Permit City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
PA
October 29, 2010
Timberline Electrical Contractors
PO Box 918
Lake Oswego, OR 97034
Re: Permit No. ELC2009 -00584
Dear Paul Hutson:
•
The City of Tigard has canceled the above referenced permits) and enclose a refund for the
following:
Site Address: 13085 SW 76 Ave.
Project Name: Fields
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $60.78.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as electrical inspector instructed applicant to continue using
temporary service under ELC2009- 00283. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
1: \Building\ Refunds \ Administration \ LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
CITY OF TIGARD RECEIPT
q
t3 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
/ h•[ iUA
Receipt Number: 180183 - 10/29/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2009 -00584 $ -60.78
Total: $ -60.78
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 035847 DHOWSE 10/29/2010 $ -60.78
Payor: Timberline Electrical Contractors
Total Payments: $ -60.78
Balance Due: $60.78
•
Page 1 of 1
• CITY OF TIGARD RECEIPT
C 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 175862 - 10/30/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2009 -00584 Reconnect Only 2200000 -43103 $67.84
ELC2009 -00584 12% State Surcharge - Electrical 1003100 -24001 $8.14
Total: $75.98
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 035847 STREAT 10/30/2009 $75.98
Payor: Timberline Electrical Contractors
Total Payments: $75.98
Balance Due: $0.00
Page 1 of 1
04/29/2010 22:41 FAX Cj001/001
- C aO 5d
•
Timberline Electrical Contractors, Inc.
P.O Box 918 CCB # 160037
Lake Oswego, OR 97034
Ph. 503-459-4089 Fax 503 - 254- 4227
pQR 3 0 2p \0
c OVIICirs0
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Fax ,N,01
7b: City of Tigard, Electrical permits Franc Paul Hutson
Fait 503 - 598 -1960 Pages: 1
Phone: Data 4/30/2010
Re: Electrical Permit # ELC2009-0058q
x Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
Good morning, -
I need your help please. Electrical Permit #E1Q009 -00584 was issued to us us 10/30/2009
The intent was to re connect the existing
/so cee alt e the trod se had bed flooded and the owner was
about to begin repairs. It was decided by Gary Nobel that the endsting service would have to be
replaced. At that time there was a temporary service on site. Mr. Nobel's advice was to continue using
the temporary service Having said that, no further work was performed on that electrical permit We
need to cancel or void electrical permit #ELC2009- 0058N
Thank you
Paul Hutson
Estimator / Project Manger
l.0 o2 Qoa?3 7 p s6
0 q. - Del a a
•
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City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
X 1111
7
October 29, 2010 I . 1
Timberline Electrical Contractors
PO Box 918
Lake Oswego, OR 97034
Re: Permit No. ELC2009 -00584
Dear Paul Hutson:
•
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 13085 SW 76t Ave.
Project Name: Fields
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $60.78.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as electrical inspector instructed applicant to continue using
temporary service under ELC2009- 00283. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
I: \Building\ Refunds \Administrat ion\ LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard - or.gov • TTY Relay: 503.684.2772
Er!
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building application
fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached
to this request. Refund requests are due to Accela System Administrator by Wednesday at
5:00 PM for processing by the following Wednesday. Accounts Payable will route refund
checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing.
PAYABLE TO: Timberline Electrical Contractors DATE: 10/22/2010
PO Box 918
Lake Oswego, OR 97034 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 175862 Case #: ELC2009 -00584
Date: 10/30/2009 Address /Parcel: 13085 SW 76th Ave.
Pay Method: CreditCard Project Name: Fields
EXPLANATION: Per applicant's request and as instructed by Gary Noble, electrical inspector, to continue
using temporary service under ELC2009- 00283. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Electrical Permit Fee 2200000 -43103 $54.27
12% State Surcharge 1003100 -24001 6.51
TOTAL REFUND: $60.78
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager _
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: 1 Date: 1 /9A9//0 By: 1 4
1:\ Building \ Refunds \ RefundReguest.doc x 09/01/2010
CITY OF TIGARD
U ELECTRICAL PERMIT
ifrt . ` COMMUNITY DEVELOPMENT Permit #: ELC2009 -00584
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/30/2009
Tlt'i'i°1RD; Parcel: 2S101 DB00400
Jurisdiction: Tigard
Site address: 13085 SW 76TH AVE
Subdivision: Lot: 0
Project: Fields
Project Description: Safe off circuits in panel and restore power to house
Owner: FEES
FIELDS, FRED W Quantity Description Date Amount
1149 SW DAVENPORT
PORTLAND, OR 97201 1 ea Reconnect Only 10/30/2009 $67.84
1 ea 12% State Surcharge - 10/30/2009 $8.14
PHONE: Electrical
Contractor:
TIMBERLINE ELECTRICAL CONTRACTORS
PO BOX 918
LAKE OSWEGO, OR 97034
PHONE: 503- 459 -4089
FAX: 503 - 254 -4227
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
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 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: )4 11 - 1)4P-1 1 / al Permittee Signature: — JO LL e a _I V�
I 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' 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.
,-`
C Electrical Permit Aaulicatio 1..O1 oute 1,SF: O\I..1
City of Tigard x «ei`zd Permit No t,L yt) d ei ,._ OV S8
n n n D By
• 13125 SW Hall Blvd., Tigard, OR 97223 0 L zr , % ' u J Plvr Rn7e«-
0 Phone: 503.639.4171 Fax: 503.598.1960 Dare/Br ther
Inspection Line: 503.639.4175 Y , r " Data Ready BY hru r 0 See P 2 for
!1C::1k11 I "IT (,r ` ;(','r;fe - ''f( (. Supplemental Internet www.tigard-or.gov Noufied/Me1hod: lememlal rnformatfon
` . 9 :,,'� DIVIciON
TLriE OF WORK -. ' . PLANT REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories,
❑ Demolition ❑ Other where the available fault current 0 Marinas and boatyards.
' • C'ATILGORY OF C:ONSTRT'CT1ON • exceeds 10,000 amps at 150 volts OT ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB til'1'L INFORMATION t1ND LOCATION
ID Emergency system. larger separately' denved system
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3",
Job no.: I Job site address 13085 SW 76th 100HP or yes occupancy.
❑ Six or mare a residential ®its. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, Or. ❑ lucre facilities ❑ Supply voltage for mare than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: I Project name: Fred Fields ❑ Service or feeder 600 amps or more.
Cross street/directions to job site:
FEE `?
J Des !too 1 Qtr. 1 Fee. 1 Taal 1
New residential single- or multi - family dwelling unit.
ladudes nasalised garage.
Subdivision: 1 I no_: 1,000 sq. 11. or less 168.54 4
Ea add'I 500 sq. 11. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential 67.84 2
- DESCCRIPTION OF WORii . (with above sq. ft.)
Safe off circuits in panel and restor power to house Limited energy, °1Lh 67.84 2
� P residential (nth above sq 8) _
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
PROPERTY: OWNER I ' '0 'TENANT " • 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
-- — 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 an pe or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I owls which is not 201 amps to 400 amps 125.08 1 2
intended for sale- lease_ rent or exchange_ according to ORS 417.419.670_ and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new. alteration, or extension, r panel
Owner signature: Date: _A_ Fez for branch circuits with
,. :❑.APPLICEI:IVT ❑ (10N'1'.ACT.PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee 56.18 2
first branch circuit
Address: Each add'1 branch circuit 7.42 2
hitscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 67.84 2
dwelling service and/or feeder
Phone: ( ) I Fax:: ( ) Reconnect only 1 67.84 67.84 2
E - mail: Pump or irrigation circle 67.84 2 • ' . . CUNTRAC'fOR Sign or outline lighting 67.84 2
Business name: Timberline Electrical Contractor Inc Signal caroait(s) or Limited
energy panel, alteration, or
Address: PO Box 918 extension Describe: Page 2 2
City/State/ZIP: Lake Oswego Ore, 97034 Each additional inspection over allowable in any of the above
Phone: (503) 459 - 4089 I Fax: (503125 227 Per inspection 66,25
k i V ' Investigation per hour (1 hr min) 66.25
CCB Lic.: 160037 I Electri - e.• 2 - 1 • uprv. Lic.: 4957,5 � Indu al plant per hour 78.18 • .' , ET.N(TR1('.T PERMIT FEES
Suprv. Electrician signature, required: u i Subtotal: 67.84
Print name: p• r . , 4j I 0/13/51q
Date: Plan review (25% of permit fee):
r t State surcharge (12% of permit fee): 8.14
Authorized signature TOTAL PERMIT FEE: 75.98
' n - �.[ 1.6 'efts p app s expires if a permit ls mil obtained widths 160
Print Dame: c Date: { 0 36 � . stays after tt has been accepted as complete.
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