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Permit Support Document 71 q CITY OF TIGARD ELECTRICAL PERMIT II COMMUNITY DEVELOPMENT I Permit#: ELC2015-00493 TRC.ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 I Date Issued: 06/26/2015 ©17i 87 Parcel: 1S136CA02209 Jurisdiction: Tigard Site address: 10945 SW 79TH AVE Project: 15-32549 Subdivision: MARG TERRACE Lot: 9 Project Description: 2 ckts for NC and Receptacle.7/9/15:Reprinted permit to include(1)service. Contractor: PARKIN ELECTRIC INC Owner: ALLEN,JUDITH M 14001 FIR STREET 2545 SW 75TH TER OREGON CITY, OR 97045 PORTLAND, OR 97225 PHONE: 503-657-4958 PHONE: FAX: 503-557-1059 FEES Quantity Description Date Amount 1 ea Services or Feeders-200 07/09/2015 $100.70 Specifics: amps or less 2 crt Branch Circuits w/Purchase 06/26/2015 $14.84 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 07/09/2015 $13.86 Electrical Type of Const: 45 Misc Administration Fee 07/09/2015 $45.00 Occupancy Grp: 10 Cash Over 07/09/2015 $9.62 Total $184.02 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 952-001-0090. You may obtain a copy les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. `--- Issued By: Permittee Signature: � � �' 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. Electrical Permit Application i _/� FOR OFFICE USE ONLY City of Tigard �-�l. ' e/B : etc • i•5 g DateB : Permit No.: 1111 1 Phone:SW Hall Blvd.,Tigard,OR 97223 • = Phone: 503.718.2439 Fax: 503.598.1960 u. Other Permit: Inspection Line: 503.639.4175 r, Date Ready/By: Juris: TIG,\IZD p Supplemental SeePent2Inr Internet: www.tigard-or.gov Notified/Method: Supplemental Information r,+J., TYPE OF WORK t , PLAN REVIEW ❑ New construction [Q(A/ddition/alteration/replac�ll�nt p� Please check all that apply(submit 2 sets of plans w/items checked below): `_0 ❑Service or feeder 400 amps or more ❑Building over three stories. ❑ Demolition ❑Other: t`�i��v-OW' where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTIIO0 "' exceeds 10,000 amps at 150 volts or 0 Floating buildings. .x"� less to ound or exceeds 14,000 gr , , 0 Commercial-use agricultural 1 and 2-family dwelling ❑Commercial/industrial Itatetessory building amps for all other installations. buildings. ❑ Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. ❑Addition of new motor load of ❑"A","E","1-2","1-3", Job no.: Job site address: ` 1001W or more. occupancy. •� , (�(� 7122" ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP:7-r,' �'1 U,K ❑Health-care facilities. ❑Supply voltage for more than r t"4 ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: I Project name: ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I * New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 I Tax map/parcel no.: Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) A / / OY� I, ^„O Et/6 t ^ A Limited energy,multi-family iq. 75.00 2 200 rLi residential(with above sq.ft.) 1 Services or feeders installation,alteration,and/or relocation / •Wa L -to f ELI y i CX J. p �) e 200 amps or less / 100.70 IW.71 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or City/State/ZIP: relocation Phone: ( ) Fax:( ) 200 amps or less 59.36 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,alteratio o extension,per panel Owner signature: _ Date: A.Fee for branch circuits with n ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee ;,[ 7.42 I y r�, b' 2 each branch circuit r/r✓//�" Business name: B.Fee for branch circuits wit out service t feeder fee,first -� ��. di 2 Contact name: branch circuit Each add'l branch circuit of ri�N'__ Address: Miscellaneous(service or feeder not included) Each manufactured or modular City/State/ZIP: dwelling,service and/or feeder 67.84 2 Phone:( ) Fax: :( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E-mail: / (y ,✓k,h)Cicely)C- Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s)or limited-energy Business name:Parkin Electric panel,alteration,or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: 14001 Fir Street Additional inspection(1 hr min) 66.25/hr City/State/ZIP: Oregon City,OR 97045 Investigation(1 hr min) 66.25/hr Industrial plant(1 hr min) 78.18/hr Phone:(503)657-4958 Fax:(503)557-1059 Inspections for which no fee is 90.00/hr specifically listed('V hr min) CCB Lic.: 3515 Electrical Lic.: 34-4C Suprv.Lic.: 4241-S ELECTRICAL PERMIT FEES Subtot Suprv.Electrician signature,required: O Plan review(25%of permit fee): Print name: David B Parkin Date: State surcharge(12%of permit f TOTAL PERMIT FEE: Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as c Print name: Date: * Number of inspections allowed per permit. I:\Building\PermitsSELC-PermitApp.doc 07/01/10 440-4615T(I1/05/COM/WEB j=1-772777j I' q TIGARD City of Tigard August 6, 2015 Parkin Electric Inc 14001 Fir Street Oregon City, OR 97045 Re:Permit No. ELC2015-00493 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 10945 SW 79th Ave. Project Name: Allen Job No.: N/A Refund: ® Check#218213 in the amount of$9.62. ❑ Credit card "return" receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ Notes: If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. 1:\Building\Refundl\Wjni§W a\f,4C ePily4,'a'a',go 1, egon 97223 • 503.639:4171 TTY Relay: 50.684.2772 • 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: Parkin Electric DATE: 8/3/2015 14001 Fir Street Oregon City, OR 97045 REQUESTED BY: Dianna Howse BT TRANSACTION INFORMATION: Receipt#: 201599 Case #: ELC2015-00493 Date: 7/9/2015 Address/Parcel: 10945 SW 79th Ave. Pay Method: Check Project Name: Allen EXPLANATION: Refund over payment of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Cash Over 100-0000-48001 $9.62 TOTAL REFUND: $9.62 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff 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 ON Y Case Refund Processed: Date: /(v//" By: 4 f:\Building\Refunds\RefundReyuest.doc x 09/01/2010 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT r Request for Permit Action TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov I O: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits @tigard-or.gov FROM: ❑ Owner ❑ Applicant El Contractor r City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) l a trk(NI E/ccj p C.. - -c- Mailing Address: 111041 t,r 57 City/State/Zip: Q QA/ C. f O1 G 701e s- Phone No.: (S 65 7—y l cs 0 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): -:► VOID PERMIT APPLICATION. M REFUND ERMIT FEES (attach copy of original receipt and provide explanation below). • • ' • CE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: ��a(j15 Cd CT3 Site Address or Parcel#: %OC/k5 erJ Project Name: C.i', -c ' r /i�e e,( Subdivision Name: — Lot #: EXPLANATION: Con) t,*T CA,Z' cn ci- cruel , �c,�- ,.,,f. • '• C. • v� 7t) '- - � .- 743//5 Signature: �� Date: Print Name: �-�,//� et Refund Policy v�/ 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE I'SE ONLY Route to S s Admin: Date 747/12. B Route to Records: Date.®® Refund Processed: Date ,' ( ,.j By _ Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By I:\Building\Forms\RegPerrnitAction_092314.doc Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10945 SW 79TH AVE, TIGARD, OR, 97223 Residential - Electrical 199 Electrical ﬁnal PASS - No C of O ELC2015-00493 Herb Stabenow Violation Summary: Inspector Contractor