Permit 1
.
7/
Building Division
TIGARD. Request for Permit Action
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: n Owner n Applicant ❑ Contractor 'ii City Staff
(check one)
REFUND OR Name: /
INVOICE TO: (Business or Individual) / 7--
\ ' ® D Mailing Address:
City /State /Zip:
S/ /e. 7 Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
yt CANCEL PERMIT APPLICATION.
n REFUND PERMIT FEES (attach receipt, if available).
n INVOICE FOR FEES DUE (attach case fee schedule and explain below).
n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: Eke_ �oo(p -00003 1e3Y (pas Q` 4o3Go
Site Address or Parcel #: 9Vo 3 &' g3aa 1 - 950/ ( 44.0 Co,Q.¢L. ,j
Project Name: 00g/9 eOJ r S
Subdivision Name: Di2F9-L d_o 71-/D� j Lot #:
EXPLANATION: 0-771-M PE a H, j s W g e g �2f -i f Q r /� - GL E 7J
,,- ✓
� % E -me Lo/u� (EL_ea00-7- oo / 19. i/93 9- 44. A.4
il5 wb>Q --<:, ,J /k- o� �t4 E `rE21 S .
Signature: _ d , - Date: 7 45 6 7
Print Name: ( ) .4% F- T)&F1f 4S r
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b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 80"o of the land use application fee for issued permits.
c) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
d) 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 OFFICE "USE -ONLY , •
Rte to Sys Admin: Date By Rte to Bldg Admin: Date //j/Cl 7 By /rr'. '
Refund Processed: Date A//F By Invoice Processed: Date By
Permit Canceled: Date >/ //C 7 By e ._ 1 !. Parcel Tag Added: Date By
Receipt # Date Method Amount $
I• \ Building \ Forms \RegPermio ctson doc Rev 05/24/06
Nov 06 06 02:33p CEDAR RIDGE HOMES 5036662408 p.7
Electrical Permit Applic -- rout OFFICE . ,v 7 1.1 �r c�. 1.1
11 • City of Tigard � Received `
111 I3125 5 W Flan Blvd., Tigard, OR 97Z �� Cl' E i j Date/By: � a ,96 /'�X Permit No.: �i � it� �3!
Q Plan Review U 7
Pho 503.639.4 ] 71 Fax: 503.598.1960
DatdBy: Other Permit:
T1 G A RD Inspection Line: 503.639.4175 NO V 6 20 Date Ready By: funs / 121 See Page 2 for
Internet: www.tigard- or.gov 2006 Nolified"Method: 17 /(2 Supplemental Information
TYPE OF WOk ♦ 0J1 I I(AI D PLAN REVIEW
Lot ..• it%
D2_ i Hpati�i�7
® New construction ation= ' " ea ' 0 ru 1i Pleas check all that apply (submit 2 sets of plans w /items checked below
❑ Addition/alteratwn /replacemen pp y below):
( p )
E l Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1- and 2-family dwelling ® COmmetelaUinduStrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building amps for all other installations. buildings.
fl Multi - family ❑ Master builder pun .
❑ Other: ❑ Fire p 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
El Emergency system. larger separately derived systen
1:1 Addition of new motor load of ❑ `A ", "E' , `] - ", "I -3 ",
Job no.: Job site address: 9384 SW Coral St a 2..... IOOHPormore. occupancy.
❑ Six or more residential units. 0 Recreationat vehicle panes.
City /State /ZIP: Tigard/OR/97223 ❑ Health -care facilities 0 Supply voltage for more than
i ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: Coral Commons ❑ Service or feeder 600 amps or mare.
FEE SCHEDULE
Cross street/directions to job site: . , Description 1 Qty. I Fee. I Taint 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less . 145.15 4
Tax map /parcel no.: Ea. add'! 500 sq ft. or portion 33.40 1
• Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
•
New Single Family Construction Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less [ 80.30 2
• • ® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Coral Commons, LLC 401 amps to 600 amps 160.60 , 2
601 amps to 1,000 amps 240.60 2
Address: 1905 SW 257 Ave. Over 1,000 amps or volts 454.65 2
City /State /ZIP: TroutdalefOR/97060 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)666.4240 Fax: (503)666 - 2408 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
® APPLICANT A. Fee for branch circuits H i[h
❑ CONTACT PERSON above service or feeder fee,
6.65 2
each branch circuit
Business name: Coral Commons, LLC B. Fee for branch circuits
Contact name: Dean Grey without service or feeder fee, 46.85 '; 2
first branch circuit
Address: 1905 SW 257' Ave. Each add'! branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City./State/ZIP: Troutdale /OR/97060 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (503) 666 - 4240 Fax: : (503) 666 - 2408 Reconnect only 66.85 2
E- mail: Pump or irrigation gation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Schroeder & Sons Electric Signal circuit(s) or limited -
energy panel, alteration, or
Address: PO Box 748 extension. Describe: Page 2 2
City /State/ZIP: Boring/OR/97009 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 658 -3369 Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: 49027 Electrical Lie.: 3 -385C Suprv. Lie.: 41525 Industrial plant per hour 73.75 ,
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Donald Schroeder Date: Plan review (25 % of permit fee):
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: This permit application expires if a prrnrit is not obtained within 180
Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: tBuilding 'Permits\EI.C-PermitApp, dot 05/23106 410- 46 15T(1 t ?05IcOMIWEB