Permit i : ; ELECTRICAL PERMIT
- CITY OF TIGARD
° PERMIT: ELC2008 00512
= COMMUNITY DEVELOPMENT DATE ISSUED: 9/4/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S104DD 02800
SITE ADDRESS: 12835 SW RIDGEFIELD LN ZONING: R -4.5
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 2 LOT : 025 JURISDICTION: TIG
PROJECT: PANAS
Project Description: Relocate (4) branch circuits in kitchen.
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: 3 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:
LEN PANAS BEAR ELECTRIC
12835 SW RIDGEFIELD LN P.O. BOX 389
TIGARD, OR 97224 DONALD, OR 97020
Phone: 503 - 209 - 9600 Contact #: PRI 503 - 678 - 1355
FAX 503 - 678 -1108
FEES
Description Date Amount Reg #: ELE 24 -107C
[ILPRMT] ELC Permit 9/4/2008 $66.80 LIC 20919
[TAX] 12% State 9/4/2008 $8.02 SUP 4881 S
Total $74.82 REQUIRED ITEMS AND REPORTS
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
suspend�6for mo : han 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Those r les are set for • in OAR • 52- 001 -0010 through OAR 952 -001 -0100. You may obtain copies • ese rules or direct questions to OUNC at
503.24 5.669 9 • r 1.800. d • 4. ' •
Issue By: �� l 0_� Permittee Signatu e: - e" _ �_.e. � . y �
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: - tk! / _ _■;. 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.
09/04/2008 THU 10:35 FAX 5036781108 Bear Electric, Inc. [2001 /002
4 Sv h 3
Electrical Permit Application
e 9 FOR
/ Q OFFICE USE ONLY
City of Tigard Date'B / ! �O Permit No.: e."(e. dt/g oc,57.2
I - 13125 SW Hall Blvd., Tigard, OR 97223 V Plan Review
Phone: 503.639 4171 Fax: 503.598 .1 YY'V eftir 1)atdBy: , Other Permit:
T IGARD Inspection Line: 503.639.4175 1e �D ReadyeBy: 1° /f H See Page i for
Internet: www.tigard or.gov 1 ed'Method / / /V� Supplemental Information
TYPE OF. WORK .1 • C - 3 \ ���� 5 � . .. PLAN , REVIEW.
❑ New construction �Addltion /alteration /replwtLi �G Please check all that apply (submit 2 sets of plans w. items checked below):
❑ Demolition ❑Other:
C O\ ❑ Service or feeder 400 amps or more ❑ Building over three stories
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTREI
exceeds 10.000 amps at 150 volts or ❑ Floating buildings
�� "' less to ground. or exceeds 14.000 ❑ Commercial -use agricultural
JU i- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder O Other: ❑ Firc pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
❑Addition of new motor load ofA', "E ". "1 -2'. "I.3 ",
Job no.: Job site address: 1 -11-3 S 51,..) R c A 1 k • 100(1P or more. occupancy
L ❑ Six or more residential units. O Recreational vehicle parks.
City /State /ZIP: (, r( k{l-& t D r) .').2‘ ❑ Health -care facilities ❑ Supply voltage for more than
J ❑ Hazardous locations. 600 volts nominal.
^ Suite/bldg. /apt. no.: Project name: LS ?
,WA,s ❑ Service or feeder 600 amps or more.
• .FEE, SCHEDULE
Cross street /directions to job site: Q FF Cr A/ ?s-, e 1 Description Qty. Fce. j -- Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add 500 sq. ft. or portion 33.40 I
Tax maplparcc l no.:
Limited energy, residential 7500 2
. 'DESCftIi (»4 OP WQRK (with above sq. ft.)
