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Permit A CITY OF TIGARD, ELECTRICAL PERMIT PERMIT #: ELC2004 -00697 ��141, DEVELOPMENT SERVICES DATE ISSUED: 11/2/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S133DD SITE ADDRESS: 12682 SW DANBUSH CT SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 ZONING: R-4.5 • BLOCK: LOT : 110 JURISDICTION: TIG Project Description: Installation of (2) branch circuits for pond, fountain and outlets. Job No. 1004 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: 1 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: JIM ESSENBERG CHRIS SANDBERG 12682 SW DANBUSH CT 3965 SW PENDLETON ST TIGARD, OR 97223 PORTLAND, OR 97221 Phone: 503 - 521 -9134 Phone: 971- 506 -3044 Reg #: LIC 161375 ELE 26 -1224C FEES SUP 4996S Description Date Amount Required Inspections [ELPRMT] ELC Permit 11/2/2004 $53.50 [TAX] 8% State Surcharge 11/2/2004 $4.28 Rough -in Elect'I Final Total $57.78 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 se orth- in-QAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-66 or 1-800- 332 - 44 Issu d By: I / Permit 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: CO ► TRACTOR INSTALLATION ONLY • SIGNATURE OF SUPR. ELEC'N: ! ' i••�� , ' v DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day FROM :BEA SANDBERG FAX NO. :5039772587 Oct. 30 2004 10:22AM P3 Ell ctrl al Permit Application t o e ()1.1 IS 1 i wt r i i. City of Tigard EEL Ec xo.: �. , 13125 W Ha11131nd., T' , OR 97273 7 Phone: 503 -639 -4171 Fax: S03.598.1960 ! i 4 , -. ��..p : DateBy: -7-4.)( Othel?ermic Inspection Line: 501639.4175 3-639.4175 , i,4. .� I' Date Ready/By: Ready/By: / 7 Internet; ww,ci.tigard.orus M NotiiedMlethod: if. ( 0 0 see See mmtall Page z rot o ormation ;��'" >/� :gN�`a�a�(��t,., `pi'd'i'i' - .'(!S• : :t'a�" " :-� :• .. � :4,':'r : §u - •�n''4`� ". :fd ";i' <) :w *',!+ y a.r w..�,,.f`': :, ,,: . 5 - :, � :.,,{ .. :,,,..�."'3,1'''.�J�� rs;. r ^' -;ssu. ':,• tt • -- -- - - ;:)•:: ;.is ,.`'�'xd „: t,� 4 �'),, ;'Yt.�., 4: I mo' , .i. ;;• :i'S - ; . .. . s. i..... xs; ��;f,�x >,U.� ^s�•;a,. .�.d'�.k�� •Y�1. :��e., ;..,��,.,� �, #, ... „ :, „ `r. 'Y'l: •�..Jir 'f.�Fr�f..rW,•. ^lv.. .r'fi2: n. Y y , t+ , .:Gn uy... ot.f�f� ` ' , ..'�i� �. J 'r'�:'�.� 1 121 New construction ddition/alteaation/replaccment Please a apply: ❑ Demolition ❑ Other ['Service over 225 amps, comm'I ❑Hazardous location ❑Service over 320 S ldn `':yrf' � ` ,�(' ? '�, + ` ° :I �' t; ,� > ” ' ,� ,�.y, c�-;' Q.«h.nt..�a ©....�.>„ :.�� :.!e�".Y� : ? • :! %�+ "�;jj.� :' ^''�� :;L'p�;�eY.iiTr�i,�Y'�KI �' � �g ❑ W $ over 10,000 SCI. ft., � r;^ 3,I:t ia.'n'�"'.,1``�,,.k.ia� S'tal..� 410°4,, ,1 .„ • p, f _;� y',a'�,; ' :.,.: p f rnrly 1 � c,... s� .�,;>;!),,: 0 1- itud 2r dwellings 4 or more new residential 0 1- and 2- family dwelling 0 Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one strucxure ❑ Multi- family El Master builder ❑Building over three stories [Waders, 400 amps or more ❑ Other: ❑Ocei pant load over 99 persons ❑Manufachucd MUM= or �'; i �. + � :,t, 'f��,w.�`'�' :,'� :7 c1 - +� r �«� .a ..�,,: , �-r 4� / : :� :i' V': ': -* r;.: .2.t. !nil' ,�iK {n`19" ,� o �6. i' '.t 0 - � { ..• 'rrf'. � ;,,.i .;a. "�/ : "1! , ",':'3h;'%4Y' „l ., ..,�.. ��Yo •f,4 }i ic. :,x:£, .; i :� , .,.. a.. ~ .,, � .., , , �.. �. '�d� ^,'- k?� : 1..; e , :i.;;r.�. iata'F..!'t;C �wP > ❑E RV park Job no.: 1® 04. Job site address' IZfip SLx) l7tI,i....el,L.St -i Cr ❑Health e ['Other! Subm 2 sets of plans with any ofthe above - City/State/ZIP: -"'fl G iw.. , cs R act '22;3 The above are not applicable to temporary construction service. Suite/bldg. /apt. no_: Projecttaame: ym.k6 cp kskrrS ..`” J, :Y .. ' lx''Af, �� - � . ° :S s M k t>tae,lptbw I Qty. I gee. I Total f Cross street/directions to job site: S $ 1,,f l't,_ ul New D New residential dingle - or multi -family dwelling unit. tnclndes attached garage. 