Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00396
DEVELOPMENT SERVICES DATE ISSUED: 6/9/2005
,- . -..: 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S112CA -02300
SITE ADDRESS: 15210 SW GENTLE WOODS CT ZONING: R -4.5
SUBDIVISION: GENTLE WOODS LOT : 015 JURISDICTION: TIG
Project Description: Furnace replacement, add AC.
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: SIGNAL /PANEL:
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:
Owner: Contractor:
VOLLSTEDT, BRUCET+ DEBORAH J JARMER ELECTRIC INC
15210 SW GENTLE WOODS CT 5105 SW 45TH AVE
TIGARD, OR 97224 PORTLAND, OR 97221
Phone: 503 - 291 -6642 (wk) Phone: 246 -5381
FEES Reg #: LIC 6924
SUP 4044S
Description Date Amount ELE 26 - 144C
[ELPRMT] ELC Permit 6/9/2005 $60.15
[TAX] 8% State Surcharge 6/9/2005 $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 Speaalty 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-$9.0-332-2 44
Issued By: � J Permittee Signature:,)( - 4 /
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.
----.
Electr i ical Permit A . l vi. it)
\ CEIVEll
FOR OFFICE USE ONLY
City of Tigard , \
t, Recived ,..!.., / /, ..„..---
Permit No.: ...- e_ _003 (3 4,
13125 SW Hall Blvd., Tigard, OR 9722 JUN 0 9 _ 05 Date e /By: wi 47 ic ..D B.6
Plan Revia (
Phone: 503.639.4171 Fax: 503.598.19 ', e li tlilIA I l'?` Date/By: Other Pertnit.
Inspection Line: 503.639.4175 ‘ ' ITY OF e- 'D..' Date Ready/By: Au:* See Page 2 for
Internet: www.ci.tigard.or.us , Notified/Method: — 3 C, Supplemental Information
p , an.Tr: nivisION _ __, ,, , _.
.,.., .....,. ,,.......--„, -, -. • :.,,.. - .,. • - ,, r , , .:., ..,-,-, :,,,,-: -, ,,,i414,-ii v i..-‘.&t,„ , ), ,, N4.0..., , w,,,,,-, , ,,,,
JVP sw,91 " ''::';'::!:- ::`"' " :;.: ; --:,,,:_,;',:, ,. -' .,,:,:,.-!: ,MI'-2.M,Yr':"k1=ktIffraViliff--al,
0 New construction ■. VkAddition/alteration/replacement
Please check all that apply:
['Service over 225 amps, comm'I ['Hazardous location
0 Demolition 0 Other: ['Service over 320 amps - rating OBuildng over 10,000 sq. ft.,
'CATEGORIVOr-CONSTRUCTION , - k , n 'f' of 1- and 2-family dwellings 4 or more new residential
Al- and 2-family dwelling 0 Commercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories OFeeders, 400 amps or more
0 Multi-family 0 Master builder 0 Other: ['Occupant load over 99 persons ElManufactured structures or
- .1013,:',SITE - INFORMATION ANI)::LOcATION i ".-- - : ['Egress/lighting plan RV park
6,56 if OHealth-care facility ['Other:
Job no.:
Job site address: /57 ID St...) &en-L. et Submit j sets of plans with any of the above.
City/State/ZIP: -- I e4 .P-#10 7 Z 14/ The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name: 0 Description I Q 1 Fee' Total I **
Cross street/directions to job site: New residential single or multi dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 2
=DESCRIPTION OF WORK =' .= ' `=: -=';;;:! ":',". Each manufactured or modular
. (---f - , — -.: `/C ( St/ (Ai\ Ft( if` A vi-C_ e- 4-(....■ dwelling, service and/or feeder 90.90 2
j
Services or feeders installation, alteration, and/or relocation
)
200 amps or less 80.30 2
OWNER - ' . - '1 ...,.. 1' .:...: .,.. ;41. 201 amps to 400 amps 106.85 2
-- :'1 - , LI 41A_.,[11' ',,,; ,-, '-
. _
--"" — - 401 amps to 600 amps 160.60 2
Name:
\J A
C ( --- 1 --- - DT 1 ;,?- 00
) e -c- --
Phone:0 ) a t,q/...-. 6.6e./.9.-- Fax: ( ) 601 amps to 1,000 amps
Over 1,000 amps or volts 454.65
Reconnect only 240.60
66.85 2
City/State/ZIP:
Temporary services or feeders installation, alteration, and/or
( 2
Address:
relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 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
1:1 APPLICANT ;-'' - ' ' - ' ‘ El CONTACT ttas-iii4j,:.-,ta-,', A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 if i 2
each branch circuit
Address:
Each add'I branch circuit Z...._ 6.65 i - 3 3 0 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
=corstgAcTok , ,
. energy panel, alteration, or
extension. Describe: Page 2 2
Business name: :7 ,A-A E./2— Eg...EC,...i tear (2_ i Ik.)C...
Address 0 s y , ST .4) 0
Each additional inspection over allowable in any of the above
: c/ — sw e ,s - e 2
Per inspection 62.50
City/State/ZIP: / - , --- A_A- /04 0 /2 ' 7 2 2 / Investigation per hour (1 hr min) 62.50
Phone: (S(53 ) 2 it& - ry E I Fax: (s3) 24/(.(- t f-e) 3 7 Industrial plant per hour 73.75
=',',-. '';';1"i' Z.
CCB Lic.: 1 9 2_ ii E ilectrical Lic.: 26 / ql/C— Suprv. L c.: "idol./ y5 Subtotal 6 is
/
Suprv. Electrician signature, required: ide......., " e , Plan review (25% of permit fee)
11 State surcharge (8% of permit fee) 1 "/' k
Print name: 3 4 /2i „./ /11 e ,2..._ ate: 6_ 9-
TOTAL PERMIT FEE ( L- f- 9
Authorized signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board
**, Number of inspections per permit allowed.
I \BuildinePernutskELC-PennitApp doc 12/03 440-4615T(10/02/COMIWEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006-0036
A
13125 SW Hall Blvd., Tigard, OR 97223 „., DATE ISSUED: 6/9/2005
Phone: (503) 639-4171 i
Inspection Requests (24 Hrs.): (503) 639-4175 ...,,, L- •
INSPECTION WORKSHEET FOR DATE: 6/10 06 TIME: 7:05AM PAGE: 83
(
SITE ADDRESS: 15210 SW GENTLE WOODS CT CLASS OF WORK:
il
.,. SUBDIVISION: GENTLE WOODS LOT #: 015 TYPE OF USE:
/ PROJECT NAME: VOLLSTEDT
DESCRIPTION: Furnace replacement, add AC.
OWNER: VOLLSTEDT, BRUCE T + DEBORAH J, PHONE #: 503 (w1
CONTRACTOR: JARIvIER ELECTRIC INC PHONE #: 246-5381
Inspection Request Scheduled For: Date: 6/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 008949-01 603-246-5381 N
Corrections/Comments/ Instructions:
, -... .
1• 00....
Ci •
PASS PARTIAL APPROVAL E CANCEL El NO ACCESS
FAIL fl • • LL FOR INSPECTION E] ADDITIONAL FEES ASSESSED
Inspector: Date: (
01 ° S Phone #: (503) 718-
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