n ` 1 Limited energy, multi-family
--(2, 1 /��'
\"t '{-
o Ct,f re) `A 1 Z. ■ WYN ri ([•(,' S • residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER 0 TENANT . 201 amps to 400 amps 106.85 2
Name: kE &J 'A f J f 5 401 amps to 600 amps —` 160.60 2
601 ainps to 1,000 amps 240.60 1 2
' Address: Over 1,000 amps or volts 454.65 2
City / State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: (,a0) ?C)— q6,00 Fax: ( ) 200 amps or less 66.85 I
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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, i er panel
Owner signature: Date: A. Fee for branch circuits with
• [❑- APPLICAR'T .. f CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee, [�
Contact name: first branch circuit 46.85 •
"tD
Address:
Each add•I branch circuit 6.65 -t -
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only _ 66.85 2 _
E -mail: Pump or irrigation circle _ 53.40 2
• CONTRACTOR .. • Sign or outline lighting 53.40 2
^ \ Signal circuit(s) or limited
Business name: ^ „S�,_C p � ` \C " -____ energy panel, alteration, or
Address: R r x _ � extension. Describe: Page 2 2
City /S(aZIP: D 1
re1 q--(02c..) Each additional inspection over allowa in any of the above
�J Perinspcction 62.50
Phone. (50 ) Fax: ( )
3. t o ` � _ 5 . � t 7 � - i 1C�� InvCShgauon h o u r 62.50 - ^
CCB Lic.: 2_0 C IQ Electrical Lic.: ‘2L-t-10 Sup v. Lic: y i Industrial plant per hour 73.75 1
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 47/ /0 _ Subtotal: 31 �
Plan l �j�J ) /�� w'(25%ofpermit
Print __ �'� , . (�_!. lu.t�l D . c 6 „I V C' - .._ - .. Q • State surcharge (12 °/, of permit fee) nature: , • I
Authorized si } - 7'} ^
-o .. 'ce 4 tall, TOTAL PERMIT FEE: 1 ._._ 1.
This permit application expires if permit is not obtained oitliin 180
Prins came: ( Date:
^ I _ days her it has been accepted as complete.
' Num•er of ulSpccnouS allowed per peril
I bud.l,u l'; nnv.11. mn, \yp a o; ty: .n ui.aoiSit11 CON! \i FB
' City of Tigard, Oregon O 13125 SW Hall Blvd. 9 Tigard, OR 97223 , ;j..
Fl 4W;
�EG
September 17, 2008
Bear Electric, Inc.
P.O. Box 389
Donald, OR 97020
Attn: Stacey Wisdom
Re: Permit No. ELC2008 -00512
Dear Ms. Wisdom:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12835 SW Ridgefield Ln.
Project Name: Panas
Job No.: N/A
Refund: n Check # in the amount of $ .
® Credit card "return" receipt in the amount of $59.86.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
r
Dianna Howse
Building Division Services Coordinator
Enc.
I: \Building\ Refunds \Administ ration \LtrRefund- CanceII ermitdoc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Bear Electric, Inc. DATE: 9/16/08
P.O. Box 389
Donald, OR 97020 REQUESTED BY: Dianna Howse
Attn: Stacey Wisdom
TRANSACTION INFORMATION:
Receipt #: 2008 -3120 Case #: ELC2008 -00512
Date: 9/4/08 Address /Parcel: 12835 SW Ridgefield Ln.
