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Permit I h i t CITY OF TIGARD ELECTRICAL PERMIT I M PERMIT #: ELC2007 -00796 . COMMUNITY DEVELOPMENT DATE ISSUED: 11/27/2007 inuARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 110BA -10000 SITE ADDRESS: 11879 SW TREEHILL CT ZONING: R -4.5 SUBDIVISION: REDWOOD VISTA LOT : 013 JURISDICTION: TIG PROJECT: KIRBY Project Description: (3) branch circuits. Garage lites, plug and heater. 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: DOUG KIRBY HEBERLE ELECTRIC 11879 SW TREEHILL CT. 18645 SW FARMINGTON #326 TIGARD, OR 97224 ALOHA, OR 97007 Phone: 503 - 603 -0597 Contact #: PRI 503 - 628 -2095 FAX 503 - 628 -3076 FEES Description Date Amount Reg #: ELI; 34 -160C [ELPRMTJ ELC Permit 1 1/27/200' $60.15 LIC 152342 I 'rAXJ 8 %State Surcharge 1 1/27/200' $4.81 SUP 3053S Total $64.96 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 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 1.800.332.2344. _ 1(22:21._40,10 / 4 .... e.,igi_ Issued By: , _ L �, � _.. � Permittee 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: 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. 11/27/2007 10:20 5036283076 HEBERLE ELECTRIC INC PAGE 01 Electrical Permit Application I. i l t (i 1 f l ( 1• l y l,: () N i ,, �s Recetvcd • City of Ti E C : \I Batem , l i 17 0 J ; Permit No. , E 13125 SW Hall Blvd., Tigard. OR 972 Plan Review Phone: 503,639 A171 Fax: 503.598.1960 I ' ► �, '' : 1 b ateB . Other Permit; inspection Line: 503.639.4175 AN 2 1 Date Ready/By: 1ndu: 1Z1 8114 Page 2 for w. Internet: wwci.tiigard,or_u , * U Notifireimethnit Supplemental Intbrmattan '?i'.:.:11,1101 .)f r,t,1' . ! ��': 4` !!Q:? "'"" . -1 "il..gtt'rP n ",,1 -V t / '.! PI, �t +p r7^ , ` ua rtlilry�yrr� I j} tl t ,i :`e<; r l.. rlT i,F �a� el��l u,t.. � ,. R �„+ ,,.� 'a., ?.. i � .::��" i���Yr s. �.. L nZ�hi�p :��n��bllYt��Riih's���'�i� 0 New construction F! t l Mh�!►1 " replacement Please check all that apply: ID Donation 0 Other; ❑Service over 225 amps, comm'1 ❑Hazardous location ray w '+ 1 E ' 'S " {�' ti "c ,; t^ ,1, , , I/ r, 1�, ❑ Buildng over 10,000 sq. ft., a/ rl Phi .iks: , ul. �i Ii t 1' x a n h rl .ITQ a •+r + `. 10 �1 ' ; ❑ Service over 320 amps - rating of 1- and 2- family dwellings 4 or more new residential I- and 2- family dwelling © Commercial/industrial 0 Accessory building ❑ System over 600 volts nominal units in one structure hting an RV par Multi farm) M aster b ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or morn 0 Oocu t load over persona ❑Manufactured structures or e F v C' G YFY .. .. n, n: i' � • � h i }y� ' r , y tyy�� pan o 99 t rpl 4 U \, 0 1 I n S i lc t tb9' y f J r. 1' ©P. css/li k .,'.; r�'.; P•� r'k h� i�?�b� e,�i'�a ,.,, :uv .<Jv.... � ;� !� 8 NA. � Job no.: ,lob site address: { t 7 7 si c --1 b(-"� C C °Het th -care facility ❑Other: Submit,, seta of plans with any of the above. City/Statc2IP: - 0 E , �'_ -7 - The above are not applicable to temporary wnatructlfn service Suitc/bldg. /apt. no.: Project name: Kry 7Y',' Sai, i0 Itii.; �: 'I `' r t. v'7 , l : ::ri7d 1'tY ,;f(( / } , i ! bwcripMnn IVY Inlet •" W Cross street/directions to job site: l'-. 10,1 4 New resaldcutlal single- or multi- family dwelling unit. Includes attached garage. 1,000 sq. ft. or Ices 145.15 ` 4 Subdivision: Lot no.: Ea. add'" 500 sq. ft. or portion 33.40 I Tax map/parcel n0 Limited energy, residential 75.00 2 r r r . , L a lY w Y Rr , y � M tl +n' •�W I . Ii r: •'i fir S �, r ( N � •n t ' Limited energy, non - residential 75.00 2 f 1 ..r �l. A . •1, fa r F, ' I/ a 'f 9, rfl ''o lift. , - ... , , N°l 6,1 .1, ., *R. n 1 �. � . bi t ' .� _1! . I ... , L Each nlanufacArrcd or modular ( _/ I ( ���Z -i.� � , l _ ( t / dwelling, service and/or feeder 90.90 2 a- Services or !seders Installation, alteration, and/or relocation C r 200 amps nr less 8030 _ Eli t r r 4'+.trl,n ?M1U> le,' •?r 4 a'' '<a 201 amps1o400 106,85 2 l d ` , r H . i rr x 4L I i T p 3 1. I , ' lG.. ¢r �< � ,7. ..�� .r r.,, .,'9- dE .,,. „k r ,.�, . r „�p > v_y ,l,.bl t13� }r l l',, r,.4,, ,... ai..:.i , u: Name ' , / f4 p (2 t� 1, 401 amps to 0 a 160.60 2 t 4 't g� 601 amps to 1,000 0 amps 240.60 2 Address: Over 1.000 amps or volts 454.65 . 2 Reconnect only 66.135 2 City /State/ZiP: Temporary services or feeders installation, alteration, and /or Phone: (ab'S) l,03 --c (3-7 Fax: ( ) relocation 200 amps or leas 66115 1 Owner installation: This installation is being made on property Mai 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 ..r(1 Branch circuits - new, alteration. or extension, peranel '1 u,: :' ilrr,I 01 1'� Lip ”. i�iir1P Q ' . i i.' t .1 I' , . 0ii ,, 4 t 8 , �r 17: i$ . µ ;6 ' t.. A. Pee for branch circuit, with ,,,, r ; ''a?A ' MiriNtta f ..Y . \ g ,,,• i v . .. A - th.,:a, r r... i . Adbli'iinn service or feeder foe, each Business name: 6 2 � aytQl P n .� broach circuit r 4 13. Fee for branch circuits Contact name: . 4 . � , 1 ' ' •V ., .,_iv thou _service or feeder ice, pp Address: each branch circuit 46.SS - • p 2 Each add'" branch circuit _ -.Z.,..- 6,65 IS r Z7 2 City /Statc/ZIP: Miscellaneous (service or feeder not Included) Phone: ( ) Fax: , ( ) Pump or irrigation circle 53.40 2 — -- ,..,._. Sign or outline lighting 53.40 2 Email y.Tc g lut i1 ',`�Qi{+ r�W t� =t'' Ctl , �JGt`,: ' i , r Signal Cirelllt(9) or limited- ,:i r � a r� t ;y .' d 1 ,, {'q . ' " - r, 4 ? } 4 ' ! �7 • , Zt it y!I ,,,, 1 enQgy panel, alteratmn, or ~ extension.I)escribc: Page 2 2 Business name: �� Heberle Electric, Inc. Address: 12 e+ , C Cash additional %speedon over allowable in any of the above � e s •' -- t"-:. e Per inspection T 62.50 city /stete/Z1P: _ l s' Oro R 9712 p ( 1 Q Investigation per hoar 1 hr min ) 62.50 , Phone: ( f ) • ) ( Z ' - ?„0 q„/ Fax: ( 1 ) ( g. -3c,--7 / _ Industrial plant per hour 73.75 CCB Lie.: lSZ3 Electrical Lic. :3I4 --ILO C.. Suprv. Lie.:; � °r.,. ,'.,: 1 (% 1 i1 h 1 � '� u �5� o- k.re`t? ..,'rr7 S subteen" ., try - Suprv. Electr ian signature, required: w '"° ' 4 Plan review (25% ofpormit Ise) ,> Print name / r r, Date: I (, � 0•--7 State surcharge (8% of permit fee) Le I, TOTAL PERMIT mil / , q piUlilOrl7Ed signature: IIIMIPP this pormtt application ealri if a permit la not nommen within 150 — dlp'R after it Ace been accepted air complete Print name: DSIte: • l'ee methodology Not by Tri my Building tuduahy � jar�i w care tmh •• Numhor of Inspections per it allowed, � J L t Q� i:\ Puildin gTealpt.C- ParmI4Ann.dee 12)03 4An.nR15T(10,07/COM/W �Q t -P S I – City of Tigard, Oregon 13125 SW Hall Blvd. O Tigard, OR 97223 3 §f' Y l�, � c r fi r L ;i . J'C Sit 4f A I,1 ® A ° D y April 14, 2008 4 46. Heberle Electric, Inc. 29012 SW Egger Rd. Hillsboro, OR 97123 Attn: Jeffrey Heberle Re: Permit No. ELC2007-00796 Dear Mr. Heberle: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 11879 SW Treehill Ct. Project Name: Kirby Job No.: N/A Refund: ❑ Check # in the am ount of $ . ® Credit card "return" receipt in the amount of $51.97. n 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. I. \Building\ Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07 Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772 If 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: Heberle Electric, Inc. DATE: 4/14/08 29012 SW Egger Rd. Hillsboro, OR 97123 REQUESTED BY: Dianna Howse Attn: Jeffrey Heberle TRANSACTION INFORMATION: Receipt #: 2007 -5212 Case #: ELC2007 -00796 Date: 11/27/07 Address /Parcel: 11879 SW Treehill Ct. Pay Method: CreditCard Project Name: Kirby 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 [ELPRMT] ELC Permit 220- 0000 - 431510 $48.12 [TAX] 8% State Surcharge 100 - 0000 - 207020 3.85 TOTAL REFUND: $51.97 APPROVALS: If under $500 Professional Staff r ex If under $7,500 Division Manager C 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: ��`'P /1''c By: ,. 57/ l:A Building \ Refunds \RefundRequest.doc 05/23/07 P:' g - CITY OF TIGAR® �/ 14/200S �' I li ' 11 - ..i 13125 SW Hall Rh (1. 1 2.22.041 M ^ '"' Tioard, Olt 97223 303.639.4171 gt, Refund Receipt #: 27200800000000001217 f r" ' -/ S<* --- Date: 04/14/2008 Line Items: Case No Tran Code Description Revenue Account No Amount Paid ELC2007 -00796 Reversal - [ELPRMT] ELC Permit 7 0000 - 431510 (48.12) ELC2007 -00796 Reversal - [TAX] 8% State Surc 100- 0000 - 207020 (3.85) Line Item Total: ($51.97) Refund: Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid Credit Reversal I IEBERLE ELECTRIC, INC. 099897 Fax (51.97) Refund Total: ($51.97) N N. ry i i ' a) O° L w o a f i O U y 4-1 �� U fi 1 F. ct )+ V 41 ,f m 4-1 1:_ Q H w x PI ;mod , iiz��i1111 IV P PLC 1 011 ; s ii � ; °- CITY OF TIGARD 4/14/2008 . ■ 5 p; 13125 s pan t ;I, d. 12:22:44PM v I ard, 97223 503.639.4171 TI� Receipt #: 27200700000000005212 6/S /6 / A.', c _ -.- Date: 11/27/2007 Line Items: Case No "Iran Code Description Revenue Account No Amount Paid ELC2007 -00796 [ELPRMT] ELC Permit 220- 0000 - 431510 60.15 ELC2007 -00796 [TAX] 84 State Surcharge 100- 0000 - 207020 4.81 Line Item "Dotal: $64.96 Payments: 1ethod Payer User II) Acct. /Check No. Approval No. 1 Received Amount Paid CreditCard I- IEBERLE ELECTRIC BB 099897 Fax 64.96 Payment 'Total: S64.96 • ,Reeeipu.rpu Pace 1 or I 03/20/2008 09:19 5036283076 HEBERLE ELECTRIC INC PAGE 01 r .: � c ::,,, ,!. ,:',,,, Community Development Request for ez lit Action r IV l :. . F I ..