Permit F1 , !' r h ? i -, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELC2008 -00015
DATE ISSUED: 1/8/2008
T[GARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
°� "' "'"" PARCEL: 1S134DB -06900
SITE ADDRESS: 11102 SW TORLAND ST ZONING: R -4.5
SUBDIVISION: TORLAND ESTATES LOT : 007 JURISDICTION: TIG
PROJECT: DOVER
Project Description: Rewire due to tree strike.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNALJPANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 11 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA /SPEC OCC:
Owner: Contractor:
DANIEL DOVER SQUIRES ELECTRIC
11102 SW TORLAN D ST PO BOX 16851
TIGARD, OR 97223 PORTLAND, OR 97292
Phone: Contact #: PRI 503 - 252 - 1609
FAX 503 - 253 - 5831
FEES
Description Date Amount Reg #: ELE 26 -110IC
IELPRMII ELC Permit 1/8/2008 $120.00 LIC 135085
[TAXI 12% State 1/8/2008 $14.40 SUP 4882S
Total $134.40 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be • •.e in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspende• or more t ,n 180 says. ATTENTION: Oregon law requires you to follow rules adopted by th Oregon Utility Notification Center.
Those r es are set forthNn • - : - 001 -0010 through OAR 952 -001 -0100. You may obtain co • these rules or direct questions to OUNC at
503.24:.6699 or 1.800.3 -.
Issued :y: p �� 1 A 4 :Li Permittee ,gnature: i ��!"� `
' 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:
CO. RACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: �` — __� \ � 6 (Zrc 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.
01/07/2008 15:53 5032535831 SQUIRES ELECTRIC PAGE 02/02
Electrical Permit _!= it,;! jt; __ ' i. is E® ri�r orrice li`>r ctrv►a '
Cl of Ti and Received Pw t ni t No.: �����7
II g Plan Re / l o g �' �icC� B
-� . 13125 SW HaIi Blvd, T' O Sr722 1008
plan Review
* ' Phone: 503. 639-4171 MY 03.598. 6 Date/By: Other Permit:
O
Inspection Line: 503 � By Date Ready/By: nu DI See Page 2 far
TICiARI) p �� �
Notified/Method: Supplemental tio
Internet: wtwtv.tigar S+t�t`a pp rtn a
7
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❑ New construction A Addition/alteration/replacement Please check all that apply (subrmt 2 seta of plans whtems checked below
0 Service or feeder 400 amps or more 17 )3uilding over throe 6tortca.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
s s s s x s : <. a s s o. vscceds 10,000 s at 150 volts or ❑ Floating buildings.
: 1 a l S s s •• , • , 'sa..3'.+ 1;•� < <, s.:. s. S s:, less to ground, or exceeds 14,000 ❑ Commercial -use agriculture • 0 1- and 2 - family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations, building.
❑ Multi - family ❑ Master builder Q Other: ❑ Firc pump. ❑ Installation of 75 KVA or
;;,
f Emagcn system larger separately derived sy
'` < t<
i t •'1 ;4 gt( ::< < f f >.,.,.<.< . A :Z ' ° 0Addition of new motor load of ❑ A" "E» "1 -2 ,. 1 -3
Job no.: Job site address: t I I b , u 1a 1 o� Six or or more. Recreational occupancy vehicle parks.
c ity /State 5F.- 7? ❑ Health -taro facilitica. ❑ supp3,y voltage for more the
CJ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: A. 6 L it.0 Ly ❑ Service or feeder 600 amps or more
Cross street/directions to job site: nom -Hutton Qty. Fee Total
New residential single- or multi - family dwelling wilt.
Includes attached garage
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15
Tax ma / 1 n0.: Ea. add', 500 sq. fl. or portion 33.40
1�� Limited energy, residential
r-T^»'" s s e -> s� a , y ,S M ,y < s , o - < <> - i 75.00
• < a -1 v t < f S S c t* "°`^ ..i i .a..... f . S < < t. , (with ab°ve aq fl.)
