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Permit L. CITY OF TIG D j ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00221 T i G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/06/2010 Parcel: 2S110DD03100 Jurisdiction: Tigard Site address: 10530 SW CENTURY OAK DR Subdivision: SUMMERFIELD NO. 1 Lot: 38 Project: Doyle Project Description: New service and 2 branch circuits. 5/14/10, revising scope of work to (3) branch circuits, no service. Owner: FEES DOYLE, VIRGINIA Quantity Description Date Amount 10530 SW CENTURY OAK DR TIGARD, OR 97224 1 ea Services or Feeders - 200 05/06/2010 $100.70 amps or less PHONE: 2 crt Branch Circuits w /Purchase 05/06/2010 $14.84 Service or Feeder 1 ea 12% State Surcharge - 05/06/2010 $13.86 Contractor: Electrical A & E ELECTRIC OF OREGON INC PO BOX 684 BEAVERCREEK, OR 97004 PHONE: 503 - 632 -8515 FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: R -3 Total $129.40 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 acc 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. ATT TION: Oreg • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001- 10 through OAR 952 - 1 01 -01' Yo ay obtain a copy of the rules or direct questions to OUNC by calline • .. •.6699 or 1.800.332.2344. lest, d By: L Permittee 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 0N SIGNATURE OF SUPR. ELEC' -- �: Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an Inspection that business day. 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 ELECTRICAL PERMIT C COMMUNITY DEVELOPMENT Permit #: ELC2010 -00221 TIGARDJ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/06/2010 Parcel: 2S110DD03100 Jurisdiction: Tigard Site address: 10530 SW CENTURY OAK DR Subdivision: SUMMERFIELD NO. 1 Lot: 38 Project: Doyle Project Description: New service and 2 branch circuits Owner: FEES DOYLE, VIRGINIA Quantity Description Date Amount 10530 SW CENTURY OAK DR TIGARD, OR 97224 1 ea Services or Feeders - 200 05/06/2010 $100.70 amps or less PHONE: 2 crt Branch Circuits w /Purchase 05/06/2010 $14.84 Service or Feeder 1 ea 12% State Surcharge - 05/06/2010 $13.86 Contractor: Electrical A & E ELECTRIC OF OREGON INC PO BOX 684 BEAVERCREEK, OR 97004 PHONE: 503 - 632 -8515 FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: R -3 Total $129.40 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. / Issued By: Ito Permittee Signature: 5 k A pp, CA r3 CA. A./ 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 an inspection that business day. 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. May 05 10 10:44a A & E fll )R ' ;a , Dt •, Oregon 503 632 -8515 p. 2 Electrical Permit Application ' � ; ` � k 11 � MAY - 5 'i :. ,�, � -�� .�r��.�,��. � �� ; 1 .741 ' City of T igard veer I r No : 4 y� a�i r - 00 13125 SW Hall Blvd, Tigard, OR 972 1 ITY OF T IGARD clan Rc i � et: P hone: 503.63 9.4171 Fax 503.5 „ „° 9 9 DING DIVISION icy: Other Line: 503.639.4175 Permit r ' / B SeePage2 for i =r1;: l I c t www.tigard-or.gov J I, G Supplemental laformadoo TYPE. OF WORK PLAN REVIEW ❑ New construction f Addition/alteration/replacement Please check an Net apply (submit ii sets of plans switema checked below): ❑ O ther 0 Service or feeder 400 maps or mine 0 Building over throe stories. ❑ Demolition whae the available fault current 0 Marinas and boatyard& CATEGORY OF CONSTRUCTION ercoeds 10,000 amps 81 150 votes a 0 Floating bwldinga. less to ground. or exceeds 14.000 0 Commercial -use agriculbaal g 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installation. buildings. ❑ Multi - family ❑ Master builder ❑ Other: 0 1iro pip. 0Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION O y lam H . 0 Addition ofsaw motor bed of ❑ °A ", "E", °I "l - , Job no.: 1 Job site address: /053/) SA.) • y Oak Dr . 100 HP occupancy. cy // 0 Sir or more residential soils. O Raseational vehicle parks. City/State/ZIP: 7 AILt 1' et �(�j 9 � 2 V ❑llealtlKare facilities. 0 Supply voltage for more than / 0 flastudous locations. 600 volts nominal. Suite/bldgJapt. no.: 1 Project name: ()Service err feeder 600 amps or more. . FEE SCHEDULE Cross street/directions to job site De uiptaa 1 Otr- 1 Fee. 1 Total 1 • New residential siagk- or multi-family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 - r 4 00.: Ea. add'I 500 sq. ft or portion 33.92 - 1 Tax map/parcel Limited energy, residential 67.84 2 DESC3lUPTION: OF WORK (with above sq. ft.) Limited energy, multi - Gamily 67.84 2 residential (with above sq. ft.) Services or feeders installation, alteration. and/or relocation 200 amps or less I 100.70 /012.70 2 ❑ PROPERTY OWNER I 0 TENANT 20! amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 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: ( ) I 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, alteration. or extension, r panel Owner signature: Date: A Fee for branch circuits with ❑ APPLICANT I ❑ above service or fader fee, CONTACT PERSON ; each branch circuit Z 7.42 / H./9 2 Business name: B. Fee for brand, circuits hvithora service or feeder Gee, first 56.18 2 Contact name: branch circuit Each add'l branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) _ Each manufactured or modular 67.84 2 City/State/ZIP: dwelling, service and/or feeder Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited-energy Business name: Avg- 6. E.466,Yri C of �jQ Qd,m e �� /d - panel, alteration, or extension. Page 2 _ 2 l additional inspection over allowable is any of the above Address: per 9Ic 6 '9 /� Additional inspection (1 hr min) r 6625/hr City/SirltdZJP: SQ t file 9 7901 Investigation l (1 hr min) 6625/ hr Industrial pied (1 hr mute) 78.18/1u r Phone: ( 6 632-13515 I Fax: ( a b3,2.-- 8 575 . lei ,1 lnspeaiens ter which no fee is 9o.00f hr r l s 1 C I, specifically listed eh hr min) CCB Lic.: (4,24 Electrical Lic. :p4 _74 Suprv. Lie.: 3752.- 5 ELECTRICAL PERMIT FEES Suprv. Electrician signature, requiredy >_R _ ij Subtotal: �/� j 5t f U. " `^• -` Plan review (25e%of permit fee): °• ---- Print name: Dan i e) R. E. (I; 0 t Date: 5/5// 0 State surcharge (12% of permit fee): / 3 • Sb Authorized signature: TOTAL PERMIT FEE: /49, #2 This permit application aspires de permit is not obtained within 180 Print name: I Date: days after it has been accepted as complete • Number of inspections allowed per permit. City of Tigard, Oregon ® 13125 SW Hall Blvd. ® Tigard, OR 97223 • October 29, 2010 A & E Electric of Oregon, Inc. PO Box 684 Beavercreek, OR 97004 Attn: Daniel Elliott Re: Permit No. ELC2010 -00221 Dear Mr. Elliot: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 10530 SW Century Oak Dr. Project Name: Doyle Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $39.89. ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as scope of work changed; refund 80% of difference of permit fees (see attached). If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. I: \Building\ Refunds \Adminis tration \LtrRefund- Overpay.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 M I I City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: A & E Electric of Oregon, Inc. DATE: 10/22/2010 PO Box 684 Beavercreek, OR 97004 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 177841 Case #: ELC2010 -00221 Date: 05/06/2010 Address /Parcel: 10530 SW Century Oak Dr. Pay Method: CreditCard Project Name: Doyle EXPLANATION: Per applicant's request as scope of work was changed. Refund 80% of difference of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund • Example: Building Permit Fee Example: 2300000 -43104 $ Amount Electrical permit fee 2200000 -43103 $35.62 12% State Surcharge 1003100 -24001 $4.27 Permit Fees paid: $115.54 State surcharge paid: $13.86 Less new amount: 71.02 Less new amount: 8.52 Difference: 44.52 Difference: 5.34 at 80% = Refund: $35.62 at 80% = Refund: $4.27 TOTAL REFUND: $39.89 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager If under $25,500 Department Manager .