Pay Method: CreditCard Project Name: Panas
EXPLANATION: Per applicant's request as job was cancelled. Refund 80 of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. • Refund
•
Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount
[ELPRIVTI] ELC Permit 220 - 0000 - 431510 $53.44
[TAX] 12% State Surcharge 100- 0000 - 207020 6.42
TOTAL REFUND: $59.86
APPROVALS:
If under $500 Professional Staff •'r
If under $7,500 Division Manager j
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: I %'.'r: ' B ,,,.`= -= `°`-
I:ABuilding \ Refunds \ RefundRequest.doc 05/23/07
_ ' -1 1C1TY OF 1 1GARD .,
-
ors 13125 S \V Hall 111“1. .. .. 1 'i ar(l. )12 97223 5113.(39.4171
e �
Refund Receipt #: 27200800000000003271 /```..(, L S; . �_
Date: 09/17/2008
Line Items:
Case No Tan Code Description Revenue Account No Amount Paid
ELC2008 - 00512 Reversal - [ELI'RMT] [LC Permit 220-0000-43 15 1 0 (53.44)
ELC200$-005 1 2 Reversal - [TAX] 1 State Sur I00- 0000 - 207020
Line Item Total: (S59.86)
Refund:
Method Paver User 11) Acct. /Check No. Approval No. I-low Received .- amount Paid
Credit Reversal BEAR ELECTRIC INC 00412Z Fax (59.86)
Refund Total: (S59.86)
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• CITY OF TIGARI) 9/4/2008
13125 SW Hall Blvd. 4:18:00PM
..n Tigard. OR 97223 503.639.4171
;TWA RP,
c>
Receipt #: 27200800000000003120 / / 4
Date: 09/04/2008
Line Items:
Case No Iran Code Description Revenue Account No Amount Paid
ELC2008-00512 [ELPRMT] ELC Permit 220-0000-431510 66 80
• ELC2008-00512 [TAX] 12% State SurcharQe 100-0000-207020 8.02
Line Item Total: $74.82
Payments:
Method Payer User 11) Accliateck No. Approval No. flow Received Amount Paid
CrcditCard BEAR ELECTRIC INC DEB 004122 Fax 74.82
Payment Total: S74.82
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09/09/2008 TUE 9:59 FAX 5036781108 Bear Electric. Inc. 0 001 /003
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'‘C4:,° �
E C.E N E 0
£_, Community Development ;h ;
Request for Permit Action S �_P
:.IC R OITV O� TI�AR�
TO: CITY OF TIGARD Bijfl.O NG OW SI ®N
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: ❑ Owner ® Applicant ® Contractor (J City Staff
(check one)
REFUND OR Name: Bear Electric, Inc.
INVOICF, TO: (Business or Individual)
Mailing Address: P.O. Box 389
,` ,'! `, , City /State /Zip: Donald, OR. 97020
0 7/6? X j Phone No.: (503) 678 -1355
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
® CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES (attach receipt, if available).
[) INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CON'T'RACTOR FROM PERMIT (do not cancel permit).
Permit # : ELC2008 - 00512
Site Address or Parcel # : 12835 SW Ridgefield Ln.
Project Name:
Subdivision Name: Lot # :
EXPLANATION: Not doing work.
Signature: ''!! . ..07, J t J pDate: 9/9/2008
taceyi&isdom
Print Name:
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds .
cu � . w.. "' USE= ONY . sx a t e. 7.., ,#.
. ,.,, �x�g'��,14i�:� � ... ...��.x��'� ;fie t,i�.�F.jlJl 1F .a +. L ' e'i .� r,e ..��'7E"� .� �.�.�:C,,.;9?'
Rte to S Admin: Date 9 9 0: E. T!3,, Rte to Bid: Admin: Date 9 /7 , j B 1,j�'�
Refund Processed: Date ' 7 0 f B i/� %, Invoice Processed: Date B
Permit Canceled: Date 9 / e f B .i'– �,- Parcel Ta: Added: Date B
Recei.t # / , Date ' Method Amount $
I:\ Building \Fomu \RegPennitAction.. oc Rev 07 /26/07
0,10643/07d
4
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 •
TIGARD
September 17, 2008
•
Bear Electric, Inc.
P.O. Box 389
Donald, OR 97020
Attn: Stacey Wisdom
Re: Permit No. ELC2008 -00512
Dear Ms. Wisdom:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
• Site Address: 12835 SW Ridgefield Ln.
Project Name: Panas
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $59.86.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
1: \ Building \ Refunds \ Administration \LtrRefund- CancelPennit.doe 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Bear Electric, Inc. DATE: 9/16/08
P.O. Box 389
Donald, OR 97020 REQUESTED BY: Dianna Howse
Attn: Stacey Wisdom
TRANSACTION INFORMATION:
Receipt #: 2008 -3120 Case #: ELC2008 -00512
Date: 9/4/08 Address /Parcel: 12835 SW Ridgefield Ln.
