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Permit 1 �,, CITY OF TIGARD . ELECTRICAL PERMIT 11 1 ,`-- COMMUNITY DEVELOPMENT Permit #: ELC2011 00340 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/22/2011 Parcel: 1S134DB12600 Jurisdiction: Tigard Site address: 11329 SW NORTH DAKOTA ST Project: Koenig Subdivision: DAKOTA GLEN Lot: 20 Project Description: Panel change Contractor: MR ELECTRIC OF CLARK COUNTY Owner: KOENIG, RONALD M & PEARL D 14300 NE 20TH AVE. D102 -313 11329 SW NORTH DAKOTA VANCOUVER, WA 98686 TIGARD, OR 97223 PHONE: 360-574-7200 PHONE: 503 - 639 -4058 FAX: 360 - 546 -2158 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 06/22/2011 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 06/22/2011 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 Required Items and Reports (Conditions) This permit is ' . - _ . .blect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be don- accordance wi 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 - • re.i ire you to follow the rules adopted by the Oregon Utility Not . ion Center. Those rules are , set forth in OAR 952 r 01 -0010 thr ugh OAR 9501 -00 I You may obtain a copy of the rules or direct questions to OU 0 t vs. 2_.1987 or 1.800.3 .2344. Is- ed By: /` il Permittee Signa r -. ' ,00 / ' /1' ��`-f 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: CONTRACTORJNSTALLATION ONLY / SIGNATURE OF SUPR. ELEC' —�� • , ,, .i e y e . '�� Date: 61,1 . � LICENSE NO. /5 6 , 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. Jun. 21. 2011 8:21PM No, 7483 P. 1 Electrical Permit Application ��,},�r FOR orhICE lisp: ONLY C ity of Ti i` L } l. E D R ,� ° j Q 1 � iC L O a- 3 „ Permit No .+ q 13125 SW Hall Blvd., Tigard, O 97223 Pla Review N Phone: 503.718.2439 Pax; 503.598.1960 JUN Dale/11 ; OtherPem»I: 1`I 2 2011 •1 1 ll.D Inspection Line: 503.639.4175 Dole Ready /13y: duria; ll See Page z for Internet: Ivwtv.tigard- or.gov Cr OFTIG A flT Notified/Method; Supplemental Information TYPE OP !JI_DIN(1 DIVISION . PLAN REVIEW • 1I New construction iii Addition /alteration/replacement Please check all that apply (submit Z seta of piano wlileros checked below): ❑ Service or feeder 40D amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas tend boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 atnpe at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural [81 I- and 2- family dwelling ❑ Commercial /industrial [] Accessory building amps For all other installations. buildings, ❑ Multi- family ❑ Master builder ❑ Other: ❑ hire pump. ❑ Installation 0175 KVA or 10B SITE INFORMATION AND LOCATION - ❑ Emergency system. larger separately derived system. ❑ Addition or new motor load of ❑ "A" "F ", "1 -2'• " I-3". 1001.1? or more. occupancy. Job no.; g\ Job site address; \\ \�� � ❑ Six or more residential units. 0 Recreational vehicle parks. City /State /ZIP: �"ock \e�, U h 472 Health -care facilities. Supply voltage for more than �-s J ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: I Project name: ❑ service or feeder 600 amps or MOM. FEE SCHEDULE Cross strect/dircctions to job site; Derrriplioa I Qtr. 1 Pee. I Total I • • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. fl.orless 168.54 4 P.a. add'1 sq. ft. or portion 33.92 1 Tax map /pareel•no•; Limited energy, residential DESCRIPTION OP WORK (with above s . ft, 75.00 2 Limited energy, multi- family ■ 75.00 © .i. M _ V Di A' i • a' g I residential with above s.. ft. Services or feeders installation, alteration, and /or relocation 200 amps or less 7 100.70 /Qn 2 • 'PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133,56 2 401 amps to 600 amps 200.34 2 Name: ` * - ` I 601 amps to 1,000 amps 301.04 2 Address: • • -• 4 i el ' \ Over 1,000 amps or volts _ 552.26 2 ` o � „` l a � 'Temporary services or feeders installation, alteration, and/or CiCity/State/ZIP; < 1 T\ C 1 relocation Phone: ( Z) L'•- L\O �� Fox, ( ) 21X1 amps or less 59.36 , I 201 amp to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 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 mi /h 0 APPLICANT jU CONTACT PERSON above service or feeder fee, 7 q2 2 each branch circuit - Business name: MV Qci `CC4 -‘ e_CA Pis if Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: \l`\ 00 �E t k:10. z_,.. \orLIG Miscellaneous (service or feeder not Included) - I l� p� Each manufactured or modular City /State /ZIP: ` V c n �k e( L,, G�loa dwelling, service and/or feeder 67,84 2 Phone: ( -5b 'S) 7816 - E55 65 I Pax :: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E Sign or outline lighting 67.84 2 CONTRACTOR • signal circuit(s) or limited energy ��!! ��((��� + ._ steel, alteration, or extension. Page 2 2 Business name: q` 1U"-A- C 4 f - .S s Each additional ins ectlon over allowable in an of the above Address; LA e, QE, 4r1 4b \.), k , .3 Additional inspection (1 hr min) 66.25/ hr 11 n investigation (1 hr vein) 66.25/ hr • • City /Statc/2IP: \iN)Cwier ' W`N CI` 81a Industrial plant (I hr min) 78.18 / hr 11 Phone: (e)� 2_• to - �G : :C � f3 I Pax: ( ) Inspections for which no fcc is 90.00 / hr specifically list (h hr min) cat Lie.: 1kor, 7� 2.t,F -1 Electrical Lie.; I Suprv. Lic.: q58-e-5, ELECTRICAL PERMIT LEES Suprv. Electrician signature, required: Subtotal: / pp , - • // Plan review (25% of permit fee): Print name; �- A Date; State surcharge (12% of permit fee): 1 TOTAL PERMIT FEE: i . _ Authorized signature: This permit application oxplras If a permit Is not obtained within 1ao days after it has been accepted as complete. Print name: mm Date: a Number of inspections allowed per punts. //2.7 D • 1:t Building \Permiis\ELC-PermiiApp.doc 07/01/10 440 - 4615T(t I /OS /COMAVLO Ili RI TIGARD City of Tigard December 6, 2012 Advanced Electrical Concepts Inc. Attn: Jim Kleiser 418 NE Repass Rd., B -6 Vancouver, WA 98665 Re: Permit No. ELC2011 -00340 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11329 SW North Dakota St. Project Name: Koenig Job No.: Refund Method: ❑ Check # in the amount of $ . ® Credit card "return" receipt in the amount of $90.22. Note: Please allow 2 -5 days for this refund transaction to be credited to your account by the company that issued your card. n Trust account "deposit" receipt in the amount of $ . Comment(s): Per applicant's request as was unable to get response from homeowner to schedule inspection. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Since ..ly, Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard- or.gov City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Advanced Electrical Concepts Inc. DATE: 12/3/2012 Attn: Jim Kleiser 418 NE Repass Rd., B -6 REQUESTED BY: Dianna Howse Vancouver, WA 98665 TRANSACTION INFORMATION: Receipt #: 182980 Case #: ELC2011 -00340 Date: 6/22/2011 Address /Parcel: 11329 SW North Dakota St. Pay Method: CreditCard Project Name: Koenig EXPLANATION: Per applicant's request as was unable to get response from homeowner to schedule inspections. Refund 80% of permit fee. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Electrical permit fee 220- 0000 -43103 $80.56 12% State Surcharge 100 - 0000 -24001 9.66 TOTAL REFUND: $90.22 APPROVALS: SIGNATURES /DATE: If under $5,000 Professional Staff If under $12,500 Division Manager 1\ ,%1 0 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: Date: I /, /6/4„2-___ I By: I , 1: \Building \ Refunds \RefundRequest.doc x 09/01/2010 Oct. 24. 2012 11:33PM No. 9561 P. 2 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT NI 11 1 � • Request Permit Action V01 1 . 1 ( i „ , ( 1 ) 13125 SW Hall Blvd.. Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov! A /�v /°� TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd., Tigard, OR 97223 Phone; 503.718.2430 Fax: 503.598.1960 w\vw.tigatd- or.gov FROM: ❑ Owner El<plicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or individual) Ad vow e ed El? e t- tal (' n ce p is Mailing Address: 11 $ h! go ass D -(p City /State /Zip: Vane,oWw (A)4 181.dt. Phone No.: S1Y3 - 2516 - BS PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): 2 PERMIT APPLICATION. Br REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fcc schedule and provide explanation below). ❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permnit #: E LC, 2-D 1 '(- 003 Site Address or Parcel #: 1' 5 2)1 5 W N () r-th D G I G O COL Si Project Name: Subdivision Name: Lot #: EXPLANATION: llu►rit j,t.e. -}•0 eohn - h DOW, O W n r 46 ne c-c7h o n . e' -' �r-� i 1�1. r 5 t nc l>7 122.. Lot 1. Signature: Date: l0 l 2. Print Name: `� I[,16 s c.t Nrfitntl_l�licy • 1. The Director or Building Official may authorise 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 bccn expended. c) not more than 80% of the land use application fee for ;slued 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 pennies prior to any inspection requests. 2. Refunds wilt be returned to the original Payer in the same method in which payment was received, Please allow 2-4 weeks for processing refunds. /00 .7v FOR OFFICE USE ONLY =_ Rte to S s Admin: Date B Rte to Bld Admin: Date 42_ AnEllErrn7 Refund Processed: Dat%1Q® B 49A Invoice Processed: Date B �0 S6 Permit Canceled: Date /. /F //2-- Bj '• • arcel Tag Added: Date By , p � Receipt # Date Method Amount $ , eo g- T: \Building \Forms \RegperrniuAaion.doe Rev 05/25/2012 9. 6 5 1 0 9o. Oct,_24. 2012 11:33PM No. 9561 P. 1 418 NE Repass Rd, Ste. B -6 Vancouver, WA 98665 (360) 574 -7200/ (503)296 -8555 Fax (360)546 -2158 ® CCB #168324/WA Lic.# MRELEEC 957RF rl CTRIC We Have The Power To www. mrelectric .com /mrelectriccc @hotmail.com Make Things Better!' . O ERtELEC1RICALSEIIYICE R ECEIVED . . OCT - -2 4,2012 • CITY OFTIG Fax BUILDING DIVISION City of Tigard Building Division Services To: From: Advanced Electrical Concepts Supervisor Fax: 503 -598 -1960 Pages: 3 including cover - Phone: 503 -718 -2430 Date: 10/24/2012 Re: Request Permit Action cc: O Urgent X For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle