Permit IN CITY OF OF TIGARD
0 � ELECTRICAL PERMIT
;. / r (/
PERMIT #: ELC2007 00660
COMMUNITY DEVELOPMENT DATE ISSUED: 9/24/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104BC -08000
SITE ADDRESS: 12955 SW OXALIS TERR ZONING: R -7
SUBDIVISION: HILLSHIRE CREST LOT : 002 JURISDICTION: TIG
PROJECT: SORENSON
Project Description: (1) branch circuit for hot tub.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BRIAN SORENSON GARNER ELECTRIC
12955 SW OXALIS TERR. 2920 SW BROOKWOOD AVE #A
TIGARD, OR 97224 HILLSBORO, OR 97123
Phone: 971 - 404 -6318 Contact #: PRI 503 - 648 -4552
FAX 503 - 642 -7925
FEES
Description Date Amount Reg #: FIE 34 -305C
IELPRMTI FAX Permit 9/24/2007 $46.85 1,1C 121159
[TAXI 8% State Surcharge 9/24/2007 $3.75
SUP 3707S
Total $50.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 0011 -0 rou•h OAR 952 - 001 -0100 '•u may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: / / j / I Permittee Signature: 4 �
\ - 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'N: 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.
FROM.: '5ARNER ELECTRIC FAX NO. :5036427925 Sep. 24 2007 08:16AM P1
Electrical Permit . A,nplLC 't1Fni F•OR OFF R'E List ONLA
City OF TigSt'd ii . -1 mi D Received ��
13125 9W Hall Blvd Tigard, pR 92 Date/I3 : fr M
_A Permit No.: Ete.,2 . ,. g
Phone: 503,639.4171 Fax: 503.598 -1 ` 4 L00 /. 4 „'- '�•,r; Datc/B :
Inspection Line: 503,639.4 � E � nW , j � • Dateit : Other Permit
Internet www ct tigard or ue �o4 rxr Date neady�r e
�"ll!! ' ¢ �'� Notified/Method: ® tee Pa a 2 for
�� �I';'r:�� Sapplamentnllofermndon
.d�'YtN �'�1il } r1Cl 11 �4' }(
� � i k p�'� W I1 I R?: '- � St S�'j4 , ,• 'r'4 � � I t , t;'" Mj�'9� �,, RRR ,,,����. ' � ! I � � r' : 0. � 1'' , " r 40 i fn Cif �r+ir
Wr �.1 ,,, "�'- �1 ,, ?�sl'I� ,,,? ( T . , ti�� i, "1 5577`�'� _, (�IIi IC l.' /-6 � fl9�c, r e , a ,.4 A I � 4{�84 l f, s i s e ji , i' W A i s, 1
u_u. iz,oru;F➢8 . 1 ..;4h.,,2L11.i n ,the tried a.l a fr ,6 /tl A zs' !: 'r e • J. 1 ;:„
Q New construction Addition/alteration /replacement Please check all that apply:
0 Demolition Other: , ❑Service over 225 amps, comm ❑Hazardous location f
! t aF r' , ,', .7,,, X 1,,1.11 1 -, uLSi fi � . 1�� 71,,,,) � R,T } l S r ti�Y� . r. ,i) , 2, �f 3 i t 1i �i i t •, w,., r4 Ca Serviae over 320'atnpA - rating • ❑Bail over 10 000 sq. ft ,
i1. ;. ral y , , ,Izt+,,, . . A `� 0 u42 1 1L4;1,4 ,,' ": 1, ,ii t i e , 2 q �d r1_ r of 1- and 2- fam ent
i ly dwell 4 or more new residential
V I I - and 2- family dwelling ❑ C on mer•cmal /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ ulti- family ❑ Master builder Other. ❑Building over three stories OFe 400 amps or more
` '{�._tt i:rd � r �.v r,, !,f *rrrn1ndr� >n,ht1� , t .� l r- , a(i •fr nr ,.�; t r+ rrr� a „ „• ❑Occupant load over 99 persons [Manufactured structures or
I'rit et!E:ki 7 ,41 {i. /lfi i� 1 �1,?r' ta deli �i0���F., i rriflG' l fl� g i,i, hi •, li�iyf ti�'1d���"t �;1� 1�A�((� �,, p,ktifl: p
n.� , � T..,,,uu; � i i „� a�,, , .:1 :�.4c r..r. v�d��/ , C7H ens /lighting plan RV park
Job no.: Job site address: 215 J )xa I / S ['Health-care facility ❑Other:
City/State/ZIP: q � +�' L.r Submit 1 sets of plans with any of the above.
y �(� _l __l 22 The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project ', � �i�,ih 1 �i'�I I� ri ' r 1 il:fi [i;tiipt)tiaOk
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t IIAII1C: • ,
� r. +,.0 1, v�:.a�.�S;{�! �e : a1::Ab c9:.a �, ;,rrc7v unt.J's..
neserlp1Ien Qty. Fen Total ”
Cross street/directions to job site: New residential single or multi - family dwelling unit.
