Permit CITY OF TIGARD I ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT / Permit #: ELC2O12 -00361
®
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
® Date Issued: 06/11/2012 Parcel: 2S111 BD00317
Jurisdiction: Tigard
Site address: 9875 SW MURDOCK ST
Project: Murphy Subdivision: PEMBROOK HEIGHTS Lot: 7
Project Description: (1) 200 amp service for PVS. Reprint to change contractor
Contractor: EAGLE ELECTRIC LLC Owner: MURPHY, EDWARD J AND DANA S
PO BOX 931 9875 SW MURDOCK ST
ST HELENS, OR 97051 TIGARD, OR 97224
PHONE: 503 - 397 -9017 PHONE:
FAX: 503 - 366 -4252
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/11/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/11/2012 $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 issued sub'ect 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 a lance with : • •roved 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. A NTION: Oregon la r= : ires you to follow the rules adopted by the Oregon Utility N • ' ' . Center. Those rules are set forth in OAR
952 -00 0010 throueh OAR 952 -O8 009e. may obtain a copy of the rules or direct questions to OUNC • -` -; 1 ;87 or 1.800.33 4 .
Iss ed By: — /or, ' � � '` / Permittee Sign. ' ? � r 7i / I /!
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 503.639.4176 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.
CITY OF TIGARD ELECTRICAL PERMIT
a COMMUNITY DEVELOPMENT Permit ELC2012 -00361
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
T [GAR I? 9 Parcel: 25111 BD00317
Jurisdiction: Tigard
Site address: 9875 SW MURDOCK ST
Project: Ed Murphy Subdivision: PEMBROOK HEIGHTS Lot: 7
Project Description: (1) 200 amp service for PVS
Contractor: BEAR ELECTRIC Owner: MURPHY, EDWARD J AND DANA S
PO BOX 389 9875 SW MURDOCK ST
DONALD, OR 97020 TIGARD, OR 97224
PHONE: 503 - 678 -1355 PHONE:
FAX: 503 - 678 -1108
FEES
Quantity Description Date Amount
•
1 ea Services or Feeders - 200 06/11/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/11/2012 $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 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 5 -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 �r 1.800.332.2344.
Issued By: �Ll Permittee Signature: Kb C 4 [ vki
(( 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.
5U3 -46e— 16
Electrical Permit Aunlif -atioq p i s I; (ii 1H t . h ., i i, l,
City of Tigard n itaand
Pmrwt a C.O /y00 /
13125 SW Hail Blvd., TIgard,OR 97223 Nat
• Phone: 503.7182439 Fag: 503.598.1960 Dat e/8v: Other Permit
n i i, i i Inspection Line: 503,639.4175 Dab Ready/By: Mr I B See Page 2 for
Internet: www.tigardar.gov Noa6ed/Mahat 1 S■ppka oral left, at'mr /
• • TYPE OF WORK . P[;M. RE1olgW
y ❑ New construction lE Addidon/alterattoNreplaeaneut Nam aterk all teat apply (submit 2 eau of p]sm whims cinched below):
El Demolition ❑ Other: 0 Swine or Feeder 400 amp, a more 0 t )ding over three gorier.
where Oro ivstiab'e fan avant l7 Marius and boatiards.
CATEGORY OF CON MEOCTION• • • eaceeda 10.000 amps at ISO vole or Mowing bolldiaga.
leas to pound, or eueedt 14,000 Cl Com4memialihse *culanat
Ir.:3 I - and 2- t dwelling ❑ Commercial/industrial ❑ Accessory building amps ile all ether hisnaltationv, buildings.
❑ Multi - family ❑ Master builder ❑ Other: O Fife pump. Cl G+mllanon of 75 KVA or
JOB sat INFORMATION AND LOCATION • O 2magency system. largo spent* derived system.
O Additon dear motor load of ❑ "A" °5" - 1-2 -, - 1.3 ",
Job no.; l lob site address: ( 5 SW r- 1&4R'jdC 1t10 mom, a eupauq.
(] Sis a mm raidetiet „gm 0 B inouronal vehicle prim
tar mom due
O
City /St8WT,1P: Heatp,saaOmaRaa. Cl Sanely voltage
J � � a r C � . �R � "� Z �7 l `�` Cl tlaraa Wean= . 600 .4114 nominal.
Suite/bldg. /aptno.: Project name: 5,,N, palm tilJ '�1kat 0 Service « Feeder 600 amps « mom
FEE SC.�ULE
^ Gross atreet/dlreetlons to job site: 9 $' aha f)1 rdo c K aswee 1 ' r r Tow I •
' New resldmtial s or malth•famUy dwelling matt.
Incledes attached gunge.
Subdivision: 1 Lot no.: �1,000 sq. R, or leer 168.54 _ 4
Ea. add'l 500 sq. R or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCA1>P'r!ON OF WORK (with above 94. 1) 75.00 2
• C H-r4oa t. or: Ca� i . Z 11-c TO& en rt '„ � s R) 1 �soo _ 2
Service or feeders iawaUartoo ull nItoo, and/or relocation
200 amps or las 100.70 2
(ps PROPERTY OWNER • I ❑ TJ24M( • • • 201 amps to 400 amps 13356 2
~ 401 amps to 600 amps 20034 2
Name; _i 'r 1 e ,t,t
�� 601 amps to 1,000 imps 301.04 2- Addn9s: p � 187 6 Sc) /�/� u r d a C R . Ova 1,000 amps or vela 552.26 ` 2
City/State/ZIP: : T �d �jR � 7 Z Z a � Temporary servIces or feeders l•amllatioo, alteration. and/or
/ relocation
Phone: (5e,3 ) t 1 ll " 0 f 71 T Fax: (Sd3) 9 69- 1 r{ 200 amps or Irso 59.36 1
Owner installation: This installation is 201 mops l0 400 amps 125.08 2
being made on property that t own which is not
intended For sale, lease,
f T etch ge, according to ORS 447, 449, 670 and 701. 401 amps to 599 carpe I68 5 4 2
Branch ehrold- neve, *Dorado'', or Weamlon, pe asset
11713//Z Owner signature: Ante: A. Pee for branch circuits with
• Kg APPLICANT I - . Q CON, PERSON N above service or feeder Ile, 7.42 2
each branch circuit
• Business name: B. P e e Fir branch circuits wimaid •
service or Reda fee, flirt
Contact name: ��. L qs abo!(e, branch circuit 56 2
Each add'' blanch circuit 7.42 2 •
Address: MLcdlaaeosa (service or feeder not Ioetaded)
Each manufactured or modular
City/State/ZIP: _ dwelling, service andtor foxier 6714 2
Phone: ( ) Fax:: ( )
Reconnect only 67.84 2
r _ 1. — Pump a irrigation circle 61.84 2
E -mail: ow er r 4 v 'I. w►T
k m 1; cc.. sign r auu
ebhe )1abu6og 67,84 2
CONTRACTOR Signal cirwit(e) or limitedeaesgy
Business name: 4: �e. panel, alteration. or extension. Paget 2
/ Each additional inspection over allowable is ley of the above
Address: JO, O. b&X 95/ Additional inspection (I hr min) , 6625/ hr
City/State/ZIP: .S1--, �k : ,vs, Q2,, ` / ind iaalal p (1 hr m) 7 825/
hr
) 3 —'o / 7 I ) 3f -. 4 252• industrial pia (1 for hrrmri) 78.18/hr
Phone: ( Fax: InspeWors for w e to a is
aped listed 06 br min) 90.001 Inv
CCB Lic J9�.i.77 Electrical ' _ _. , I' Suprv. Lie.: 567'1 • ELECTRICAL PERMIT PEES
Subtotal:
1
Suprv. Electrician signature, required/ _ / J Plan review (2596 of permit fee):
Print name: 1>z C p 4 !'Ir Date: '6[ 4 r I .� Stare surcharge (22% of permit &e)
Authorized signature:
TOTAL PERMIT FEE:
This permit appeases eapiree de pewit is not obtalnal Milan 280
Print name: day, afar it tae been soaped as amplete.
