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Permit
p CITY OF TIGARD ELECTRICAL PERMIT lig r 2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2011 Parcel: 2S102CB05700 Jurisdiction: Tigard Site address: 13045 SW GRANT AVE Project: Halstead Subdivision: WINSOME TERRACE Lot: 1 Project Description: (2) branch circuits for heat pump and GFCI outlet. Contractor: TRI COUNTY TEMP CONTROL INC Owner: HALSTEAD, ERIK 13150 S CLACKAMAS RIVER DR 13045 SW GRANT AVENUE OREGON CITY, OR 97045 TIGARD, OR 97223 PHONE: 503 - 557 -2220 PHONE: FAX: 503 - 557 -0919 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 01/05/2011 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/05/2011 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through • =R 952 - 001 -0090. You m- - - •- -j or direct questions to OUNC by calling 503.2 or 1.800.332.2344. Issued B - / Permittee Signature: ✓ li /L� - --�� // OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept In a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. JAN -3 -2011 11:09A FROM: TO:5035981960 P.1 r n ran Electrical Permit Application': ' , f p l t1l( 1.1( I I S, c,\l,, City of Tigard JAN 0 3 2011 Received Dat /B . ' ®' t . fl ELI - 13125 SW Hall Blvd., Tigard, OR 97223 1 . P lan Review Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 CITY OF T AR[, DateB : M • a 11 —Ut►, , - i i i, n I: I) Inspection Line: 503.639.4175 A J Date Ready/By: ® See Page 2 for Internet: www.tigard- or.gov BUILDING L 1 VISI i$oti fied/Mothod: EM Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ID Service Service or feeder 400 amps or more ❑ Building over three stories. 13 Demolition ❑ Other. where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 0.1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family 0 Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 7S KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E", "1 - ", "t - 3", Job no.: l JO 11-11.,x$ I Job site address: 16045 e,w ts, X `I A�- o Six or or more. occupancy. ❑ Six or more residential writs. 0-Recreational vehicle parks. City/ State/ZIP: 719 ard 41 ❑ Health-care facilities El Supply voltage for more than ['Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I tar'. I Fee. I Total J • New residential single- or multi - family dwelling unit. - lnelndes attached garage. Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4 Tax map /parcel no.: Ea. add'; 500 sq. ft. or portion 33.92 1 Limited energy, residential 67.84 2 DESCRIPTION OF WORK (with above sq. ft.) f1 P UM) , r _.,;,_ 1 f , fl( t Limited ei energy, thab o e multi-family 67.84 2 �'�' � r �(/1 residential (with above sq. ft.) 6 Fa Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 _ 2 ' PROPERTY OWNER I CI TENANT 201 amps to 400 amps 133.56 2 Name: Eric E ric 4.46 I, 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: C C . . J A j VY ' c Over 1,000 amps or volts 552,26 2 City/State/Z115: Temporary services or feeders installation, alteration, and /or relocation Phone: (503) eg05 . Ls 11 I Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: Same as contractor B. Fee for branch circuits Contact name: Diane Mason without service or feeder fee, I 56.18 7 , 1j 2 first branch circuit Address: _ Each add'I branch circuit I 7.42 7. It)._ 2 Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 6764 2 dwelling, service and/or feeder Phone: ( ) I Fax: ': ( ) Reconnect only 67.84 2 E -ma Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: Trl County Temp Control energy panel, or limited- t o or energy panel, alteration, or Address: 13150 S. Clackamas River Drive extension. Describe: Page 2 2 City/ State/ZIP: Oregon City, OR 97045 Each additional inspection over allowable in an of the above - Per Phone: (503) 503 ( ) 557.0919 Investigation I Fax: inspection iga 66.25 on per hour (I hr min) 66.25 CCB Lie.: 72623 I Electrical Lie.: I F�N I Suprv. Lie "'L�1�G� Industrial plant per hour 78.18 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: („,,,...