -4171 4 ,,ru� fiill
Inspection Requests (24 Hrs.): (503) 639 -4175 --t11-
INSPECTION WORKSHEET FOR DATE: 7/612005 TIME: 7:12AM PAGE: 19
SITE ADDRESS: 12318 SW WINTER LAKE DR CLASS OF WORK:
SUBDIVISION: CAPSTONE LOT #: 010 TYPE OF USE:
PROJECT NAME: GEBERT
DESCRIPTION: A/C circuit, reconnect furnace, outlet. 1 73 N ../. 'Oli 01
OWNER: GEBERT, LEISSA, PHONE #: 503.590 -2397
CONTRACTOR: DOUBLE E ELECTRIC INC PHONE #: 503 - 807 -5156
Inspection Request Scheduled For: :a e: 7/$ Iii Pour Time:
Code # Inspection Description , " • ' _ - Contact # Message
199 Electrical final 010826 -01 503-781 -7648 N
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N e �", J Date: 1 4 0c- Phone #: (503) 718-