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Permit
City of Tigard, Oregon 0 13125 SW Hall Blvd. 0 Tigard, OR 97223 uftF t` V r - z k LI e a L :, �M! AIf � X Y 9 i :a SO . A ., t"'d{ • 1 • ". 1~. F December 11, 2009..v. Bear EIectric P.O. Box 389 Donald, OR 97020 Attn: Stacey Wisdom Re: Permit No. ELC2009 -00585 Dear Ms. Wisdom: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 13609 SW Essex Dr. Project Name: Dolan Job No.: N/A Refund: ❑ Check # in the amount of $ . ® Credit card "return" receipt in the amount of $56.98. ❑ Trust account "deposit" receipt in the amount of $ . Notes: Used minor label. 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- CancelPemut.doc 01/16/07 Phone: 503.639.4171 o Fax: 503.684.7297 e www.tigard- or.gov o TTY Relay: 503.684.2772 J City of Tigard TIGARD Accela 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 Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Bear Electric DATE: 12/10/09 P.O. Box 389 Donald, OR 97020 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 175864 Case #: ELC2009 -00585 Date: 10/30/09 Address /Parcel: 13609 SW Essex Dr. Pay Method: CreditCard Project Name: Dolan EXPLANATION: Used minor label. Refund 80% of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: (BUILD] Permit Fee Example: 245- 0000 - 432000 r $ Amount Electrical Permit Fee 2200000 -43103 $50.88 12% State Surcharge 1003100 -24001 6.10 TOTAL REFUND: $56.98 APPROVALS: If under $500a Professional Staff l0 11 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 FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Refund Request Reviewed: Date: r • " : By: , Case Refund Processed: Date: - ` . By: ` <; 1: \Building \Refunds \RefundRequest.doc 04/13/09 • N07 03 - 2009(TUE) 15:27 Bear Electric (FRX)5036781108 P. 001 /001 ., -t ° Community Development RECEIVED ;T:Gi�R Re for Permit Action NOV 0 3 2009 TO: OITY OF TIGARD OF TIGARD Building Division Services Coordinator � DIVISION 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov FROM ❑ Owner El Applicant El Contractor ❑ City Staff (check one) REFUND OR Name: Bear Electric, Inc. INVOICE TO: (business or individual) Mailing Address: P.O. Box 389 City /State /Zip: Donald, OR. 97020 Phone No.: (503) 678 -1355 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V): ❑ CANCEL PERMIT APPLICATION. ® REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (ate ch case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: ELC2009 -00585 Site Address or Parcel #: 13609 SW Essex Dr. Project Name: Subdivision Name: Lot #: EXPLANATYON: Only needed minor Label. Minor Label # used - PI -S217590. ), Signature: Date: 11/03/2009 •, ice' Wis om Print Name: RefrmrlPnliry 1. The Director or Building Official may authorize the refund of a) Any fer, 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 8tt"/ of the land use application fee for issued permits. d) not more than 80% of the building plan rcvicw fee when an application is etnceled before any plan review effort has been expended. c) 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. FOMMICE V SE ONLY Rte to Sys Adrnin: I Date By Rte to Bld Admin: Date L-002.7 By Refund Processed: Date B ' Invoice Processed: _ Date By Permit. Canceled: Date / B Parcel Tag Added: Date By Receipt # Date Method _ Amount $ 