— C If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: I Date: /e /v2 s/! U BY: 1 4 l: \Building \Refunds \RefundRequest.doc x 09/01/20111 May 11 10 03:54p A & E Electric Of Oregon 503 632 -8515 85/11/2818 13:19 SG:ibtfl'yan g ----„ p' 2 N,,-- RECEt\! �- MAY 11 2010 Community Development Request fox Permit Action CITY OF TIGARD BUILDING DIVI510N TO: CITY OF TIGARD . Building Division Services Coordinator 13125 SW Hall Blvd. Tigard, OR 97223 Phone 503.718.2430 Fate 503 - 598.1960 www.tigard- ot.gov FROM: ❑ Owner ❑ Applicant 0 Contractor ❑ City Staff (check onc) REFUND OR Name: INVOICE TO: (&relicts an tndir dua9 !, 4- 6- E dtd 7C. , a j,. . . Mailing Address: 59 SC b S y- Cit /State /Zip: 13 O.Q.4.e.i.e � G`e. 9 7O'2 Phone No.: 6'03 6 ..3 •• - es/5 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). INVOICE FOR FEES DUE (attach case fee schedule and explain below). REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: E La aa icy-- CX?.al Site Address or Parcel #: A9.5 o 544), Ces2u, oak Imo. T 9'742...z-f Project Name: _ Subdivision Name: Lot #: EXPLANATION: '4 s /21.41».-t 5 J `g-Pe -■ &ey hG� 3 Cat cu c-fs / ,Stu -, w M6 .SelAnc e..iole../ e4 15 .e4- , . 5 . A uric+ = 7. e,7- /'/.Syr gib. /g ---- y/.00 -x / .2/o 9.5. '7/•4 =79 - 1 Signature: �4:--Q i'_ D - Date: 51/0.o40 Print Name: l>14.1 ref 6/) 07t - 5 (, / P y' P 1. The Director at Building Official may authorire the refund of • a) any fee which oraa erroneously paid or calmed. 7 b) not more than 80 % oldie Mad UPC apprwatioo foe when an application v withdrawn or =ceded befroe any review effort brew bees expended / -, c) not mint than 8O% of the lord tare application foe for Seated pennies. T ' d) not mtae than 80% of the building plan review fee when an application is canceled before any plot review effort has bean eipended. ----- a) not more than FM of the budding petroit fee for issued penults prior to any inspection regncau. 2. Refundo will be returned to the enii final Payer in the swim m was in which payment as received. Please allow t -2 weeks for ptocersing redattde. ' I t l.. rsl l i..1 1 `•I: ,-.1 •, ' 9 /.O� IMECM2MINI Date L"' Rte to : • • Malin: Date /.. Refund Processed: Date AD L9 4, 'r' .�� Invoice Ptoceased: Date �- Parent Canceled Date ,. � 4 M Pateel T : Added Date ' 29 - 5 V Date S . 0 Method Amount 5 AZ - a 1: • ']ding \Flr.mutaa . wruenet inn. • .c ex 0712G 07 //, s :sy /3.cF4' . WI- Oa-. I - - -7/, o.2_ - . - 3s. ion- ce,sz 4.tfr-cl— -5 ,3 25, YO —g. a 7 �/ y y .5 ec �' 35, i . 4/'a-7 CITY OF TIGARD RECEIPT U C . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD /?. c L Receipt Number: 180188 - 10/29/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2010 -00221 $ -39.89 Total: S -39.89 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 000713 DHOWSE 10/29/2010 $ -39.89 Payor: David Elliot, A & E Electric of Oregon Total Payments: $ -39.89 Balance Due: $39.89 Page 1 of 1 CITY OF TIGARD RECEIPT n C _ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD O, f c- A14 Receipt Number: 177841 - 05/06/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2010 - 00221 Services or Feeders - 200 amps or less 2200000 -43103 $100.70 ELC2010 -00221 Branch Circuits w /Purchase Service or 2200000 -43103 $14.84 Feeder ELC2010 -00221 12% State Surcharge - Electrical 1003100 -24001 $13.86 Total: $129.40 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 000713 MVANDOMELEN 05/06/2010 $129.40 Payor: A & E Electric of Oregon David Elliot Total Payments: $129.40 - Balance Due: $0.00 Page 1 of 1 May 11 10 03:54p A 8. E Electric Of Oregon 503 632 -8515 p.3 FA/C. From: A & E ELECTRIC OF OREGON, INC. P.O. Box 684 Beavermeek, OR. 97004 Phone & fax: (503) 632 -8515 Date: /Q To: e / at /Ze i tel toe., F (.5703)59:—/960 Attn: /t#:4l 6 4-Gv2pio r Bea-/ Pages sent (mcluding cover):, c3 please call if you do not receive all pages Notes: e47.5i • par? a-7' 414€0100 a ssorn v - 12.401' ,e.ii"" /Me A.41 ` i tiL e'ra4:-/ .. ,... r 4• Id "° � \ CI 131Y5 RA1 RLUD 1I00D. OR. 97223 r 3 . - 0 ' 2 e ' y.A t...c..e% 4-.e4.0 TE01RRL 1.0.' BA17349828888313869031 I ( 6.5 q 71.° = ` I. US IT NBE13D658 X935 # 3 . 8 (p $,. SALE t 4 IMV= en DA Et lYIP 86. 1D mu 89118 S BOW S1Y OM 8A0713 1A9•41° --- ? `� • �g • 8 4 CPA '22P 9 DIGIT BP MMES, MESS DOES HOT TOTAL $129.48 ' I ASREE TO PAY ARGUE TOTAL HUNT ( RC RC D�ITN AO A EEONT ISSUER OEM IF Di CRER)