Permit .< (1 - :; -- .
1 11 1111 ° Community Development SEP 27 201
Request for Permit Action CITY OF I21-;11D
TIGARD Fli l I DIVISION
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 p Applicant ❑ Contractor LF', City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State /Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
M 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 L-C A001- 0o aZ K '7
Site Address or Parcel #: C (37 g 6.-w 11AiDR'HU.6 cr
Project Name: LO 1.16 5 rc}F F co#J -DOS
Subdivision Name: ) s- P3lo41. 3
--- D EXPLANATION E _ 1 PEIL IA VV - t.) e) r ,1 g P te.T 013 ACT, ✓1 TY
/ o20
Signature: _ , ° - - A co.wwtl i Date: q /AV/ �
Print Name: ----,/23ii l £.- _ ab411.4 k1
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b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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.
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 OFFICE USE ONLY
Rte to S s Admin: Date ` ormuniMil Rte to Bld. Admin: Date / /IMAM B
Refund Processed: Date /7 By • . I Invoice Processed: Date By
Permit Canceled: Date / / / /l/%{,.t By =9 rr Parcel Tag Added: Date By
Receipt # Date Method _ Amount $
I: \Building \Forms \RegPerrnitAction.doc Rev 07/26/07
. EXPIRED /0y /i;- zeW
Electrical Permit ApplicatRECEIVED FOR OFFICE I `l: 0\1,1
R eceived `Q- V)Cr(. ^�,, 2 7
City of Tigard Permit No.:
13125 SW Hall Blvd., Tigard, OR 9Y 2 7 2009 Date/By:
Plan R
I Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit.
t i t_, n t I , Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: .;5' El See Page 2 for
Internet: uww.tigard- or.gov
BUILDING niVISION, Notified/Method: r Supplemental Information
TYPE OF WORN ,::: PLAN REVIEW
® New construction ❑ Addition /alteration/replacement Please cheek all that apply (submit 1 sets of plans wlitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ 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 gmund, or exceeds 14.000 ❑ Commercial -use agricultural
❑ I. and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
® Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation (11'75 KVA or
JOB SITE INFORMATION 'AND LOCATION - ❑ A dii o system. larger separately derived system.
.�...
_ _ - ❑ Addition of new motor loud of ❑ "A" "F' "I -2" "I -3"
Job no.: Job site address: 9378 SW Mandamus Ct Io0H1'ormore. occupancy.
❑ Six or more residential units ❑ Recreational vehicle parks.
City / State/ZIP: Tigard, OR 97223 ❑ l'lealth facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt no.: 3 Project name: Longstaff Condos ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description FEE SCHEDULE
I q'. Qty. I
l Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. It. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF .WORK (with above sq. 0.)
Limited energy, multi - family 75.00 2
Electrical Service, wiringsadveltage residential (with above sq. ft.) -
MST2008-00166 Services or feeders installation, alteration, and/or relocation
200 amps or less 2 80.30 1( 2
ED PROPERTY OWNER . 0 TENANT 201 amps to 400 amps 106.85 2
Name: Brownstone at Lincoln Park, LLC 401 amps to 600 amps 160.60 2
601 amps to 1.000 amps 240.60 2
Address: 7050 SW Clinton Street Over 1,000 amps or volts 454.65 2
City /State /ZIP: Portland, OR 97223 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 signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
. ❑ APPLICANT . . . . I • ® CONTACT :PERSON ' • above service or feeder fee,
each branch circuit 6.65 2
Business name: RCM Homes, Inc. B. Fee for branch circuits
without service or feeder fcc,
Contact name: Ron Lightner first branch circuit 46.85 2
Address: 7050 SW Clinton Street Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Portland, OR 97223 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 598 -7565 x 101 I Fax: : ( ) Reconnect only 66.85 2
E - mail: rlightner®brownstonehomes.net Pump ur irrigation circle 53.40 2
CONTRACTOR _ Sign or outline lighting 53.40 2
Business name: Dms Electric, Inc. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 8504 SE Stark ST extension. Describe: Page 2 2
City /State / /.11': Portland, OR 97216 Each additional inspection over allowable in an • of the above
Per inspection 62.50
Phone: (503) 209 -9298 Fax: (503) 252 -6611 Investigation per hour (I hr min) 62.50
CCB Lie.: 118073 I Electrical Lie.: 3 742C prv. Li .: 4542 S Industrial plant per hour 73.75
ELECTRICAL PERMIT. FEES
Suprv. Electrician signature, required: Subtotal: `( (). ( O
Print name: Vacile Petri . . a .� Date: 5/26/2009 Plan review (25% of permit fee):
I
- - State surcharge (12% of permit fcc): 19.2. 7
Authorized signature: TOTAL PERMIT FEE: 17c). 8 7
Print name: Paul Grushevskiy Date: 5/26/2009 This permit application expires if a permit is not obtained within 180
days after it bas been accepted as complete.