1:\Buildntg \ Forms \ RegPermitAction.doc Rev 07/26/07 • • City of Tigard, Oregon e 13125 SW Hall Blvd. ° Tigard, OR 97223 4" 'r } ' fit £ s " t l a :w l December 11, 2009 � • Bear Electric P.O. Box 389 Donald, OR 97020 Attn: Stacey Wisdom Re: Permit No. ELC2009 -00585 Dear Ms. Wisdom: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 13609 SW Essex Dr. Project Name: Dolan Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $56.98. ❑ Trust account "deposit" receipt in the amount of $ . Notes: Used minor label. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 4; ) Dianna Howse Building Division Services Supervisor • Enc. I: \ Buil ding\ Refunds\ Administra tion \LtrRefund- CancelPermit.do 01/16/07 Phone: 503.639.4171 o Fax: 503.684.7297 0 www.tigard - or.gov o TTY Relay: 503.684.2772 111 City of Tigard T 1 G A R D Accela 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 Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Bear Electric DATE: 12/10/09 P.O. Box 389 Donald, OR 97020 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 175864 Case #: ELC2009 -00585 Date: 10/30/09 Address /Parcel: 13609 SW Essex Dr. Pay Method: CreditCard Project Name: Dolan EXPLANATION: Used minor label. Refund 80% of permit fees. .REF>4JND` INFORMATIONc -: " : - • ' • • • ..: _ .. ,: , .. . • Fee Description From Receipt • Revenue Account No " . Refund Example: [BUILD] Permit Fee .. - Example: '245-0000-432000 $ Amount Electrical Permit Fee 2200000 -43103 $50.88 12% State Surcharge 1003100 -24001 6.10 TOTAL REFUND: $56.98 APPROVALS: If under $5000 Professional Staff k , @-/V 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 . FOR ACCELA SYSTEM ADMINISTRATION USE ONLY .. • Refund Request Reviewed: Date: ,7 / /l ilt � By: L Case Refund Processed: Date: / S r _ By: '1 I: \Building \Refunds \RefundRequest.doc 04/13/09 N0'v- 03- 2009(TUE) 15:27 Bear Electric (FAX)5036781108 P.001 /001 Comnaunit3r Development REcENED T I G A R D Request for Permit Action NOV 0:3 2009 TO: CITY OF TIGARD (°i�` DIVISION Building Division Services Coordinator X16 amp • 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov FROM: ❑ Owner (J Applicant El Contractor ❑ City Staff (check one) REFUND OR Name: Bear Electric, Inc. • INVOICE TO: (Business or Individual) • Mailing Address: P.O. Box 389 City/State /Zip: Donald, OR. 97020 Phone No.: (503) 678 -1355 . PLEASE TARE 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 #: ELC2009 -00585 Site Address or Parcel #: 13609 SW Essex Dr. • Project Name: Subdivision Name: Lot #: EXPLANATION: Only needed minor label. Minor label # used - F.T 4217590. Signature: ! / / Date: 11/03/2009 c om Print Name: • • R futrur 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 mote thnn 8&P/. of the land use application fcc for issued pennies. d) not more than 80! /a of the building plat review fee when an applimtion is canceled before any plan review effort has been expended. • c) not more than 801/4 of the building permit fee for issued permits prior to any inspection requests. . 2. Refunds will be returned to the anginal Payer in the Fame method in which payment was received. Please allow 1 -2 weeks for processing refunds. ' +k . ; ;FOR OFFICE USE"ONLY Rtc to S Admin: Date B Rte to Bld_ Admen. . Date ./ / - Mir& Refund Processed: Date „ . B ordj / Invoice Processed: Date B 1>ctmit Canceled: IlEfiggiffAZIErgram Parcel Ta : Added: Date ' B LEEMEMEMI Date Method Amount $ 1: \build ng \Yonne \ltegPermitAction.doc Rev 07/26/07 • CITY OF TIGARD RECEIPT O 2 . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 176273 - 12/11/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2009 -00585 $ -56.98 Total: $ -56.98 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 000007 DHOWSE 12/11/2009 $ -56.98 Payor: Bear Electric Total Payments: $ -56.98 Balance Due: $56.98 Page 1 of 1 • CITY OF TIGARD RECEIPT • i � I : . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 175864 - 10/30/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2009 -00585 Branch Circuits wo /Purchase Service or 2200000 -43103 $63.60 Feeder ELC2009 -00585 12% State Surcharge - Electrical 1003100 -24001 $7.63 Total: $71.23 PAYMENT CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card STREAT 10/30/2009 $71.23 Payor: Bear Electric w Total Payments: $71.23 Balance Due: $0.00 • Page 1 of 1 : , :q CITY OF TIGARD ELECTRICAL PERMIT ; . - COMMUNITY DEVELOPMENT Permit #: ELC2009 -00585 T 13125 SW Hall Blvd., T igard OR 97223 503 Date Issued: 10/30/2009 ,.,,, Parcel: 2S104CCO5300 Jurisdiction: Tigard Site address: 13609 SW ESSEX DR Subdivision: Lot: 0 Project: Dolan Project Description: Install (2) branch circuits for A/C and service outlet Owner: FEES DOLAN, ANTHONY F & MARLYS M Quantity Description Date Amount 13609 SW ESSEX DR TIGARD, OR 97223 2 crt Branch Circuits 10/30/2009 $63.60 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 10/30/2009 $7.63 Electrical Contractor: BEAR ELECTRIC PO BOX 389 DONALD, OR 97020 PHONE: 503- 678 -1355 FAX: 503 - 678 -1108 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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. { 01 1 00. You may p obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. By: 3 IssuedB `'mat Permittee Signature: C � iK� p /1g �/ f a J�� • 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. , OCT- 30- 2009(FRI) 11:12 Bear Electric (FAX)5036781108 P. 001 /002 Electrical Permit Application FOR OFFICE: USE ONLY IN City o -� RECEIVE 11 neeer.I.l t�r,A ;t,o; � - . 13125 SW Hall Blv Ti • rd, OR 972 Malt. . 1 MIMIC: 503.639.4171 Fax: 303.59x. t9fiU n �� » saber Permit: I Line: 503.639.4175 O C T 3 U 200 I'd' pale Rrad fu 1wI Pare TIGARD ) r. f/ Seel acs_ fur Internet; >'v<�w.tiganl- or.guv KnntiortI ritn.l: (� Supplemental Infurroatinn CITY OF TIGARD TYPE or w WW1LDING DIVISION PLAN Rl :vl>rw r ❑ --1t Niwconstruction Addititnl /ahm ei /renhiecm te:n cnt Pechec1 all that arra (, nmit h ,s etso rplans »nrernsciccae4below): 0 J Demolition ❑ OIhCt" 0 soviet Of feeder .100 anrpt of more 0 !Wilding met Ilnce 1.Io11ei where the orniluble fault current 0llatinu hnagard+ CATEGORY OF CONS'l'Rt1CI'ION neeeds 10,000 amps of ISO sa or 0 Floating buildinus. less to ground, or exceeds 14.000 ❑ Contmereiaf •luc minimal 01- and 2- lamity dwelling . ❑ Commercial /industrial ❑ Accessory building amps Cot all other installations. Inuldingt. ❑ Multi- family ❑ :Ouster builder ❑ Other: D Pitu pump. I:1 1n,taltatioo uns xv or ❑l JOtIrStTE.1NFonsIA'1l0\ AND LOCATION mtngency largsrsepuatdydetiwd Addition anew motor load or 0 `A; "t -, "1 -':" "IJ ", Job no.: Job site 100111' of more_ occupancy. • ' 1L1� ><I L�I,v 4 �� lS x De. © Sot or more rot idemial units. O Recreational vehicle parks. +1 , CilylStatc/Ll1'2 T t r ' t 7 , 1 1 Q �' - ^� ❑ l lcam .care rotation. 