1,000 sq. fl_ orless 145.15 4 Subdivision: 1 Lot no.: Ea add1 500 sq. R or portion 33.40 1 • Tax map/parecl no.: Limited energy, residential 75.00 2 'r,= "7i�'1� %r °'.s2p 'n' %1''ri'%l :vl�'ii'�l 3 d' :'� are' , ,J ,e ;'7!!thc,•tt: ti '!,�;�.� �.c :w .x•.'t ', ; :rtg,, Limited energy, non - residential 75.00 2 Ai :t;.'dx :.�. n :�tU�M" �{'� T�„yr /� .v. �i- v!+'Mr,�� y� 2�'r sV�•� � t : ; :., : :�f r• Each F�MIWW oI 1JR,{li7/A3 .... ' � '1 . �) �;' ' .t.. rtaant 2 r 'C F' P( F o i tT 1J . dwelling, � Services o r feeders s installation, 90.90 2 �7 Y �`al�c` ? 1°� vic�s r installation, alteration, and/or rrlocxtion CILA''S'UM' 200 amps or less 8030 2 ... - % :.sa .. �'� y., x, �� �r , , 4 , w , y ,:,.., K',,,: , '_' 201 Sm t0 400 106,85 .. 7, '�r t/ ;, :,? t at H ;�i. C c! "' ; ,, j k . t ,." , pS amps 2 �t N�(i'�J gr,�[yl��,,�'�`V��y .-.. �tx( 'r t �� 1 ) , � yy J %��y�.� k.01 :i�A`.. «"`.9. : ,:.,a. 5.,iF ' " "- YY41Rµ hd: teen + : iq) 21' M ,.l' : , :lr�'j : ^, , .' %�K, it n4y.. H aol amps to 600 amps 160.50 2 Nano: i l _sc.t.1 a elz C 601 amps to 1.000 amps 240.60 2 Address: I 2( so brA �"r Over 1,000 amps or volts 454 -65 . 2 Reconnect City /State/ZIP: ` \ 1'� , 6 k . cr cr Temporary 2.23 only 6a 2 services or feeders installation, alteration, and/or Phone: ( 1 —1 i 34 I 'Pax: ( ) 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 4 00 amps - 10030 _ ' 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 pant! °• ° t' r0 h ,. ')• . "'.0'.:.r:;6. , . . Fcc for rcits with - :.( <w ',aka;•, ti;�:. y .$k� 1c ro rQ`Ak"R : ,- n A or blanch feeder ci fe u e, each 6 -65 2 Business name: C r , s branch circuit A A t so neat : 1 � �' r . B. Fee for branch circuits Contact •Ag,,D a with.: service or feeder fee, each branch circuit 46.85 44 s5. 2 Address; S Ir) ? i.r' 'd l,.1 S'- . Each add'l branch circuit i , 6.65 ( 2 City /State/ZIP: -. - - p p Q C m"2 t Miscellaneous (service or feeder not included) , ,��' : ( ) Pump or irrigation circle 53A0 2 Phone: (100971,66,63,:s.0 Tj 1"' ax Sign or outline lighting - ighting 53 -40 2 E -mail: Signal circuits) or limited - Sfi't`,,?+'VS + } +� VRBP�r.�R,wtY„�jr:•{i :. . i t oe t`uur' i'tY "'1Ly.r, Mrti;;Rtn;��:yi;4l "` °, . ;;: ?�' •,`T;t' enef$,yllanel aitClatl on, Or kFfSf. m., 1.. o: c. a.:. ti: 7�a�f: '�..•r.�i.�a..1w :a.ve'ilkfn,'�, a'�WN�e1�% ,�,- .,,,,, ,.'..»., - n,Es _5,�4'e k Ai- �z`( :4+.,.e.... ,.:nw...), .. Business name: OAR t, A S extens lhsc Page 2 2 Address: .'4 Cts 5 S U3 g ' Z LG NJ 1 , Each additional inspection over allowable in any of the above Per inspection 62.50 City /State/ZLP: p R� co - 2 . 71...) �,..' u investien per hour ( hr min) 62 -50 _ - Phan: l j1 t) 5 < - d 44 1 Fax: (510 9 71 25%7 Industrial plant per hour 73 -75 CCB Lic.: 101315 Electrical Li t2Z, �' ; Suprv" Lic.: 4-9q sub. 53, 5o S . Electrician signature, required: -// / &j� Plan review (25% of it fee uPr'' ! L lA ` J A , •I ii... Aim ( perm ) State surcharge (8% of permit fee) 4 c Print name: 04 R ` S A . SANDS ` > Date: t 0 ` a si ., 6 4_ TOTAL PERMIT FEE 57 ,1 13 Authorized signature: 7 //04 This permit application ewines ifa permit is not obtained widths ISO days after it has been accepted as complete Print name: Date: : Pee methodology act by Tr:- Co.a.ty Building Indosuy Service Board • CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: 03) 639 - 4171 MST BUP Received Date Requested 1/ — AM PM BUP Location ` ° D.- i b�'a-j L Suite MEC Contact Person Ph ( ) PLM Contractor Ph (_7/ ) 50‘ 30 SWR BUILDING Tenant _ ELC a d d Yf -00 4 9 7 Footing j D— ) - g / ,j ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear 0 - 1 1/144,1' ' Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler , Fire Alarm Susp'd Ceiling Roof / 6°.°°1.11Th rm . Other: Final PASS PART FAIL * / PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam R6ugTi -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service ce lab Low Voltage Fire Alarm PART FAIL LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ) ADA � 1�� (� Approach/Sidewalk Dat Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL