Permit Building Division
T1GAR Request for Permit Action
MAY 1 6 2007
CITY Cr TIGARD
TO: CITY OF TIGARD Butume DIVISION
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 ❑ Applicant ❑ Contractor V City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) /
Mailing Address:
\foto City /State /Zip:
fly.° ? "----, Phone No.:
�c,6
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
F CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: E j...L „Z Oj p 7-00/7
01
Site Address or Parcel #: 7 aC 5w ' JA i 1 /4: J0 a
Project Name: E.96 L f /40 /2,T(og-(o £
Subdivision Name: 44 Lot #: /∎,�� 9.
EXPLANATION: O D f 7 j 4 , do,i 1 e4 e T - a . I Q Li E 577 6.,0/ZA
D60 e. L.1Ai2 M- E 2007 - I 00 /3 / e‹.)/ e ee el 7-e71/4),1-,Jr" s- 6IA/ i f £ or 4 - iJC�gL ✓ 5 /eIJ1 .4? , T_ At)o)
Signature: / _ f / Date: 6 %A7
Print Name: /—)f4 /j / 47,/1- 14/
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b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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% 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 S s Admin: Date a o-4�l�►w�i Rte to Bld: Admin: Date `?. e B ;X,
Refund Processed: Date A / it By Invoice Processed: Date By
Permit Canceled: Date .5 :4 /0 7 By 2)&0 Parcel Tag Added: Date By
Receipt # Date Method Amount $
1:\ Building \ Forms \RegPermitAction.doc Rev 05/24/06
•
3/t1/27 12:39 503-363-2302 AC&E ELECTRIC PAGE 02/02
Electrical Pe/1)iilt Appbcati onRECEtVED .. • FOR OFFICE USE ONLY
p it i c: R iv:i mw ..,.....-7 .....,
. 4 City of Tigard MAR 0 1 2007 Datc/B : -0 7 ( . 3 , , ) (.... Permit No,- /47
; 13125 SW Hall
Blvd sR 7223 0
• 2 ,. ', Phone: .503.639A1 71 Tigrd Fax nq ;QR lowiA
Ph ' O5---.-- ' - vITY OF TIGARD T , P , Q 15 Y ,. — Other Permit:
inspection Line: 503.639,4175 Dam Ready/By: Aids IEI See Page 2 for
TICAR.T) Internet wwvv,ligard-Or.gov BUILDING DivistoN '
Notified/Method: Supplemental Informatio
:
..4 ! ::.;. .ig:', ..: 1V4:. :=1:•:. : ; ft..I....',.; ...:7 ... , F , 41., 7 - Ta" . 4. ^:etirittky a.E...:. :'''',',4r:..'&,•; ' :•.•'#
Please cheek all that apply (submit 2 seis or plans wiiterris checked Wow);
0 New construction El Addition/alteration/replacement
0 Soviet or fbocler 400 =in or MOM 0 Building over three stories.
El Demolition • Ej Other: • where thc available Null. cUrrent 0 Marinas and boatyards,
tiviitORV,1*.5tONST111TOtIORSti; ''..',;;' 7 - .: • . exceeds to,000 amps at ISO volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial artricultura I
0 1- and 2-lbrnily dwelling lEl Commercial/industrial El Accessory building amps Ibr all other installations. builditTs,
0 Multi-family 0 Master builder. 0 011110r: 0 Fire Pump, n Installation of 75 KVA or
...,- ... . . 0 Emergency system. larger separately derived ay3MM,
Atit O
'. 11qFRIVAiitoN Aiki:43 . " .77 ''''t '." • ' '
;:? .. ' • ••••• • • . :: . • ••J• • • • . •'' • .,,, :.•!....• . • 0 Addition 01 MOW load of I:1"A",
P
Job no.: Job site address: '7320 Bunziker Rd 100H or more, occupancy.
ID Six or more residential MOM. 0 ReerviiinnsIvehicie parks.
•
City/State/ZIP; Tigard, OR 97223 0 licnith facilities, 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: Eagle Mortgage 0 Service or feeder 600 amps or more.
,....
:1, , ,1;nt,. ••,,,,d,.4..i4J-. • .. .••-..,,,!:,,:,,;,;. : .• *,, A.' ... • • .:
' E"'"' " . •'•" .!!!::AgA '..32A,.!.n ,,...--'}'....'..-, '',..4 -
Cross street/directions to job site: Otampi lion 1 Qty. I Fee. I Mtn]
New residential single- or multi-family dwelling noit,
Includes attached garage.
_
Subdivision: • Lot no 1,000 sq. ft, or less 145.15 4
En. add'I 500 sq, ft. or portion 33.40 1
Tax map/parccl no.:
Limited energy, residential
7500 2
- .- ' ''' -g "" ' '" . •%.% t" gir '•;•''';!•' • • ', JP'' ' . ' n• !it/ .1 Citrer10 .: Oe*ijitiC•Zn '• ."•.. :.:.. ...: . .-: (with above ki. 1.1,)
Limited energy, multi-family
Commercial T1 work residential ,,,, 91bove g j )I 75.00 2
Services or &Mem installation and/or relocation
200 amps or less 8030 2
4 ,04*SW.: ,: 7; . . ". .... ................ '. .'' ...:::.:,!...,.... .4,‘ . ::.,"..1;,.. 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps ... 160.60 2
601 amps to 1,000 amps 240.60 2
.
Address;
Over 1,000 amps or volts 454,65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
—
Phone: ( ) Fax: ( ) _200 amps or less 66.85 I
Owner installation: This installation is being made on property that I 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 133.75 2
Owner si nature Date Branch circuits - new, alteration, or extension .er . g l
: :
-- A. Fee for branch circuits with
,CIFAAititiiiiii V
i. ...;Lt ,lititgON , .. above service or feeder fee,
. . ' ..,',:', , „.4 .....; , --..... . d '• ••••"•'`l, "•f • •..:., ..;•104:, • A,n- .' •.' • ' — ''''''.....,„;._ II
each branch circuit 6.65
Business name:
B. Fee for branch circuits
without service or feeder fee. I 46.85 II
Contact name:
!list branch circuit 46,85
Address: Each add'l branch circuit 41 6.65 272,65 2
- , Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modwar _
dwelling, service and/or fe 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66,85 2
E-mail: Pump or irrigation circle 53.40 2
. ' •:''r. • "": 'A.z:. . ..' ;.,IiC1/2 . ":' 7 '.' : 7 , c: - ;:!1' . i . '! Sign or outline lighting $3.40 2
„. ..... .........
Signal circuit(s) or limited-
Business name: A C & E Electric
energy panel, alteration, or
Address: 3535 Del Webb extension. Describe: Page 2 2
City/State/ZIP: Salem, OR 97301 Each additional inspection over allowable in any of the above
_ Invegatin per hour (1 hr loin) 62,50 Per inspection 62,50
Phone: (503) 363-2301 Fax: (503) 363-2302
- stio
CC13 Lie,: 591 Electrical Lie.: 24- I C Suprv, Lie.: 4702S Industrial plant per hour 73.75
Suprv. Electrician signature, required: ill 0 ” .:'.2-5"' " . 7. .:" . . r' :',:- . .'' 7 ? • 7 ..:TTEito:R.: t, A vrtitim. • Tyo. .x. a-, ,,. .
. .,_ subtotal: 319.50
Print name: Dan Allen Date: 3/1/07 .. Plan review (25% of permit fce): 25.56
State surcharge (8% of permit fee):
Authorized signature:
TOTAL PERMIT PEE: 345.06
This permit application expires If a permit it not obtained within 180
Print name: Date: days after it has been accepted no complete.
•
' Number of inspoctions allowed per permit,
I: \ Buildii*Pci'm its \ ELC-PermitApp, doe Os/23/06 140-451ST(11/0)/COMAVEB
03/01/2007 12:39 503 - 363 -2302 AC &E ELECTRIC PAGE 01/02
FAX COVER SHEET
AC & E Electric
3535 Del Webb Ave. NE
Suite 100
Salem, Oregon 97303
Phone: 503- 363 -2301
Fax: 503 - 363 -2302
SEND TO: — — —
Company Name: From
City of Tigard Carl
Attention: Date:
Mark 3/1/07
Office Location: Office Location: ' " "'
Fax Number: Phone / Fax Number
503 - 598 -1960
❑ Urgent ❑ Reply ASAP El Please Comment ❑ Please Review El FYI
Total Pages (including cover): 2
Comments:
Mark this is the permit application for the EN le Mortgage II space at the Hilltop project.
the original application and the payment check will be there this afternoon. Contact me if
you have an . uestions.
Thanks Carl
Document/
Documentl