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Permit (10) 1 � City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT I all 1,11 iRe Request for Permit Actio n Nov 14 2019 GITYUF 1)G' .i 1,,,,p t} 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.ti t • , TO: 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 ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: f INVOICE TO: (Business or Individual) Clatter_ FLt//Qy- Mailing Address: )t/ 3 S- 3uj 50-fl - City/State/Zip: l rci ota Ot_ Q 1a,).Li Phone No.: i— 060 g& 3 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): D ,CANCEL/ OID PERMIT APPLICATION. rREFUND P RMIT FEES (attach copy of original receipt and provide explanation below). FOR'FEES DUE (attach case fee schedule and provide explanation below). Permit#: 1..C' (4 — Site Address or Parcel#: ly—(3 s-- f g C.f 0 Q- - Project Name: Subdivision Name: Vc\m sly* 0,0 C I( Lot#: Z EXPLANATION: aft 014,c oxii deel Signature: NA- Date: )1—/'-H / Print Name: 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. FOR OFI ICI; t'SL ONLI Route to Sys Admin: Date, MSie By 9.- Route to Records: Date efi. / B ,,t Refund Processed: Date /' f7 Z? l :••• , Invoice Processed: Date By Permit Canceled: Date , 9 I By ./ Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_1 0518.doc III d 7 TIGARD City of Tigard January 28, 2020 Pamela Elliott 14735 SW 84th Ct Tigard, OR 97224 Re: Permit No. ELC2019-00755 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: 14735 SW 84th Ct Project Name: Elliott Job No.: N/A Refund: ® Check#234459 in the amount of$24.94. ❑ Credit card "return" receipt in the amount of$ . ❑ Trust account"deposit"receipt in the amount of$ . Notes: Per applicant's request as scope of work changed resulting in reduction of permit fees. Refund overpayment. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. I:\Building\Refunds1\AdmuniSW�LtarlZetu d Uve•aTJ am4,I6/r�egon 97223 • 503.639.4171 TTRe1lay: 50�3.684.2 72 • 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: Pamela Elliott DATE: 1/17/2020 14735 SW 84th Ct Tigard, OR 97224 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 426674 Case#: ELC2019-00755 Date: 10/28/2019 Address/Parcel: 14735 SW 84th Ct Pay Method: Cash Project Name: Elliott EXPLANATION: Per applicant's request as scope of work changed. Refund overpayment. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Cash Over 100-0000-48001 $24.94 TOTAL REFUND: $24.94 APPROVALS: SIGNAT ES/DATE: If under$5,000 Professional Staff 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 FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: �f/3 /Z % By: ,fd I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 11111a; 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD' Project Name: ELLIOTT Site Address: 14735 SW 84TH CT /"— /lr4AO Receipt Number: 436200 - 09/03/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2019-00755 $-24.94 Total: $-24.94 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 234459 DHOWSE 09/03/2021 $-24.94 Payor: Pamela Elliott Total Payments: $-24.94 Balance Due: $24.94 Page 1 of 1 CITY OF TIGARD RECEIPT i•;, 13125 SW Hall Blvd.,Tigard OR 97223 '. 503.639.4171 TFGAR.t3 Project Name: ELLIOTT Site Address: 14735 SW 84TH CT i/E74) Receipt Number: 426674 - 10/28/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2019-00755 Services or Feeders-200 amps or less 220-0000-43103 $100.70 ELC2019-00755 12%State Surcharge-Electrical 100-0000-24001 $12.08 ELC2019-00755 Cash Over 100-0000-48001 $24.94 --- Total: $137.72 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Cash JDRINKWATER 10/28/2019 $137.72 Payor: Pamela Elliott Total Payments: $137.72 Balance Due: $0.00 i Page 1 of 1 CITY OF TIGARD RECEIPT "_ a` 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Tft;Ati.1:3 Project Name: ELLIOTT Site Address: 14735 SW 84TH CT �G-r/J4't..- Receipt Number: 426674 - 10/28/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2019-00755 Services or Feeders-200 amps or less 220-0000-43103 $100.70 ELC2019-00755 Branch Circuits w/Purchase Service or 220-0000-43103 $22.26 Feeder ELC2019-00755 12%State Surcharge-Electrical 100-0000-24001 $14.76 Total: $137.72 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Cash JDRINKWATER 10/28/2019 $137.72 Payor: Pamela Elliott Total Payments: $137.72 Balance Due: $0.00 Page 1 of 1 - CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2019-00755 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �' Date Issued: 10/28/2019 Parcel: 2S112BC01800 /1 . 4/ ' " Jurisdiction: Tigard Site address: 14735 SW 84TH CT Project: ELLIOTT Subdivision: HAMBACH PARK Lot: 2 Project Description: Replacing 200 amp service panel and adding(3)branch circuits and garage. 11/14/2019: REPRINT permit to remove branch circuits. Contractor: OWNER Owner: ELLIOTT,THOMAS SCOTT& PAMELA THOMAS SCOTT AND PAMELA ELLIOT 14735 SW 84TH CT 14735 SW 84TH TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 971-506-5683 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 10/28/2019 $100.70 Specifics: amps or less 1 ea 12%State Surcharge- 10/28/2019 $12.08 Type of Use: SF Electrical Class of Work: ALT 25 Cash Over 10/28/2019 $24.94 Type of Const: Occupancy Grp: Total $137.72 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 ossuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notifi,a on Center. Those rules are set forth in OAR 952-001-0010 through OAR 52-001-0090. You.r,ray p�/'p)a co of the rules or direct questions to OUNC by calling 0 232.19 7 or 1.090 332.2344. Issued By: — Permittee Signature: 4‘ , ?°';�� .4.•` � :�k '.. 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. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 114 NOV 14 ZQ19 Request for Permit Action T i G A R 1) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigitcn-L'r` Ni D91 SI I f, TO: 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 ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: �� INVOICE TO: (Business or Individual) ° �(�`^ ' / iar Mailing Address: )/4 7 3 S 3w ' ' - City/State/Zip: \ cq er(& ( L C1 ,),)- Phone No.: q .) 1—SO(p—g&g3 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR`FEES DUE (attach case fee schedule and provide explanation below). Permit#: F LL4 ( 1 __ Do-7S Site Address or Parcel#: l 13 . 1*"C..1 01 Q ii--- Project Name: Subdivision Name: 4 bwh i'`0 C 'L Lot#: 7 EXPLANATION: 11� _ _ \\bde_ ovu_ ot& 6/41 -0.4 r Signature: P.PI-kat Date: ))`/ '/ / Print Name: 4 Vik-k 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. FOR OFFICE USE ONLY Route to Sys Admin: Date/l/('r///4 By 9 T Route to Records: Date By Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_120518.doc CITY OF TIGARD ELECTRICAL PERMIT a COMMUNITY DEVELOPMENT Permit#: ELC2019-00755 T j t~;;\R ID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/28/2019 Parcel: 2S112BC01800 Jurisdiction: Tigard Site address: 14735 SW 84TH CT Project: ELLIOTT Subdivision: HAMBACH PARK Lot: 2 Project Description: Replacing 200 amp service panel and adding(3)branch circuits and garage. Contractor: OWNER Owner: ELLIOTT, THOMAS SCOTT&PAMELA THOMAS SCOTT AND PAMELA ELLIOT 14735 SW 84TH CT 14735 SW 84TH TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 971-506-5683 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 10/28/2019 $100.70 Specifics: amps or less 3 crt Branch Circuits w/Purchase 10/28/2019 $22.26 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12%State Surcharge- 10/28/2019 $14.76 Electrical Type of Const: Occupancy Grp: Total $137.72 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 o issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you e follow e ru- adopted by the Oregon Utility Notifica'on Center. Those`-.rules are set forth in OAR 952-001-0010 through OAR 952-0 0090. u ma ''btain a Apy o e rules or direct questions to OUNC by calling 50 .232.1987"«r 1.800.„3132. 344. � Issued By: A4,// 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 holt of i icl.: LSI:0y1.1 City ofTigard Received / (Th g Date/B : C e/ iA1,I MI 4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Date/B : Related Permit#: Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: Rids: !0 See Page 2 for TI G A R D Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑New construction 0 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. ❑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. ig 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. 0 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 0 Addition of new motor load of system. Job#: Job site address: �Li 17 Th- GO 31 e 4 I OOHP or more. ❑" occupancy. City/State/ZIP: T�(b n p i ot—pc) ❑Six or more residential units. P y J ❑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: /40(1/ 0( /�J/&n FEE SCHEDULE t Description I Qty. I Each I Total * 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'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 /. ,,l ` y�. A (with above sq.ft.) NE`EW GGA- V fi/t�ei775 !Og, er�U"E ANN, 7Ay Limited energy,multi-family 75.00 2 67/ . 4 - ger�Wc f.U/ �P/i/VaG W/77-/ )/4 residential(with above sq.ft.) �-t c / /r Renewable Energy 0 See Page 2 ti PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: �+.,` S '(`1-- .1 ,Atcle- E Li O' 200 amps or less j 100.70 2 Address: ii.-/7-')s- S W `1 '� e 201 amps to 400 amps 133.56 2 l..l�u` 401 amps to 600 amps 200.34 2 City/State/ZIP' �1 r-iiii O� ZZU 601 amps to 1,000 amps 301.04 2 Phone:III •- ��3 0.i _ (�`. Over 1,000 amps or volts 552.26 2 9 Temporary services or feeders installation,alteration,and/or Email: "7:,� LLI CO" rn p) 1 ,0 c relocation Owner installati •This installati is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,l4a ,rent, r exchange,accord'n to ORS 447,449,670, nd 701. 201 amps to 400 amps 125.08 2 Owner signature: t� c j (, Date: rl Zs 1 401 amps to 599 amps 168.54 2 Branch circuits—new,alteration,or extension,per panel 0 APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: ?-'"V-4° B.Fee for branch circuits without service or feeder fee,first 56.18 _� 2 Address: 1 ..OD' branch circuit City/State/ZIP: Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder 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 ❑ See Page 2 2 Address: panel,alteration,or extension. Each additional inspection over allowable in any of the above City/State/ZIP: Additional inspection(1 hr min) 66.25/hr Phone:( ) 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 Lic.: Electrical Lic.: Suprv.Lic.: specifically listed(''A hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: Print name: Date: 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signature: 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. 1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. I Each I Total j * 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 n Audio 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 n Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) ❑ Heating, 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: n 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(Y hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical n Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling n Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 10/26/2017