. 7 � - Limited energy, multifamily 75.00
LO t re._ t? YtE' . a residential (with above sq. ft.)
Services or feeders installedo _alteration, and /or relocation
. f. I 200 amps or less 80.30
.. <, <.: >, ss.r�1 is Q ' : ' r . ' < > ° .'. i.:.'0. 201 amps to 400 amps 106.85
Name: DPI kt � ` . e---12- 401 am to 600 amps 160.60 _
t •C� 601 a mps to 1,000 amps 240 -60
Address: over 1,000 amps Or vott5 454.65
City /State/ZIP; Temporary services or feeders installation, alteration, and/o
relocation
Phone: ( ) I Fax: ( ) 200 amps or less _ 66.85
Owner installation; This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75
Branch circuits - new, alteration, or extension, der panel
Owner signature: Date:
i i ' i i `�.<. f �eTy s ti< s o s s x t ` i ' abo 'e service
OT feeder fee,
each branch circuit
Business name: B. Fee for branch circuits
Contact tame: first service or feeder fee, i 46.85 l g�
first branch circuit
Address! Each add'I branch circuit 11 6.65 ( • 1 •••••
-- Miscellaneous (service or feeder not included)
City/Statc/ZIP: Each manufactured or modular 90.90
dwelling, service and/or feeder
Phone: ( ) 1 Fax: : ( ) Reconnect only 66.85 •
E - mail; Pump or inigation circle 53.40
' :.:.F :. .;. ..:.E sl Vf dE ..�s s s s <� i .:: Sign OY outline lighting. 53.40
z , s z i :. .f s# , ., ss..i.. si io.....<,z<3oi.<..:,, �..,,` : , < < : .zs : _
9usixiess n ame �y y Signal circuits) or limt -
�`� Y .' _? , l e t t r 1 C energy panel, alterat or
Address p b 'lb i 1 g_5" j
extension. Describe' Page 2
Cit /State/Z1P v \ bie., ?17.).-9.1- Each additional inspection over allowable In any of the abov
i Per inspection 62.50
Phone: (,5Z� a 5 ,=)_ - / to d 9 I Fax. 5 ) , tt- . S Investigation per hour (1 hr min) 62.50
CCB Lie.:1,3 ��-0 e6 . 1 Electrical Lic - ( p (C1 Suprv. Lic.: se Industrial plant per how 73 75
s i .f...,.,00..40.,m0,-,,........„..,- ., ..
�0 �� O u
Suprv. Electrician signature, requi� Subtotal: ( , Q,,
Print name Je ...6915..4 f"e`'..� Date: '1 (7/(� Platt review &N. ofperrnit fee),
State aurehar o of permit fee):
Authorized signature; TOTAL PERMIT FEE: i, ,-
Print name: Date: This Permit- arolie tion eIirea if a permit h not obtained within 18
days after it has been accepted as complete.
- * Number of inspections allowed per permit.
lAguildinsaVe mitaLC- Permitaundoo 05/23/06 440 4615T(1 uo5 /COM/WEB '
- r
City of Tigard, Oregon o 13125 SW Hall Blvd. ® Tigard, OR 97223 14! `` -
:. ear v ` i,' „,„ r . 4 4. o
,
INOARD
June 3, 2008 , 3,",-, }:i ':
Squires Electric Inc.
P.O. Box 16851
Portland, OR 97292
Attn: Donna Toothman
Re: Permit No. ELC2008 -00015
Dear Ms. Toothman:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 11102 SW Torland St.
Project Name: Dover
Job No.: N/A
Refund: ❑ Check # in the amount of $ .
® Credit card "return" receipt in the amount of $107.52.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
I t( '- - " .F.7.7. i , ‘ -( - 1--j-e—
Dianna Howse
Building Division Services Coordinator
Enc.
