Permit fed 14rrrs ELECTRICAL PERMIT
41,F4: CITY OF TIGARD
° PERMIT #: ELC2008 -00018
COMMUNITY DEVELOPMENT DATE ISSUED: 1/9/2008
,TIGARD. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102AA -03903
SITE ADDRESS: 08861 SW COMMERCIAL ST ZONING: CBD
SUBDIVISION: MORINS ADDITION LOT : JURISDICTION: TIG
PROJECT: LUNDSTROM
Project Description: Demo.
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: SIGNAUPANEL:
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: 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:
RICHARD LUNDSTROM NELSON ELECTRIC LLC
PO BOX 230207 1745 4TH AVE
TIGARD, OR 97281 WEST LINN, OR 97068
Phone: 503 - 849 - 6325 Contact #: PRI 503 - 267 -8529
FAX 503 - 237 -6472
FEES
Description Date Amount Reg #: ELE C123
IEL,PRMTI ELC Permit 1/9/2008 $46.85 LIC 168080
ITAXI 12% State Surchar 1/9/2008 $5.62 SUP 3506S
Total $52.47 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.
Issued By: Permittee Signature: C-7-1 a p L (.71.■
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.
•
JAN -8 -2008 10:11P FRO1 s�IL`f` I;i , I - o � v v ' 1 ' 61.8 7a31 T0:18662376472 F'.1'2
Electrical Permit � 1)I qp Q (� , tnt'7s, 3 :xi 4.� x r - '.X9 '''''
# a! ���11 5€ r , hill Wloly U t'tw( '4 4 t
Tigard
)_\ M
i ° City of T 13125 9W Wall li . ,1`i n O 4 3 2 fi 1 11 i,- r'°• /A . I a �,�/� - <.` h% i J / / ,L
Phone: 503.639. 503. b lit �tl' � meat.. I ns nan Li 4 1T it f j �M� i� r - -.
I It, \till i R b / ± ��D J De • R e ady � y. � See Pogo 2for
s:K .Y''' Internet: ww Nbti " NottfredlMatt t MIN= Supplemental Information
'lryjm (i+'WOitXX PLAN REVIEW
0 New construction 1' _4 Addition/alterBtion/replacemcnt Mean chock ail that apply (submit 1 sets of plans w/ilems ohmked below)'
CIStcvtco feeder 400 amps or more ❑ Building aver t three glories
❑ Demolition ❑ Other:
wham the evadable Ault carom 0 Marinas and boatyards.
. • . r,' • 4 , GA•t'LCUI§Y .tor oafora oN exceeds 10,000 amps et 150 volts or 0 Floating buildings .
less to ground. or exceeds 14.000 D Commmci2l -use agricultural
0 I - and 2- family dwelling 0 Commercial /industrial 0 Accessory building amps futon other installations. building
0 Multi - family 0 Master builder 0 Other: 0 Piro pump. 0lastanatinn 073 KVA or
]f)t+lirrrE."!1V'1 T)RMAT.rON •Al4r). ,t.(,1'A,,T% . ' - ❑ Euuricewy system !urger separately dcrind system.
• _ -- ».a. ❑ AddiUrm of brew mow bad or [} "A" "B "1 - Z" "1.3»
I 00HP or more, oacupnnuy
Job no.: Job site address: 21861 SW Commercial St 0 Six or morn residential units 0 Recreational vehicle parks
City /State/ZIP: Tigard, Oregon 0 Hmlth -cars facilities. 0 Supply voltage for more than
QHnurdous localities . 600 volts nominal.
Suite/bldg. /apt no.: Project name: Richard Lundstrom I7 adviseerfacdar600 amps ormom.