• ,, TO: CITY OF TIGARD M AR 2 02 '. , Building Division Services Coordinator 13125 SW Nall Blvd., Tigard, OR 97223 CITY OF TIGAt+' Thone 503.718.2430 Fax: 503.598.1960 wwar_oigatd- or.gov BI,JILDING DIVISICII FROM: ❑ Owner ❑ Applicant .Contractor ❑ City Staff (cheek one) REFUND OR Narnc: INVOICE TO: (Bueineetorriidirddi,al) Heberle Electric, Inc. Mailing A.dd:tess: Heberle \ �I • �� , City /smote /zip: Hillsboro, OR 97123 y//Voi" At e....4 Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (d): tr4 . CANCEL PERMIT APPZ•JCATION. 61 REFUND PERMIT FEES (attach receipt, if available). O INVOICE FOR FEES DUE (attach case he schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do .not cancel, permit). Petx,it #: _ — Z---C__ 72 007- Site Address or Parcel #: 1( Y 7 'L2 ` - i+ i u c qi zf Project Name: ( -j Subdivision Name: Lot #: EXPLANATION: M _�n'` O h� C --- 'o -` — " > dir L Signature: �' 'S —: —t5 Ali ..A►1 = lute: Prier. None: Al ' . ." — Babesir-allCt 1. Tea Director or - ' . ing Official may authorize 0+ tth,nd of a) nap fcc whit wan erroncou_gly paid or colloe • b) not more th tin% of the had use aaspiicati. fcc when an applicator al withdranm or rancdcd bcfbre any review effort hne born expended, c) =mow th• RO%/n of the bald use application fcc for imam, pamtit& (1) not nkon thin : i, of the buildingpinn • , fee when an application is canceled before any plan review cfrort hex been expended. c) not mom than A +b of the 1u>ildlnR remit • • frrr iccucd perrnItx prior to any inspection eeyucsci 2 , ReMrnde Wilt be r+etu n c 2 j j n oo tilpnal Pay r . • same method in which payment was received Plarote itdow 1 - weeks for procearine refund:_ tom' t ` . ' Z ' . ',': " er 1P ii ) r TZ l' j l j R c- ll.a!_ ,.y�l l )r ,�r "'�F�i6d r ice 4ii agli , an Rte to 5 is Actinic: Date 1 !'0. Il Rtc to B1d_ Admin• Date Refund Plnoceaaed, Date i ' B . , 'r� Invoke Ptoccsscd: Date B Permit Canceled: Dare / /jf !r a Parcel T : Added: Date Rccc.' . #6 - _ Date / .7 Method 'C... Ammar $ 1: Milken* \Firms \R •c f17 /2b /d7 \/ w y l a -:� � ��ri^�a. -+ ,. �y II " 1'i'.'F ier+1,N?�" r<. :.tea n va, � � "��' � � �..,... a p.,.. Ni.. 'y��� .^� ai �cb.?'+'r=.a.+- '.Vn 'Wa}rlyr► ' � NJ ^ tea C1TY OF TIGARD 117271.X)07 i m ? , ¢ .. Juts sa. Hsti lore. 3 :58 PM rcp rd. OR 47263 503Ail9Afl l 1.49 ..q, .1 ; % Ft I' CD Q a. Receipt #: 27200700OQ001/0005212 1C2-2 Date: 11f2712007 Lime ltewi - Case to Tram Code Deacriptioot Reroute Amour No Amami Paid ELC2007 -00796 (ELPRAIT] EEC Perim 220-0000-431510 6 0.1 5 ELC2007 -00796 [TAX] 8°.4.State Surcharge 100-0000-207020 4-81 " '� H a Give item Total: 564.96 H Payments: CE I ~ U Method Payer User 1D AcctiCheek Se. Aparatial No. Elam Received A frtorm Paid J itl w CacciitCarrl Elf BERLE ELECTRIC BB 099897 Fax r,;l gf, w ..� w Pay man' Total: x_96 Ao w a Cik)e‘Ce � Vy V < (3—keg S -Art-i--GN) _ P.- CI C r C (-- Lo cn c--.) e S ..... r` N co G3 to CO m CO W f m � J Lc) f � / ‘10 N CO Hebei° cn ea 012 SW E er i CD Cr; co m Hillsboro, d X7123 tl�erie Int. 03 ao m N ( C I' to( - z 3s.' c_sel- ( N 01 m m N m diKaira11NW t P 1 of