I: \ Building\ Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772
r C I C. �¢oc /S
I in City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Squires Electric Inc. DATE: 6/3/08
P.O. Box 16851
Portland, OR 97292 REQUESTED BY: Dianna Howse
Attn: Donna Toothman
TRANSACTION INFORMATION:
Receipt #: 2008 -56 Case #: ELC2008 -00015
Date: 1/8/08 Address /Parcel: 11102 SW Torland St.
Pay Method: CreditCard Project Name: Dover
EXPLANATION: Per applicant's request as job was cancelled. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund',
Example: (BUILD] Permit Fee Example: 245 - 0000- 432000 $ Amount
[ELPRMT] ELC Permit 220 - 0000 - 431510 $96.00
[TAX] 12% State Surcharge 100- 0000 - 207020 11.52
TOTAL REFUND: $107.52
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager r I - :
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: 1 Date: Y :' ; 1 %? -r By:
1: \ Building \ Refunds \RefundRequest.doc 05/23/07
CITY OF 'TIGARD 5/23/2008
117
13125 SW Flail Blvd. 9:46:31 AM
Tigard, OR 97223 503.639.4171
.TIGAR.D,
Receipt #: 27200800000000000056 % ! c /v 1
Date: 0.1/08/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
ELC2008 -00015 [ELPRMT] ELC Permit 220- 0000 - 431510 120.00
ELC2008 -00015 [TAX] 12% State Surcharge 100- 0000 - 207020 14.40
Line Item Total: $134.40
•
Payments:
i\lelhod Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard SQUIRES ELECTRIC INC DEB 085809 fax 134.40
Payment Total: $134.40
acceipi.rrpi Pzuze I of I
rr CITY OF TIGARD 6/3/2008
il 13125 S ' Hall Blvd. 2:41:57PM
Tigard, OR 97223 503.639.4171
TIGARD
Refund Receipt #: 27200800000000001886 /2.4. . %" 4 -
Date: 06/03/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
ELC2008 -00015 Reversal - [ELPRMT] ELC Permit 220-0000-431510 (96.00)
ELC2008 -00015 Reversal - [TAX] 12% State Sur 100- 0000 - 207020 (11.52)
Line Item Total: ($107.52)
Refund:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal SQUIRES ELECTRIC INC. 085809 Fax (107.52)
Refund Total: ($107.52)
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• E5/23/2008 10:10 5032535831 SQUIRES ELECTRIC PAGE 01/01
r RECEIVED
—,
IIII
C ommunity Development MAY 2 3 2008
TIGARD Request for Permit Action CITY OFTIGARD
BUILDING DIVISION
TO: CITY OF TIGARD
• Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.59 8.1960 www_tigard -or.gov
FROM: ❑ Owner ❑ Applicant 04 Contractor ❑ City Staff
(check one)
REFUND OR Name: / I
INVOICE TO: (Business or Individual) w r e J ,r 1 p� r 1 C
Mailing Address: C g5
g Ss o ?max l�
V 1 D cit /state /zi : 1 D.YA-� Q b 1J'9.)-
p f
Phone No.: 60,' 5. - -/ a A 9
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( ✓):
[ ANCEL 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 #: , L e . 0 e- D 0 D 15
Site Address or Parcel #: 41 l b)- 4.30 c TE4- )a,s n 6 *.
Project Name: Thave 1'
Subdivision Name: /e0-4(.1 4.6 O e Lot #:
EXPLANATION: ' 1 Vi 1 14.ir aL 1,-.•
•
Signature: J A, C_ +, e Date: 5,215 Dr'
Print Name: lOfl►1ra- / T0Arna i
1. The Director or Building Official may authorize the refund o
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more then 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be renamed to the original Payer in the same method in which payment was received please allow 1.2 weeks for processing refunds.
Rte to Sys Adxnin: Date .5 Rg of Rte to Bldg Adxnua: Date (0 3 p By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt #Q,Q S n Date / /e /c G P Method G C Amount $ /gY,, Co
I:\ building \Fom \Re gPermitActioa. oc Rev 07/26/07 / cf y0
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