„ j � Subtotal: (.9 j . C d Print nam 14614 � l Date: I ! ` t) Plan review (25% of permit fee): , ) � ' l State surcharge (12% of permit fee): /7 + 1 Print name: Diane Mson Date: 1 l [ 1 Authorized signature: 4 1 TOTAL PERMIT FEE: ' 1 1 This permit application expires if a permit is not obtained within 180 days after It has been accepted as complete. • Number of inspections allowed per permit. I\ B uilding \Permit AMC- Permit App.doc 10 /01/09 4404615T(I1 /OSICOM/WEB JRN -28 -2011 08:120 FROM: TO:5035981960 P.1 rl 4 "it n H r ..v ,.., dz .,...., . , , ,., , , ,;,. - . 'S. . r, ' Community Development JAN 2 g 2011 Request for Permit Action 7�} l llInKl� "TV' 7.ri - � .' ,.lU TO: CITY OF TIGARD 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 4 Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Tr l C) werN Ttmp cont I Mailing Address: 13 15O 6. CiCC(,VnO! ikt\ter 1r1 VT) City /State /Zip: _Orea0 n o, x7045 Phone No.: boa 567 . 2120 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED et): V 0 1 0 CANCEL PERMIT APPLICATION. ,o/y /// zv 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 #: EL,GI0( 1-0001 ) Site Address or Parcel #: i o M S QQ, s ,, � � €,r kick uU C- Project Name: I1 110Ld Subdivision Name: �, Lot #: EXPLANATION: aw in 8uta ttr& n� or ((g') who e6ther_puli l.thCdr own Fir tit ©r used tr or label Signature: Date: ( 1l 1 Print Name: J)I C MC o Y 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 10% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than BO% 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 OH ICI , I Itil% ()NIA Rte to Sys Admin: Date B Rte to Bldg Admin: Date - / B : ,1-(/ Refund Processed: Date 4 1 y /, By ,c{, "' Invoice Processed: Date By Permit Canceled: Date , yij By 1 `, • Parcel Tag Added: Date By _ Receipt # Date Method Amount $ 1:\ Building \ Forms \RegPcrmitAction.doc Rev 07 /26/07 City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 February 4, 2011 F . ` Tri County Temp Control Attn: Diane Mason 13150 S. Clackamas River Dr. Oregon City, OR 97045 Re: Permit No. ELC2011 -00011 Dear Ms. Mason: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 10345 SW Grant Ave. Project Name: Halstead 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: Per applicant's request as work was completed by another contractor; 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\ Administration \LuRefund- 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 Accela Refund Request TIGARD 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: Tri County Temp Control DATE: 2/4/2011 13150 S Clackamas River Dr. Oregon City, OR 97045 REQUESTED BY: Dianna Howse Attn: Diane Mason TRANSACTION INFORMATION: Receipt #: 180940 Case #: ELC2011 -00011 Date: 1/5/2011 Address /Parcel: 10345 SW Grant Ave. Pay Method: CreditCard Project Name: Halstead EXPLANATION: Job done by another contractor; 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 $50.88 12% State Surcharge 1003100 -24001 6.10 TOTAL REFUND: $56.98 APPROVALS: If under $5,000 Professional Staff \ • .��I / 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: I Date: T By: • I:\ Building \Refunds \RcfundRcqucst.doc x 09/01/2010 • • CITY OF TIGARD RECEIPT q g 13125 SW Hall Blvd., Tigard OR 97223 • 503.639.4171 TIGARD Receipt Number: 181377 - 02/04/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2011- 00011 $ -56.98 Total: $-56.98 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 02507D DHOWSE 02/04/2011 $ -56.98 Payor: Alan Sanchez, Tri County Temp Control Total Payments: $ -56.98 • Balance Due: $56.98 Tidemark System Administration �� Finance Department Request Date: oV0/ • To: Liz Lutz Angela McCoy From: Dianna Howse/ Re: Receipt #: • • Please process this request as follows: Journal Entry (route copy of JE to Dianna Howse). Reversal (fees have been reversed on • Revenue Account Report). I� Credit Card Return (fees have been reversed on Revenue 'Account Report). Other /Explanation: ,e ie,/Li Thank you I: \Bu ( ding \Forms \RteSlip- FinanceReq.doc Page 1 of 1 • • CITY OF TIGARD RECEIPT q p 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: Number: 180940 - 01/05/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2011 -00011 Branch Circuits wo /Purchase Service or 2200000 -43103 $63.60 Feeder ELC2011 -00011 12% State Surcharge - Electrical 1003100 -24001 $7.63 Total: $71.23 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 02507D BTAGGART 01/05/2011 $71.23 Payor: Alan Sanchez / Tri County Temp Control Total Payments: $71.23 Balance Due: $0.00 Page 1 of 1 •