'" Includes attached garage,
- 1,000 sq. ft. cr less __ 145.15 4
Subdivision: . Lot • im; Ea. add'] 500 sq. it or portion 33.40 1
- - Limited energy, residential 75.00 2
Tax map/parcel no.: t
1} ^N i ll�y4 �L� prf � �f Sri I ILry �7Vrr C } dG{,3 �l�itm � ''i Q'f� ?p�t'�ti 4� { '' Ili . I�ry h�I "f't {',' f iw l ��g a •j! ' Limited energy, non- residential 75.00 r 2
ono: ,k f d i r iir.. Er i 1.fri n :rd OT e;1,n IL �l.'d}Uh , emii.', Itotltriftl 'nt'r5��til i 1 `,�
(d! - Bach manufactured or modular
W / t t � +-1-•� t I _
dwelling, service and /or feeder 90.90 2
V y I W Y J Services or feeders histnitation, alteration, and /or relocation
' A u�p T 200 amps or less _ __ � 80.30 ' 2
IG , i ,� r ;�l .4 t w f yn' ^� / A 4 RIC -V,T 15 E k c7.7}}} e 1 }ire 1A,eza�G i I��ra • l z � ' s to 400 amps mow -.
s�d r r 11,�. ,..t...m 1.,, ,. ��- b1'1 ?,r1 445. t�F t�.rF ',/1 . ° .,10,, '.i
4 �a 1 ��l .IY.il
'�f Ml i t 1i. r,, ,li �','al 201 amps mp 106.85 2
401 amps to 600 amps 160.60 _ _ 2 __
■ h i :ay -4 , �s�� �..—. 601 amps to1000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/ State/ZI': -- Reconnect only 66.85 2
I„_ en() ' , Temporary services or feeders Installation, alteration, and/or
Phone: 4 O 4 - - (j k c' FaX ( ) relocation •
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 100.30 2
intended for sale, lcattc, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 600 amps 133.75 2
Owner signature Date: )Brauoh circuits -new, alteration, or extension, per panel
?"1 ek 17 1 r `Jp ! q Yu�0." i' tT A c
o 4 u 'r 9LT f , , 1'
L �� 6� .J 1�' l l ' , � : ,AtIk•- Aa " � ;1 .2 1 .2 00 , .. h!� t � L Y . ,' c it -6t+I ? r i i i a '' �r�! '0� ' � ' s A . Fee for rfeederfee, each
1i,u a:�s.1 � 1f,r:1,,.Ps. r, 7 ', . .,. di � �!I g
� � ; ; I .� _,,�� 61z r I4rnr„a ti Prr.>ti �.t.3;1 rs,rl ����'i�x�i,�i ,
service or feeder fee, eac
Business name: branch circuit 6.65 2
- - -._ — ""`. - - " - -' B. Fee for branch circuits -
Contact name. _ _ T • without service or feeder fee, 1 46.85 7� 2
Address:
_ each branch circuit
- - -- Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service-or feeder not included)
Phone: Pump or it igation circle _ 53.40 2
( ) -,. -_w . -.— Fax: : ( ) Sign or outline lighting 53.40 2
B yp Signal circuit(s) or limited _ _�.
� ,!, ,p �1l 6'! ,l1i „ t1 I, i�� ^iv n'' id tT`k ,, ij � ^lA I� x 5 " +a f, energy �� ��. l e? , ' q cri,� .d.a^.I i ? fi1 r ti��?!�14�i�l �' p anel, alteration, or
Business name: 7 extension, Describe: Page 2 2
Address: :� e r ;; ?. ('.;• ;E ► U L, Y ,� - Each addltlonalis� action over allowable In any of the above
- � ' 1 - -- - - Per inspection 62.50
City/ State/ZIP: , r > —
F i E : 4 . } i_s•; -( �_ t •�_ ` l „ I t✓ •. _ _ Investigation per hour (1 hr mint 62,50
. Phone: ( ,,,..-7 .). %, ) c j. ( ` . ' , -•L `' " ' __ Fax. ) �. .... `� � .. Industrial plantpar ou 73 75
L ! ) ( , ) 4ff 1` 3 n i l: hr o,rev"d mt a 'r � th , :Jay'i 411 h gl .lei ;:ti'r
CCB Lic.: G- Ele c trical Lit' ' lc.: o , -
FS
t . � .� l .� 7,..., 5 Subtotal
Suprv. Electrician iignattlre, required: //10; Plan review (25% of permit fee) -
Print name: � a ls, s , ...:7'') , . — / __ .7 _ '`,. ( ` Date: Q (1.0 7 State surcharge (8% of permit fee) 3 „
�' ��- _ , �'" �,1 ( 2 ( ,C TOTAL PERMIT FEE Co
Authorized signature: This permit application expires If a permit Is not obtained within 180
' '' — days niter It has been accepted as complete
Print name: A -' JJJ b ate: --- •• Number of inspections per permit allowed.
