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Permit KIMCITY OF TIGARD ELECTRICAL PERMIT . COMMUNITY DEVELOPMENT Permit#: ELC2015-01004 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/23/2015 Parcel: 2S103DD00413 Jurisdiction: Tigard Site address: 10860 SW FAIRHAVEN ST Project: Bauer Subdivision: FAIRHAVEN COURT Lot: 5 Project Description: Add(2)200 amp panels to replace existing service panel. Contractor: OCHSNER ELECTRIC INC Owner: BAUER, CLAYTON D& DIANE E 8724 SE YAMHILL ST 10860 SW FAIRHAVEN ST PORTLAND, OR 97216 TIGARD, OR 97223 PHONE: 503-254-0015 PHONE: FAX: 503-254-8126 FEES Quantity Description Date Amount 2 ea Services or Feeders-200 12/23/2015 $201.40 Specifics: amps or less 1 ea 12%State Surcharge- 12/23/2015 $24.17 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $225.57 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 OA 2-001- Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.2332.1,99887 por 1.80000 33�2.2�3444. �L Issued By: Permittee Signature: '6)wr `� r✓ wvl� 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. M--ST v o a RECEIVED Electrical Permit Application DFC 2 3 2015 City of Tigard p q�pp,, 4 Received Permit N: 13125 SW Hall Blvd-Tigard,OR 97223 0 a V alp' � GA °,a;;Review Phone: 503.718.2439 Fax: 503.598.1 �p6�7i �`��,�tJ ate/B : Related PettrJil Inspection Line: 503.639.4175 WILDING a Ready Date/By: 13 See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction ®AdditiuiL/tdteratiun/replaceutent Please check all that apply(suhmit 2 sets of pkms w/ilemn checked): 17-1 Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards. CATEGORY OF CONS"IRIICTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commermal-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 K VA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address: 10860 SW Fairhaven St ❑Addition of new motor load of system. I001111ormore. ❑"A" "E""1-2""I-Y" City/State/ZIP:Tigard,Oregon 97223 ❑Six or more residential units. occupancy. ❑Health-care facilities. ❑Recreational vehicle parks. Hazardous locations. ❑Supply voltage for more than Suite/bldg./apt.#: Project name: tEh e C o. f(bt C✓ ❑Hdoli ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/direclions to job site: FEE SCHEDULE Description I Qty. I Each I 'r'oml New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ga.add'I 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 200 amp service upgrade and panel change (with above sq.11.) 75.00 z Limited energy,multi-family 75,00 2 residential(with above sq.It.) Renewable Ener ❑ See Page 2 ❑ PROPERTY OWNER El TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 2 100.70 201.40 2 Address: 201 turps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended I'or sale,lease,rent_or exchange,according to ORS 447,449,670,and 701. 201 amps In 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 ❑ APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder tee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without service or Address: branch circuitder fee,first 56.18 2 City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous service or feeder not included Phone:( ) Fax::( ) Each manufactured or modular 67.84 2 dwcllin ,service and/or feeder Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Ochsner Electric,Inc Sign or outline lighting 67.84 2 Signal circuits)or limited-encrgy ❑ See Page 2 2 Address:8724 SE Yamhill St panel,alteration,or extension. Each additional inspection over allowable in any of the above City/State/ZIP:Portland,Oregon 97216 Additional inspection(1 hr min) 66.25/hr Phone:(503)254-0015 Fax:(503)254-8126 Investigation(I hr min) 90.00/hr Industrial plant(I hr min) 78.18/hr Email:jochsner2@msn.com Inspections for which no fee is CCB Lie.: 88522 / Z(� L ectric 26-8230 Suprv.Lic.: 5363 specifically listed(F.hr min) 9000/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,requireSubtotal: 201.40 Print name: Justin K.Ochsner Date: 12-10-2015 ❑Plan Review Required(25%of permit fee): 0 State surcharge(12%of permit fee): 24.17 Authorized signature: TOTAL PERMIT FEE: 225.57 '!'his permit application espins if o permit is not obtained within 1811 Ur:.,r.,o.,+.+ fhre. dove nRnr it hav Iv.nn prronhwi�c rmm�lrtr i .i TIGARD City of Tigard January 28, 2016 Clayton Bauer 10860 SW Fairhaven St Tigard, OR 97223 Re:Permit No. MST2015-00125 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: 10860 SW Fairhaven St Project Name: Bauer Job No.: N/A Refund: ® Check#219904 in the amount of$58.18. ❑ Credit card"return" receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ Notes: Refund overpayment of electrical permit fees for reduction of electrical work on MST that was covered under separate permit ELC2015-01004. If you have any questions please contact me at 503.718.2430. • Sincerely, Dianna Howse Building Division Services Coordinator Enc. 1:\Building\Refun ; , niStWIRKW: ,;r,T. roidlcArtgon 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 ibr Permit Action totln (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 P`._ 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: Clayton Bauer DATE: 1/21/2016 10860 SW Fairhaven St Tigard, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 401038 / '2'10 e '7 Case #: MS-F013-00125 Date: 12/15/2015 7 7/.221,10.5'.5 Address/Parcel: 10860 SW Fairhaven St Pay Method: Check Project Name: Bauer EXPLANATION: Refund portion paid for electrical service work that was completed under separate permit ELC2015-01004. REFUND INFORMATION: Fee Description From Receipt Revenue Account No.. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Electrical Permit 220-0000-43103 $51.9.1- 12°4, State Surcharge 100-0000-24001 6.24 TOTAL REFUND: $58.18 APPROVALS: SIGNAT :ES/DATE: If under$5,000 Professional Staff ( .77&71--e If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 Cit Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: /7.,2,f//4.7 By: ...d) I:\Building\Refunds\RefundRecluest.doc x 09/01/2010