Permit Support Document 114 CITY OF TIGARD ,et7 ,,� �d ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT
Permit#: ELC2021-00191
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/1 312 02 1
TIGARD 9 Parcel: 1 S134DA07500
Jurisdiction: Tigard
Site address: 11230 SW BUFFALO PL
Project: Pure Environmental-11230 Buffalo Subdivision: DAKOTA MEADOWS Lot: 8
Project Description: Complete Rewire,Burn Job,2179. 8/27/2021: REPRINT permit to change scope of work to(14)branch circuits
without service.
Contractor: NICE ELECTRIC CO Owner: BUTORI, EUGENE R TRUST&
PO BOX 636 BUTORI, VIRGINIA A CREDIT SHELTER
MCMINNVILLE, OR 97128 TRUST
BY BUTORI, EUGENE F TR
7645 SW CEDAR
PORTLAND, OR 97225
PHONE: 503-434-5802 PHONE:
FAX: 503-472-1628
FEES
Quantity Description Date Amount
14 crt Branch Circuits wo/Purchase 04/13/2021 $152.64
Specifics:
Service or Feeder
1 ea 12%State Surcharge- 04/13/2021 $18.32
Type of Use: SF Electrical
Class of Work: NEW 25 Cash Over 04/13/2021 $24.93
Type of Const:
Occupancy Grp:
Total $195.89
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 throuoh ARr952/11-0090. You may obtain a copy of the rules or direct auestions to OUNC by callina 503.232.1987 or 1.800.332.2344.
Issued By: . �` %'� �/ R Qom. Permittee Signature: !1/✓ / J�G d C
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 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.
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
.111111 Request for Permit Action
r !,. 1 F:1 t 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439•www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd,Tigard,OR 97223
Phone: 503-718-2439 Fate 503-598-1960 TigardBuildingPe:mite®tigttd-or.gov
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
Chn k M one
REFUND OR Name:
INVOICE TO: Ci°a11e"°"nd * Nice Electric Co
Mailing Address: PO Box 636
City/State/Zap: McMinnville OR 97128-0636
Phone No.: 503.434.5802 /4f7! /J/�.Q,— s CQ /-1-1t
i7s
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED(i):
$ — • -•. OlD PERMIT APPLICATION.
4-12 REFUND • ' ' FEES(attach copy of original receipt and provide explanation below).
"'='OR.FEES DUE(attach case fee schedule and provide explanation below).
Permit#: ELC2021-00191
Site Address or Parcel#: 11230 SW Buffalo PI
Project Name: Pure Environmental
Subdivision Name Dakota Meadows Lot#: 8
EXPLANATION:
This is a burn Lob. However,Laid not know that the first floor was not damaged,so the
service was not affected. Pleas• DELETE the Service,but add FOUR(4) more Circuits
for the upstairs remodel.T h I ices us a total of FOURTEEN (l41 Circuits&No Service.
Signature: I 11) Date: 5/3/2021
Print Name: Lnnifer J S ks,Office Manager
Arlaciardirx
1. The dty's Community Development Director,Budding Ofhanl or City Engineer may anthotize the refund of
• Any Fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2 All refunds will be returned to the original payer in the form of a check via US postal service
3. Please allow 3-4 weeks for processing r f nd repeats.
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Route to.Sys Admen: bare By Route to Records: Date
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LRefund Processed: Date By d f] Invoice Processed: Date By
P P/ S/emit Canceled: Date !✓ By�/f) Parcel Tag Added: Date By
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