Permit (107) CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2017-00948
T[ ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/26/2017
Parcel: 2S104CA02400
Jurisdiction: Tigard
Site address: 13607 SW LAUREN LN
Project: Middleton Subdivision: HILLSHIRE Lot: 24
Project Description: (1)panel and(1)branch circuit for(5)receptacles,(1)smoke detector,and(4)can lights.
Contractor: OWNER Owner: MIDDLETON, NEWELL GRANT&MICHEL
NEWELL MIDDLETON 13607 SW LAUREN LN
13607 SW LAUREN LN TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-747-8959 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 12/26/2017 $100.70
Specifics: amps or less
1 crt Branch Circuits w/Purchase 12/26/2017 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 12/26/2017 $12.97
Type of Const: Electrical
Occupancy Grp:
Total $121.09
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 obtai ... . the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
���,
Issued By: c, _ Permittee Signature: e" ,/'�
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 1 O R (I1-1 1( 1 I ,, (0.1 'i
City of Tigard +eceived �[ff�:., Permit#:
13125 SW Hall Blvd.,Tigard,OR 97223an _
I Phone: 503.718.2439 Fax: 503.598.19 !cvN D Review Related Permit#: >: C`
i i �\i Inspection Line: 503.639.4175 •1 Ready Date/By: 10 •See Page 2 for
) Internet: www.tigard-or.gov q a 7\1\+ Notified/Method: � Supplemental Information
TYPE OF WORK ��� !�II
PLAN REVIEW
New construction (` (t'�N ry Please check all that apply(submit 2 sets of plans w/items checked):
❑ ®Addition/alteration/r fr
Te r + Elce or feeder 400 am Servi
❑Demolition 0 Other:
t j Ps or more ❑Building over three stories.
> i where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTR''ii't . exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other:
El Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:13607 SW Lauren Ln 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard/OR/97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 244 ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 6°0 volts nominal.
Cross street/directions to job site:Off of 135th ave FEE SCHEDULE
Description I Qty. I Each I Total I .
New residential single-or multi-family dwelling unit.
Subdivision:Hillshire Lot#:24 Includes attached garage.
Tax map/parcel#:2S104CA02400 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
1.0.,. /"\'. Cor- .-t- 6 (with above sq.ft.)
7` t, Limited energy,multi-family
ti p, - '-\-. (i 31,�- residential(with above sq.ft.) 75.00 2
14 PROPERTY OWNER ❑ TENANT Renewable Energy 1:1 See Page 2
Services or feeders installation,alteration,and/or relocation
Name:Newell Middleton 200 amps or less / 100.70 ton,?v 2
Address:13607 SW Lauren LI)1 201 amps to 400 amps 133.56 d 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard/OR/97223 601 amps to 1,000 amps 301.04 2
Phone:(503)747-8959 Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature_door Date: 12126//` 401 amps to 599 amps 168.54 2
0 APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, I 7 42 7 ) 2
each branch circuit 1
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular
dwelling,service and/or feeder
Email: 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90hr
CCB Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(Y2 hr min) �/
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: ((J
Print name: Date: ❑Plan Review Required(25%of permit fee): —State surcharge(12%of permit fee): i 9_••"'(
Authorized signature: TOTAL PERMIT FEE: foil C
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\BuildiogTermits\ELC PermitApp_ELR ERE.doc Rev 06/17/2015 440.4615T(11/05/COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13607 SW LAUREN LN, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Electrical ELC2017-00948
Inspection Type: Inspector:
199 Electrical final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
City TI ofGARD Tigard
March 1,2018
Newell Middleton
13607 SW Lauren Ln.
Tigard, OR 97223
Re:Permit No. ELC2017-00948
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: 13607 SW Lauren Ln
Project Name: Middleton
Job No.: N/A
Refund: ® Check#227728 in the amount of$58.17.
❑ Credit card "return"receipt in the amount of$
0 Trust account"deposit"receipt in the amount of$
Notes: A change in the scope of work reduced permit fees;refund difference.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
\Building\Refunds is5N„ itAY6il,erfp'a iga46Wegon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit ernut Actio
TI G A R C) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718' t gov
TO: CITY OF TIGARD JAN 01
Building Division CITY OF '$G AR
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 3-598-1960 Tig : �n e ''stflInrr4l`1-or.gov
FROM: ❑ Owner pplicant ❑ Contractor D City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Ncc .
Mailing Address: 1 � � '-.j 4.5
City/State/Zip: t Z l 7-Z 7 3
Phone No.: SG_j 74 -
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL/VOID PERMIT APPLICATION.
®- REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
0 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: LC"'
Site Address or Parcel#: (3 C,GJ-- 2%,J- ,_ - '
Project Name:
Subdivision Name: Lot#:
EXPLANATION: ' 7c'f test—, - &y k4<<
Signature: Date: 0(// '/ /b
Print Name: l�y ikt
Refund Policy
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. , 9 .2 — *7 `, , A � rr✓s
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FOR OFFICE USE ONLY ,T9L �
Route to Sys Admin: Date % t By .!"1 Route to Records: Dates y2 /
Refund Processed: Date�/ � B x'01 Invoice Processed: Date' B, '�' /
Permit Canceled: Date Byy � C(iicJ
�� Parcel Tag Added: Date By
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