Mlaunding\Pan ioNEILC•Perm&App.cbr,. 12103 d40•d61sT(10/02/CQM/wbrt
City Of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
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0
TI S 1%1 1
October 10, 2007 a7-
Garner Electric
2920 SE Brookwood Ave., #A
Hillsboro, OR 97123
Attn: Andrea Sumner
Re: Permit No. ELC2007 -00660
Dear Ms. Sumner:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12955 SW Oxalis Terrace
Project Name: Sorenson
Job No.:
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $40.48.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
\Bull ding \Refunds \Administra Lion \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
FRPM : aiRNER ELECTRIC FAX NO. :5036427925 Sep. 25 2007 03 : 11PM P1
. uZ/25/2007 08:50 FAX 5033981960 CITY OF TIGARD 2002
. ,
i 'ir
III .
' 1
Community Development
. Request for Permit Action
TO: CITY OP TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223 I
Phone: 503.716.2430 Fa= 5015981960 vw.tierd-or.gov
0 own I er
FROM: 0 Applicant 1 Co4ttactor El City Staff
(check onti) 1
REFUND OR Name;
•
INVOICE TO: C °r 1G2c__.
. 1
D Miffing Address: O 0
V s& Ave.i,.A--
City/State/Zip: Pi/ iSban ,iS 9712-3
0 $0
0 4;
Phone No: 503 6; ttk 4/5 ,P‘
—_.
. i
PLEASE TAKE ACTION POR THE ITEM(S) CHECKED (1):
Q CANCEL PERMIT APPLICATION.
REFUND PERMS FEES (attfiCh receipt, if available).
IIII INVOICE FOR FgEs DUE (attach case fee schedule and explain below).
D REMOVE CONTRACTOR FROM PERMIT (do not cancel penult). - i IGNFD
GIV ° svCAA
1 NIG ON
Permit #: ELC 70C=--&2(-____
Site Addressor Parcel #: J255 Sw o)Cct.; I;
Project Name: , k Lel‘_O_lrell 5 0 ijn '
'
Subdivision Name: 1 , 1
EXPLANATION: : (7, CAIVC_E t-.'L_________
! ,
. .
V
! ,
. .
- .
• Signature:
4 9 : . Att. .I/V AP .. At_. I ..I... Date: 7-2-5-;-02
Print Name: :AMD/2.? lLT.( ,Eil'INI
Brfencl PriVey
1. The Director or Bolding Official may aurbotixe the refund of: .
a) any fee which was ermenconaly paid or collected.
b) riot more than 80% of the li use applleAdon fee when an app8melon le withdrawn or catcalled before any review effort has been expended.
e) not more than 80% esf the land use application fee for issued pemtita, I
d) on more than RO% of the btulcrmaplan review fee when an application is canceled before any plan review effort ha: been upended.
e) not mote than 80% of die building permit fee for issued ponies prior Da any inspection reejums.
2. Reflande will be returned ro the origirol Payer in the tame method In which payment Vtag seedvaa Ream ellew 1 - 2 weeks for procoaang raihods.
I 4 ■F': t)1 1•102, ii._ ( )NI \
R t o t o S y s Mania: D a t e , 1 1 7 = 1 1 1 1 1 1 A t e t o B1- 1 • .... • Data , , 1. 13
Refund Processed: Date , AT 0 B _ a y:ha • Invoice Pd: Date
Permit Canceled; Date ,A47ArrEallJrtf:,7 Parcel int. Added; Date lialliiiii
ReCati2t # I — - IFEM72TVATI Method Am.:lit $
IABIdingi • own. RecTeemarAction.. V.V . 07/26/ .
i
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Garner Electric DATE: 10/9/07
2920 SE Brookwood Ave., #A
Hillsboro, OR 97123 REQUESTED BY: Dianna Howse
Attn: Andrea Sumner
TRANSACTION INFORMATION:
Receipt #: 2007 -4316 Case #: ELC2007 -00660
Date: 9/24/07 Address /Parcel: 12955 SW Oxalis Terr
Pay Method: CreditCard Project Name: Sorenson
EXPLANATION: Per appliant's request as job was cancelled. Refund 80 °A of permit fees.
:REF'U'ND: N ... FORMATION.
I
.. >FeezDescn t,on:From ROOT(
evenuerllccount
Example : <. UILD Permit Fee=
,. ,
[ELPRMT ] ELC Permit 220-0000-431510 $37.48
FAX] 8% State Surcharge 100- 0000 - 207020 3.00
TOTAL REFUND: $40.48
APPROVALS:
If under $500 Professional Staff t�
If under $7,500 Division Manager , " t� c l • c`
If under $22,500 Department Manager ` j ,<
J
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
✓ Case Refund Processed: I Date: I iC /je /p 7 I By: _
I. \13uilding \ Refunds \RefundRequest doc 05 /23/07