i Q rton
Cross street/directions to job site: a cre rb FEE .aiCtlP,t 1:iG
1 per. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage. _
Subdivision: I Lot no.: 1,000 sq. IL or less 145,15 • 4
Ea. add") 500 sq. 11. or portion 33.40 l
Tax map /parcel no.: Limited energy, residential
,& - 74 ) 7 77 555;7 4 . 'QP 1N (with above sq. n.) 75. 00 2
-
Limited energy, multi - family
Demo Work residential (wgb above sq. a.) 75.00 2
Services or feeders inatallation, alteration, andJar relocation
■
2 _2 pus 00 am or leas 80.30 2
,a PRO . F , . :
.(I 1YZNANT. 201 amps to 400 amps 106.85 2
Name: Richard Lundstrom 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: (7• 0 • 1 26x 1101.0-7 7f /� �1 Ova 1,000 temps or volts 454.65 2
City/State/ZIP: /r1�/� v( ` b p' . -174 � I- Q•,t�O -1 Temporary services or feeders Installation, alteration, and/or
relocation
Phone: 4 4i (P" dm Pax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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 13335 2
Owner signature: _� Gjutc: Branch circuits- new, alteration, or extension, r panel
- -• --- A. Fee for branch circuits with
"' . ?1 Flint iyR'' I" 1 . CONY
ON t'4CT .PERSON above service or feeder fen, 6.69 2
each branch circuit
Business name: B. FCC for branch circuits
Contact name: without =Vice or feeder fee, I 46.85 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 7.
Miscellaneous (service or feeder not Included)
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling. service and/or feeder
Phone: ( ) r Fax:: ( ) Reconnect only 66.85 2
' E -mail: Pump or irrigation drubs 53.40 2
,:, , ..CG►t ekKarAR[ • z !"' Signor outline ilp,hting 53.40 2
Business name: Nelson Electric LLC. Signal circuit(s) or limited•
energy panel, alteration, or
Address: 1743 4 Ave. extension. Describe; Page 2 2
City /State/ZlP: West Linn, Oregon Each additional Inspection over allowable In any of the above
Per Inspection 62,50
Phone: (503) 267 - 8529 I Fax: (1466) 237 - 6472 investigation per hour (1 hr min) 62.50
CCB Lic.: 168080 Electri !c. Cl , 3 . Sup' c.: 3506 S tndustrinl Plant per hour 73.75
pp pJu!! I'!'1 ELECTRICAL PER PEES
Suprv. Electrician signature, mini • : . r _ . v�I:'' " "` Subtotal: 46.85
Print name: Michael Alford (1/4.11 f C,44 :r _ 4 " , Date: 01 OB - O8 - Plan review (25% of gambit fee):
. State surcharge (12;'3 of permit fee): 5.62
Authorized signature: TOTAL PERMIT FEE: 52.47
Ibis permit appllcadon expires If a permit Is not obtained wUt,le 180
Print name: I Dale: days after 11 has been accepted as complete.
• Number of Inspections allowed cayenne.
ilbuOAh PremetdELC-r rmitAppece 03/2 1.03 440-4&ISf(tir0SICOMlw1111
City of Tigard, Oregon e 13125 SW Hall Blvd. ® Tigard, OR 97223 , rt , r
. 14400 �._ d
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February 6, 2008
Nelson Electric
1745 4` Ave.
West Linn, OR 97068
Attn: Jocelyn Nelson
Re: Permit No. ELC2008 -00018
Dear Ms. Nelson:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 8861 SW Commercial St.
Project Name: Lundstrom
Job No.: N/A
Refund: n Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $52.47.
0 Trust account "deposit" receipt in the amount of $ .
Notes: Permit not required for 'demo' work. Refund 100% 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- CancelPermit.doc 01/16/07
Phone: 503.639.4171 e Fax: 503.684.7297 ® www.tigard- or.gov ® TTY Relay: 503.684.2772
r ' !p 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 PermitAction 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: Nelson Electric DATE: February 6, 2008
1745 4 Ave.
West Linn, OR 97068 REQUESTED BY: Dianna Howse
Attn: Jocelyn Nelson
TRANSACTION INFORMATION:
Receipt #: 2008 -80 Case #: ELC2008 -00018
Date: 1/9/08 Address /Parcel: 8861 SW Commercial St.
Pay Method: CreditCard Project Name: Lundstrom
EXPLANATION: Permit not required for 'demo' work. Refund 100% of permit fees.
REFUND INFORMATION
Fee Descipt�on From Receipt Revenue Account No Refund
Example _,[Bt.ILDJ,Pernitt Fee Example. x245 43'2000. $ Amount
[ELPRMT[ ELC Permit 220 - 0000 - 431510 $46.85
[TAX] 12% State Surcharge 100- 0000 - 207020 5.62
TOTAL REFUND: $52,47
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FO1R/TIDE MARK SYSTEM ADMINI TRATION USE ONLY T `
Case Refund Processed: Date: By: rr
l:\ Building \Refunds \RefundRequest.doc 05/23/07 •
: . :.. CITY OF TIGAR®
:,.
lir,* 1/29/2008
13125 s\N 1 -tan n1\d. 1 2:48:58PM
Tigard, OR 97223 5(13.(39.4171
;.T IGARD),
Receipt #: 27200800000000000080 Z. i = . ; TC :_.
Date: 01/09/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
ELC2008 -00018 [ELPRMT] ELC Permit 220- 0000 - 431510 46.85
ELC2008 -00018 [TAX] 1 2% State Surcharge 100- 0000 - 207020 5.62
Line Item Total: $52.47
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCatd NELSON ELECTRIC BB B87968 Fax 52.47
Payment Total: $52.47
,.. :,:cyx.io Page 1 of 1
t tw1X >X C ITY OF TIGARD 2/6/21)08
• -t
t ?, `'. 13125 SW Hall BI . 4: 1 1 .43PM
Tigard, OR 97223 503.639.4171
TIG'ARD
Refund Receipt #: 27200800000000000388 >/- /" - - /T' '. /L-
Date: 02/06/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
ELC2008 -00018 Reversal - [ELPRMT] ELC Permit 220-0000-4315 1 0 (46.85)
ELC2008 -00018 Reversal - [TAX] 12% State Sur 100- 0000 - 207020 (5.62)
Line Item Total: ($52.47)
Refund:
i'lethod Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal NELSON ELECTRIC B87968 Fax (52.47)
Refund Total: ($52.47)
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III Community Development
U
I ,l (, (r;; Request for Permit Action
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard OR 97223
Phone: 503.718.2430 Fax: 503.59$.1960 www.tigard- or.gov
FROM: Owner ❑ Applicant ❑ Contractor ❑ City Staff
(check onc)
REFUND OR Name: p�
INVOICE TO: (Rotiincss or Individual) (,. J])L? G // . P , fL/ ( "(6'c) K)
Mailing .T �� .� �b -,. f 1 r. 7
VIVID f
g Address; P" Pry �p
City/State/Zip: _ r� �° '. 41 . �� i�tiic
a
�' ` Phone No.: , 2-(e)-7 }d,
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 #: LL tm g'[ /
Site Address or Parcel #: _____2$1, ..." C p wit, t A
Project Name: L VL2 r,)
Subdivision Na.nie: Lot #:
f '
EXPLANATION: e ; ,ri, ,IJ 'o r 7Y' it Z) /6' rniii,C
'G ° . ��/n/z . /r--v % — G/ cwt,
frk1 g. . AID ®' e+/e ',) 6'ya / f=c2 CZ-e, � /2/<-
Signature: �'/rt' / • /' ' , 0 l;t /°E-7. qi ?')
Print Name: ` i 'r ' I /tile I 0/
Remxtrigux
1. The Director (n Building Official may authotiac the refund of
a) any fcc which was erroneously paid or collected.
b) not more than 80 "/a of the land uae application fcc whun an applicllinn is withdrawn or canceled befor any review eFfort has been expended
c) not mote than 80"la of the, land talc npplicaion to for issued permit .
d) net more than Rfl% of the building plan review fee when an application is canceled before any plan review efFort has been expur,dtd
a) not mote than Rflal attic building permit fee for issued psrmits prinr to any inspection requests.
2. Itcfundi .vi1l b returned ro the original Payer in the tune method in which payrnenc received Pieoc allow 1-2 weeks For processing refunds
Rte to • B Rte to Bld_ Adm ^ i f r
I . ii'; ,� OR 01 1 1 1 :',F CE ,l SErONI ti, _
n S • s Adman: Dane �'�%r� _ �� . ' tra : Dat �?,45fffil B _,
Refund Processed: Date ' B. ._ Invoice Processed. Date ' B.
Permit Canceled: Date _ /per M". • Parcel. 7"a: Added: Date B
Rccta.t # /'. V; �,� Method _ Amount $ --
7;\ t}, uld; ng\I'otma \Rr . c ter 07/26/07 — 74:4
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