Permit (136) `III a •
TIGARD
City of Tigard
April 4, 2019
Heather White
14430 SW 94th Ct
Tigard, OR 97224
Re: Permit No. F.I.C2019-00134
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14430 SW 94th Ct
Project Name: White
Job No.: N/A
Refund Method: ® Check#231734 in the amount of$70.27.
❑ Credit card"return"receipt in the amount of$ .
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit"receipt in the amount of$ .
Comment(s): Per applicant's request as they took out the permit for the wrong item
and electrician will obtain permit for the work. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincceereelly,
Dianna Howse
Building Division Services Supervisor
Enc.
1
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard
C
T c n R a 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 PermitAction form (if applicable) must
be attached to this request form. Refund requests are due toAccela 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: Heather White DATE: 3/29/2019
14430 SW 94th Ct
Tigard, OR 97224 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 421793 Case#: ELC2019-00134
Date: 2/28/2019 Address/Parcel: 14430 SW 94th Ct
Pay Method: CreditCard Project Name: White
EXPLANATION: Per applicant's request as they took out permit for the wrong thing. An electrician will
obtain permit for work. Refund 80%of permit fees.
;`.u,,' " s ,.«,. 0 •�w,aus ,a� ,+„, ,,;a_.. .�,�.....,.,,,r.-.raa,�s,..;:�e,..�.,.... ;s,:n.�.k,..�,,...��s .„.�,... a.:.._ ..�
p
• •°�,�
k to
'024i `� 9s art"; axe � �� �`.� ,.r �• � '��`��"ssgs��a
� + •- - -- �1 "�. o,�.e^ ,��.¢-.,.2�..,mss.,ru.�''.
Electrical Permit 220-0000-43103 $62.75
12%State Surchar•e 100-0000-24001 7.52
TOTAL REFUND: $70.27
APPROVALS: SIGN`` S/DATE:
If under$5,000 Professional Staff I� •i
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
'
t
Case Refund Processed: Date: S /y By: �-.'
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD _ ELECTRICAL PERMIT
I1 ' COMMUNITY DEVELOPMENT Permit#: ELC2019-00134
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/28/2019
T i ''�1:0 g Parcel: 2S 111 AB08500
Jurisdiction: Tigard
Site address: 14430 SW 94TH CT
Project: WHITE Subdivision: PENROSE TERRACE Lot: 30
Project Description: (4)branch circuits for new bedroom converted from portion of bonus room.
Contractor: OWNER Owner: WHITE, HEATHER
HEATHER WHITE 14430 SW 94TH CT
14430 SW 94TH CT TIGARD, OR 97224
TIGARD, OR 97224
PHONE: 360-901-3429 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 02/28/2019 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 02/28/2019 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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: Or n 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 RAR 52- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
r
eZe
Issued By: l 4 ''J .., 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 UV-A"-
`"- Dater 1 r r I
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 Applicatia ECEIVED FOR OFFICE USE ONLY
City of Tigard FEB 2 8 2019 Received .-a/S vP� i� �1,,/ �y�y/ .
Date/B �J " Permit#: GL - e
n 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C+
C Phone: 503.718.2439 Fax: 503.598.1 lY OF TIGARD Date/B : Related Perm �c�f�y O//—���
Inspection Line: 503.639.4175 BUILDING DIVISION Ready Date/By: Jmis: B See Page 2 for
TIGARD
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system
Job#: Job site address: 14430 SW 9405 Ct
IOOIIP or more. ❑"A" "E" "1-2" "1-3"
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:McDonald and 93"Ave FEE SCHEDULE
Description I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Adding three electrical plugin outlets to downstairs bedroom.
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
® PROPERTY OWNER ❑ TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name:Heather White 200 amps or less 100.70 2
Address: 14430 SW 94th Ct 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard,OR 97224 601 amps to 1,000 amps 301.04 2
Phone:(360)901-3429 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 for sale,leas ,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: iLittre Date:_ I `(ci 401 amps to 599 amps 168.54 2
0 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: panel,alteration,or extension. g
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
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed(i2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 71- 4/9.
Print name: Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): q, l%7
Authorized signature: TOTAL PERMIT FEE: 3 r, ,1
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:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/CAM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENT AL WOR ONLY: SCI1EDUL
Description I Qty. Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
(1 A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
(1 H• eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
• Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/2 hr min)
COMMERCIAL L ORK ONLY:: EltsePRICAL PERMIT PEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ A• udio and Stereo Systems
n B• oiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
Fl Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ N• urse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
1\Building\Permits\ELC_PemtitApp_ELR_ERE.doc Rev 06/17/2015