Rate: • Number of inepec6om allowed pa pemtit.
r:iealulpgirarnian - PwmiiAppam 07101/10 4404eISAI1 /03/COpr/wEa
•
JUN- 07- 2012(THU) 14:29 Bear Electric (FAX)5036781108 P. 002/003 5 i
Electrical Permit A licati EcE i FOR OFFICE USE ONLY 4t '' G
N. City of Tigard n' mac ' le / j (y Permit No , > f , ... 13125 SW Hall Blvd., Tigard, OR 97''U IV 0 7 2012 Plan Hevtew vt
Phone: 503.718439 Fax: 503,598.1960 Deena; Other Permit
TIGARD Inspection Line: 503.639.4175 CITY °aeaeady /dy ' �, �nolrmen
Internet www.tigard- or.gov „ Notified/Method: WMethod;
TYPE OF DIl11S1ON •PLAN REVIEW • , •
❑ New construction Addition /alterulionIreplacement Please check all that apply (wbmil a sets of plans whams checked below):
0 Demolition Other. where or feeder 400 amps of inure 0 Building wet dues statics.
wbee the available meth amen D Marinas and boatyards.
CAYECORY. OF CONSTRUCTION • - exceeds 10,000 amps at ISO volts or D.Floeting buildings.
V I dwelling lea to ground. or exceeds 14,000 0 Commercial -use agriculture] 1 - and 2 Y g ❑ Commercial/industrial ❑ Accessory building tar an cam inuallatlons. buildings,
❑ Multi - family ❑ Master builder ❑ Other. ❑ Fire pomp. 0Insmaodon of 75 KVA or
JOB 31i'& INFORMiITlON , AND . IAC ON. 0 Emergency system Career separately derived system. •
.-'- CI Addldoa draw mom tow of 0 - A ". -E -1.2 -Id - .
Job no.: Job site addro
I ss:Ci r 7 S . OG� ( I DOHPormore. occupancy.
0
`' 1 - -- - - - Sin or more residential unite, ❑ Recreational vehicle parks.
City/State/LIP: Ti g iro Q D Heoll -care facilities, ❑ Supply voltage fm more than
1 1 Cl I lourdnua Walden& 600 vuhs national.
Suiteibldg,/apl. no.: Project name: 0 Service or feeder 600 amps m more,
Cross street/directions to job site: o 86B SAD to Toed
New raldentlal sole• or multi-family dwelling snit
includes attached garage..
Subdivision: I Lot no.: 1.000 sq. R or less 16834 4
Ea add'I 500 sq. R or portion 33.92
Tax map/parcel no.: _ Limited energy. naldenHol 76.00 2
.. DESCRIPTION :OF WORK . (with above en. II.) .
Limited energy, multi - family 75.00 2
t M SilICL-1—. residenGd_(with above sq. R.) _
/� , / �r� Services or feeders lastallation ratlen, and/or relocation
l 200 MVP .cG 2V l \ - FI P (f S 200 amps or less 100.70 ITC.) 2
PROPERTY_ OWNER;':... ' . .. . ........ - Q.rx'ENAI!11"., ._ : 201 antes to 400 amps 133.56 2
Name: • = 4 401 amps to 600 amps 20034 2
601 amps to 1.001) amps 301.04 2
Address: Over 1,O0D amps or volts 53226 2
City /State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) F ax: ( ) 200 amps or less 59.36 r 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, atternUpu, or =lension, Ear panel
Owner signature: Rule: A. Fee for brunch circuits wish
APPUCAN3!; ` .: ®'CO •:a : above se rvice or f fee.
v - -. .. I�° _ ...._.._ M'AG7PER.9011f:: -- 7. 2
each branch circuit
Business name: [� ., e. om ' an without
B. Fee for branch circuits witho
T� lc, / ( t service or feeder fee, first
Contact name: branch circuit 56.18 2
1P ID x44'1 branch circuit 7.42 2
Address-, 1-'I, � ..� 01 Miscellaneous (service or feeder not included)
City /State/ZIP: r ll d . 01 O Q Each ins, service a or modular 67.84 2
C — . dwelling, service and/or feeder
Phonc: ( G t z ; 451 l Far :: ) L' 11 O6. Reeummcl only 67.84 2
' t TS a ?e x��aaG `1 Putnp or irrigation circle 67.84 2
E -mail: d�� . Sign or outline lighting 67.84 2
• I : ter . ... 47' ... :'. _ _ '' COIY7'INACTOR =.'::;;::,:...f r. -'' :: R ` : f : I . = Signal circuit(s) or limited-energy
Business name: 1;01 �� ( e . panel. alteration, arexteanioa. Take 2 2
�`''' �'�' / Each additional inspection over allowable in any erase above
Address: pp 9 - G, Additional inspection (1 In Mill) 66,25/ hr
City /SWIr./ZIP: �� �C) f �- C fl Investigation ( Its thin) 66351 hr
(�. ` Industrial plant (1 hr min 78.18f hr
Phone: ( ) 67 g_. tic I Fax: (1 1 6-18410_5 , � \` Inapeelions for which no fa is
a ilia)) listed ('/a hr min) 90.00/ fir
' ` CCB Lic. 401 Electrical Lic.. 4 G l Suprv. Lic.: 40 6 2.. 5 . ;;IT;: F CMCAt tmnIFE � ; %fi:
r ( D
X� J.7
Supry ` A C . Electrician signature, required: �) �J � Plan review (25% of permit Subtotal: 1 fee):
Print name: k l CL,LA c Date: 61 1 State surcharge (12% of permit fee): 12 .