0 Supply%wrag rc fur than ` � J r• ' � �, ❑1tarardoaslocations. 4tln►n114 Minimal. Suite/bldg,./apt. nu,: Projectrame; ❑ Scrviccar fccder600snipsormac, -... . SCilEDUL`E''_,. ,‘ ,ta j`_ Cross street/dirtcarats to oh site: Orofiplion 1 ri+.. 1 r.r. 1 t ! New residential single- or mail- lit mlly dwelling unit. J luctodcyattnchcdgura c. rl Subdivision: Lot nn.: 1.000 . • ft. or less MI 1611.54 4 J Ea. add'I 500 sq. iL or portion 33,92 I parcel no,: Limited energy, residential lax map/ y- , .DESCRIPTION t%0Rf{- 6711.4 . with abuse . R ? ` Limited tilt � , Huila•( "amity � �� t A �' r r I ` _ All fesidi:1111W with abo+asr. R. alio Services or feeders installation uttenuion. 0nt1for relocation .. 200 amps or suss 100.70' C , 1. , r O''PROPl RTV :OWNhlt ;;, . .0 TENANT 201 mnps to 400 amps _ 13356 -- Name; _ __ _ -` 401 amps to GOO amps 2003.1: 61)1 nntps tn_1,0U0 amps 301.0.1 2 Address Ova r 1.000 amps'or volts 552.26 2 J) City /State/7.1P: re,itpnrary. services. nr feeders Installation. a Iteration. mid/or . relocation * Phone:. ( ) Fax: 1 200 mops Dries 5936 1 1i vl Owner instaitution: MU'S installation is being ninth: on' property salts l own which is not IUt sops to 400 anrPs. 125_08 , '2 interned I'nr.salc, lease, rent or =lump:. according to ORS •1.17. •149.670. and 701. 401 :maps to 599 untps j 16x.5.1 , Itrunchcircuits -•new. alteration nreetension. er unel Owner sil;nat _ Doc: __ - _- A. I=ce for branch circuits with `.,. ;' :, at: APPLICANT - C CO\TACr pi. ,o' . - - atom . scrviee nr ii;cdcr fee, catch branch citcuit 7:42 2 Business name: 11. lee fir branch circuits f t service or feeder fee, contact name: 6.It1 5(0,.i , , 2 sisal branch circuit Address: t_actt atld'1 brunch circuit 1 7.•12. � r miscellaneous (;service or feeder nisi included) City /Stan %II': Bach manufactured or mndulur ' - dwelling. service nndlar feeder 67.84 2 Phone: 1 ) Fax:.: ( 1 Reconnect, only - 67.8•1 2 E-mail: • Pump or urn :ation circle - 67.34 2 r ' '' 't; '• CO; TIIAC1'OIt c °- i ' :; Signor outiinc ;lighting 67.134 2 ( ],_, , :(.., E' � s Stynatcirt uitis9 or limited- — Business 7 � ` � l energy panel. alteration. or Address: P c) x ., C 1l 11sion. Describe: Page 2' City /Statelfi': C . y ��� r `\ -C ,. 1 ( , Knell.. additional lospeIl1w, sorer allow l lle(1 hitvI,r Ibe:,t1u e Col L+" YYY 1 1 ,11 1 } .� i'crinspectidd 6G „5. Plum: 1 W3,1 I ,- •ax: ( 54, • •,.” - i you,ptnlon ptr;hnur fl In. min) �- 6 6."2,5 V C l3 1 it .: �arctrical Lic.: �_ Su rv. lie.: L.. X4 p n 7&18 �O , q 2 ` p s lal la cr hour � " _ ` f <.... 'd ficrRuc.tc P,ERilil t , r FEE - st: ,rd . ; : ,; ; rr.�,.? , upr�. lcclriciali 1q trltuic, rtgwrcd. -AS " _ s Silbtotal :!. 1 o3• c 40 Print name: *fir �� �M , (Jett; v • Plan rnrcw125%ofperinit1 c):' , — �J y Statcsiuchar ifl=ultra): Authorized signature: , _ TOTAL P1:R1+t1T t'i E.: _- 11023 rhir permit uppacnilnn esplM* lea ; :perndt IS nut obtolncd within Ufa Ran:: Ra:: (Jute: - - darn Atcr - tl No% hero accepted as complete. • Malibu inspcnians allowea;perpermir. ''S S tadiui'.t' I..tue,I!t,ti'cIlatir..1D 1.0i /CO aab- IbI}Iil,rU4Ct MVO - •