Pay Method: CreditCard Project Name: Panas
EXPLANATION: Per applicant's request as job was cancelled. Refund 80% of permit fees.
REFUND INFORMATION: ; `': . :a'• • `.Fee.Des'criptionrF Receipt'.
• -: Revenue Account
mpl
Exae: : = [BUIID]` Fee ,
Example:.. 24`5 - 0000432000;
[ELPRMT] ELC Permit 220 - 0000 - 431510 $53.44
[TAX] 12% State Surcharge 100- 0000 - 207020 6.42
TOTAL REFUND: $59.86
APPROVALS:
If under $500 Professional Staff i ? . ,'
If under $7,500 Division Manager s /� `' �`�� "'/
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE'ONLY '.:,::. •
V Case Refund Processed: I Date: I y'/ /G' 9' I By: I ; `"'` ` -
1: \Building \Refunds \RefundRequest.doc 05/23/07
74 Pfi CITY OF TIGARD 9/17/2008 .
13125 SW flail Blvd. 1 1.39:
_ + . . :. A Tigard. OR 97723 503.639.4171
TIGARI
Refund Receipt #: 27200800000000003271 /&' : ‘.___
Date: 09/17/2008
Line Items:
Case No Trail Code Description Revenue .account No Amount Paid
ELC2008 -00512 Reversal - [ELPRMT] ELC Permit 220-0000-431510 (53.44)
ELC2008- 00512 Reversal - [TAX] 12`%, State Sur 100- 0000 - 207020 (6.42)
• Line Item Total: ($59.86)
Refund:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal BEAR ELECTRIC INC 00412Z Fax (59 86)
•
Refund Total: ($19.86)
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• rr CITY OF TIGA.RD 9/4/2008
13125 SW Hall Blvd. 4: 18:00PM
Tigard, OR 97223 503.6.39.4171
o TIGARD
0
Receipt #: 27200800000000003120 ei /2/E- /N -- c--
Date: 09/04/2008
Line Items:
Case No Tram Code Description Revenue Account No Amount Paid
ELC2008 -00512 [ELPRMT] ELC Permit 220- 0000 - 431510 66.80
ELC2008 -00512 [TAX] 12% State Surcharge 100- 0000 - 207020 8.02
•
Line Item Total: $74.82
Payments:
Method Payer User II) Acct. /Check No. Approval No. I•low Received Amount Paid
• CreditCard BEAR ELECTRIC INC DEB 004122 Fax 74.82
Payment Total: $74.82
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09/09/2008 TUE 9:59 FAX 5036781108 Bear Electric.Inc. Z001/003
•
REGEED
• • Community Development
Request for Permit Action
SE.
TI.GARD
CITY OF TlIVlSION
TO: CITY OF TIGARD BUILDING
Building Division Services Coordinator
• 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
. FROM: ❑ Owner ® Applicant ® Contractor ❑ City Staff
(check one)
REFUND OR Name: Bear Electric, Inc.
INVOICE TO: (Buses or Individual)
Mailing Address: P.O. Box 389
VOID City/State /Zip: Donald, OR 97020
9� 77d 3 Phone No.: (503) 678 -1355
• PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit # : ELC2008 -00512
Site Address or Parcel # : 12835 SW Ridgefield Ln.
Project Name:
Subdivision Name: Lot #:
EXPLANATION: Not doing work
•
•
Signature: !t ; 74; , � � Date: 9/9/2008
tacellsdom
Print Name:
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneouslypaid or collected
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date 9 9 D • 7O Rte to Bldg Admin: Date //7/t e By .
Refund Processed: Date 7' D By <get Invoice Processed: Date By
Permit Canceled: Date 9 , e f By , L . Parcel Tag Added: Date By
Receipt # 0 — 3,[20 Date 7fiO Method G Amount $
I:\ Building\ Fomu\RegPennitAaion.d Rev 07/26/07
3 �a