Authorized signature: TOTAL PERMIT FEE: 1 � , ,/ ,
-
lab perndt application ash es U a permit V not atrtaload within 180 yL y
Print name: days alter II hes bem accepted as complete. -1
I D ate: • Number of inspections allowed per penult.
r: IDuitdinglhemitslaC .PermiUtpp.dne 07'01/10 44D t3T(1 t/a.S/Co.1WF,P
171!
TI GARD-
City of Tigard
December 6, 2012
Bear Electric
Attn: Alex Morris
PO Box 389
Donald, OR 97020
Re: Permit No. ELC2012 -00361
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9875 SW Murdock St.
Project Name: Murphy
Job No.:
Refund Method: n 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 general contractor abandoned job due to
bankruptcy. 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.
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: Bear Electric DATE: 12/6/2012
Attn: Alex Morris
PO Box 389 REQUESTED BY: Dianna Howse
Donald, OR 97020
TRANSACTION INFORMATION:
Receipt #: 187115 Case #: ELC2012 -00361
Date: 6/11/2012 Address /Parcel: 9875 SW Murdock St.
Pay Method: CreditCard Project Name: Murphy
EXPLANATION: Per applicant request as general contractor abandoned job due to bankruptcy. 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 220- 0000 - 43103 $80.56
12% State Surcharge 100- 0000 -24001 9.66
TOTAL REFUND: $90.22
APPROVALS: SIGNATU /D TE:
If under $5,000 Professional Staff /rr i 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: Date: I / /(/,L.___ By: I ,../9
1: \Building\Refunds \RefundRequest.doc x 09/01/2010
DEC- 03- 2012(MON) 14:25 Bear Electric (FRX)5036781108 P. 001 /004
4 ,0.,,),‘,„4,). - Q,J aa-- --- 1 1 p Azte4,1
Community Development
Request for Permit Action
TIGARD e'.--96C< / �/ 0
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR. 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant Contractor ❑ City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) p , D!�t - - }
Mailing Address: ii3C)C 2 S C
City /State /Zip: mc l -�l i 0 7, d
Phone No.: c_ Q% G S - I
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ `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 #: e LC 2 � ^
ol - O `-', C 1
Site Address or Parcel #: `(�,
•
•
Project Name:
Subdivision Name: Lot #:
EXPLANATION: ...-r r • - . V' - n A -CY1(21 — '
I ; fa `
W • . L • G & • • a - & I. ■
4f cOW•
Signature: ( / Orli Date: q r. ! e ` l ? ,
Print Name: P-Q_ J C r-r -
grfnnd Voliry
1. The Director or 1Suilding Official may authorize the refund of:
a) any fee which was erroneously paid or collected
b) not more than AO% of the land use application fee when an application i withdrawn or canceled befote any review effort has been expended,
c) not more than 80u/ of the land use application fee for imbed 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%u of the building permit fee for issued permits prior to any inspection requests.
2.. Refunds will be rctusued 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 .5 Admire: Date 101111.1 Rtc to BI Admire: Date /, B tr%F 6F6.5/, i
Refund Processed: Date /e2 iMIN Invoice Processed: Date B 9. G 6 2,V0
Permit Canceled: Date , `� B , -f-ZZ Parcel Ta • Added: Date B
Receipt # Date Method Amount $ 96. a-I=.Z7. s{.
T:\ Building \Forms \ReciPermitAction.doc Rev 02/23/2011