• Number of inspections allowed per permit.
1 1 Building 1permits\ELC- PcrmitAppdoe 05/23/06 440-46IST(II /0S /COM/ E•D
EXPIRED •
CITY OF TIGARD / / / /N //d_ ELECTRICAL PERMIT
li g e COMMUNITY DEVELOPMENT Permit #: ELC2009 -00247
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/01/2009
Parcel: 1 S135ACLC013
•
•
Jurisdiction:
Site address: 9378 SW MANDAMUS CT
Subdivision: Lot:
Project: LONGSTAFF CONDOMINIUMS
Project Description: Install (2) 200 amp or less panels for building 3.
Owner: FEES
LONGSTAFF LLC Quantity Description Date Amount
7050 SW CLINTON
TIGARD, OR 97223 2 ea Services or Feeders - 200 06/01/2009 $160.60
amps or less
PHONE: 1 ea 12% State Surcharge - 06/01/2009 $19.27
Electrical
Contractor:
DMS ELECTRIC INC
8504 SE STARK ST
PORTLAND, OR 97216
PHONE: 503 -516 -8393
FAX: 503 - 252 -6611
Type of Use: SFA
Class of Work: NEW Type of Const:
Occupancy Grp:
Total $179.87
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5' .246.6699 or 1.800.332.2344.
Issued By: _ /,f _ ( (r ► Permittee Signature: Zas1 11
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 an Inspection that business day.
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.
8. OR dclkd ) -- U m n pc. ►ru0 .
CITY OF TIGARD ELECTRICAL PERMIT
v
5 ' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00247
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/01/2009
Parcel: 1 S135ACLC013
Jurisdiction:
Site address: 9378 SW MANDAMUS CT
Subdivision: Lot:
Project: LONGSTAFF CONDOMINIUMS
Project Description: Install (2) 200 amp or less panels for building 3. 6/8/09 ADDED (1) Temp panel.
Owner: FEES
LONGSTAFF LLC Quantity Description Date Amount
7050 SW CLINTON
TIGARD, OR 97223 2 ea Services or Feeders - 200 06/01/2009 $160.60
amps or less
PHONE: 1 ea 12% State Surcharge - 06/01/2009 $19.27
Electrical
1 ea Temp Services or Feeders - 06/08/2009 $66.85
Contractor: 200 amps or less
DMS ELECTRIC INC 8 da 12% State Surcharge - 06/08/2009 $8.02
8504 SE STARK ST Electrical (manual
PORTLAND, OR 97216
PHONE: 503 - 516 -8393
FAX: 503- 252 -6611 •
Type of Use: SFA
Class of Work: NEW Type of Const:
Occupancy Grp:
Total $254.74
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 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
1
Issued By: Q .rk �� n Qt�n f, Permittee Signature: .1 Q Q f C n
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 an Inspection that business day.
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.
w4, /& ct i m u 6 -to Qokyo e,J1,0 o p2r'vnct,rti n4
CITY OF TIGARD ELECTRICAL PERMIT
1111 I: COMMUNITY DEVELOPMENT Permit #: ELC2009 -00247
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/01/2009
Parcel: 1 S135ACLC013
Jurisdiction:
Site address: 9378 SW MANDAMUS CT
Subdivision: Lot:
Project: LONGSTAFF CONDOMINIUMS
Project Description: Install (2) 200 amp or less panels for building 3. 6/8/09 ADDED (1) Temp panel.6 /11/09 cahnged
temp panel to permanent panel -fees paid.
Owner: FEES
LONGSTAFF LLC Quantity Description Date Amount
7050 SW CLINTON
TIGARD, OR 97223 2 ea Services or Feeders - 200 06/01/2009 $160.60
amps or less
PHONE: 1 ea 12% State Surcharge - 06/01/2009 $19.27
Electrical
Contractor: 1 ea Temp Services or Feeders - 06/08/2009 $66.85
200 amps or less
DMS ELECTRIC INC 8 da 12% State Surcharge - 06/08/2009 $8.02
8504 SE STARK ST Electrical (manual
PORTLAND, OR 97216 13 da Investigation Fee (Equals 06/11/2009 $13.45
PHONE: 503 - 516 -8393 Permit Fee)
FAX: 503-252-6611 1 ea Investigation 12% 06/11/2009 $1.61
Surcharge
Type of Use: SFA
Class of Work: NEW Type of Const:
Occupancy Grp:
Total $269.80
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 - 0 01 -0 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
IRA ,c)✓1`ic\ ei ' 1 1 1 1 J��
Issued By: ∎� •� V ! _ ' �Permittee Signature: Q Q_ App -
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 an Inspection that business day.
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.
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
9378 SW MANDAMUS CT
Residential - Electrical
199 Electrical final
2013-11-21 (null)
ELC2009-00247
PASS - No C of O
Violation Summary:
Inspector Contractor