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Permit 7/3-gb U a c _c) 6) (() b ►rztitir_L„ c r c, II : CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2010 -00303 Date Issued: 06/18/2010 ? F G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134ACO2631 Jurisdiction: Tigard Site address: 11105 SW COTTONWOOD LN Subdivision: ENGLEWOOD NO. 3 Lot: 188 Project: Martin Project Description: (2) branch circuits for hot tub and service outlet. 6/24/10 added (2) branch circuits B.T. 7/16/2010 add (1) 200 amp service /feeder for hot tub. 7/28/10 added (1) feeder and (1) branch circuit per Gary Noble. (B.T.) Owner: FEES MARTIN, EDWARD Quantity Description Date Amount 11105 SW COTTONWOOD LN TIGARD, OR 97223 2 crt Branch Circuits 06/18/2010 $63.60 wo /Purchase Service or PHONE: 971 - 221 -6911 Feeder 1 ea 12% State Surcharge - 06/18/2010 $7.63 Electrical Contractor: 15 da Electrical Permit 06/24/2010 $14.84 PRECISION NW ELECTRICAL 2 da 12% State Surcharge - 06/24/2010 $1.78 12020 SE ANNA CT Electrical DAMASCUS, OR 97009 101 da Electrical Permit 07/16/2010 $100.70 PHONE: 503 - 413 -9870 12 da 12% State Surcharge - 07/16/2010 $12.08 FAX: 503 - 594 -2873 Electrical 108 da Electrical Permit 07/28/2010 $108.12 13 da 12% State Surcharge - 07/28/2010 $12.97 Electrical Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $321.72 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 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: / !cif -- Permittee Signature: L- X-ik.3- \- A , - 1 V 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. CaII 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. (o//o Cad )) Bc&vciA Gr“, ; is e r ' CITY OF TOGAR® ELECTRICAL PERMIT w f s x q 2 II °W COMMUNITY DEVELOPMENT f Permit #: ELC2010 00303 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/18/2010 ai -.E Parcel: 1 S134ACO2631 Jurisdiction: Tigard Site address: 11105 SW COTTONWOOD LN Subdivision: ENGLEWOOD NO. 3 Lot: 188 Project: Martin Project Description: (2) branch circuits for hot tub and service outlet. 6/24/10 added (2) branch circuits B.T. • Owner: FEES MARTIN, EDWARD Quantity Description Date Amount 11105 SW COTTONWOOD LN TIGARD, OR 97223 2 crt Branch Circuits 06/18/2010 $63.60 wo /Purchase Service or PHONE: 971 - 221 -6911 Feeder 1 ea 12% State Surcharge - 06/18/2010 $7.63 Electrical Contractor: 15 da Electrical Permit 06/24/2010 $14.84 PRECISION NW ELECTRICAL 2 da 12% State Surcharge - 06/24/2010 $1.78 12020 SE ANNA CT Electrical DAMASCUS, OR 97009 PHONE: 503 - 413 -9870 FAX: 503- 594 -2873 Type of Use: SF 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: 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 B ��� Perm ittee Signature: ....=:C f x/! /1/9/ 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. r CITY OF TIGARD ELECTRICAL PERMIT , • - •:''_:,...4: , .-''' , • COMMUNITY DEVELOPMENT Permit #: ELC2010 00303 ` Date Issued: 06/18/2010 T1G PADs 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S134ACO2631 Jurisdiction: Tigard Site address: 11105 SW COTTONWOOD LN Subdivision: ENGLEWOOD NO. 3 Lot: 188 Project: Martin Project Description: (2) branch circuits for hot tub and service outlet Owner: FEES MARTIN, EDWARD Quantity Description Date Amount 11105 SW COTTONWOOD LN 2 crt Branch Circuits 06/18/2010 $63.60 TIGARD, OR 97223 wo /Purchase Service or PHONE: 971 - 221 - 6911 Feeder 1 ea 12% State Surcharge - 06/18/2010 $7.63 Electrical Contractor: PRECISION NW ELECTRICAL 12020 SE ANNA CT DAMASCUS, OR 97009 PHONE: 503 -413 -9870 FAX: 503- 594 -2873 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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. l - f p ®/v "7 G / C/--77 0 A) Issued By: ` °�" "-u'`� 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 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. t ELECTRICAL PERMIT .: '. CITY OF TIGARD ` _ COMMUNITY DEVELOPMENT Permit #: ELC2010 -00303 Date Issued: 06/18/2010 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel; 1S 134ACO2631 Jurisdiction: Tigard Site address: 11105 SW COTTONWOOD LN Subdivision: ENGLEWOOD NO. 3 Lot: 188 Project: Martin Project Description: (2) branch circuits for hot tub and service outlet. 6/24/10 added (2) branch circuits B.T. 7/16/2010 add (1) 200 amp service /feeder for hot tub. Owner: FEES MARTIN, EDWARD Quantity Description Date Amount 11105 SW COTTONWOOD LN 2 crt Branch Circuits 06/18/2010 $63.60 TIGARD, OR 97223 wo /Purchase Service or PHONE: 971 - 221 - 6911 Feeder 1 ea 12% State Surcharge - 06/18/2010 $7.63 Electrical Contractor: 15 da Electrical Permit 06/24/2010 $14.84 PRECISION NW ELECTRICAL 2 da 12% State Surcharge - 06/24/2010 $1.78 12020 SE ANNA CT Electrical DAMASCUS, OR 97009 101 da Electrical Permit 07/16/2010 $100.70 PHONE: 503 -413 -9870 12 da 12% State Surcharge - 07/16/2010 $12.08 FAX: 503 - 594 -2873 Electrical Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $200.63 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 0 • R 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: it AtAW � Permutes Signature: t2/ /9 / ' ' , -' 6 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 503.639.4176 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. Electrical Permit Application Aa •,`. 1 clli oi 1 Ic is lltil: oil N. City of Tigard l tit 1.4\ Date /B ( �I • y/ Permit No.: �� iId C) — ° 13125 SW Hall Blvd., Tigard, OR 972 /4 0 ` \� Other Permit: Phone: 503.639.4171 Fax: 503.598.1960 J� ��� �� Inspection Line: 503.639.4175 � \``,.. � ` s ate Ready/By: . . VI See Page 2 for T R , A R D ^' �,A �j ' ' Internet: www.tigard- or.gov C� �` `�-i — :V II TYPE' OF WORK 9� J PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. 11 • CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ l- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family • ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE 'INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor Toad of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: 100HP or more. occuPaney. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. 'FEE SCHEDULE Cross street/directions to job site: Description I Qty. 1 Fee. 1 Total 1 " New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1 Limited energy, residential 75.00 2 • j .. DESCRIPTION OF WORK • (with above sq. ft.) Limited energy, multi - family 75.00 2 r. _ ` 6 \ t -- a aft-f residential (with above sq. ft.) (� l Services or feeders installation, alteration, and/or relocation 200 amps or less / 100.70 100:76 2 . B1 PROPERTY OWNER 1 ❑ TENANT 201 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 City/State/ZIP: Temporary services or feeders installation, alteration, and /or Y relocation Phone: ( ) 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, per panel Owner signature: Date: A. Fee for branch circuits with above service or feeder fee, 1 . �I ❑ APPLICANT ❑ CONTACT PERSON 7.42 7 L( 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 tY dwelling, service and/or feeder Phone: ( ) Fax:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 • II CONTRACTOR Signal circuit(s) or limited- energy Business name: panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (V2 hr min) CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES= Subtotal: a( )6 a s, Suprv. Electrician signature, required: o Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): ('a, , 9.7 TOTAL PERMIT FEE: p...1 . 0 ' Authorized signature: This permit application expires if a permit is not obtained within 1 days after it has been accepted as complete. Print name: Date: * Number of inspections allowed per permit. 1: \ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(1 l /05 /COM/WEB 07/14/2010 04:06 FAX PRECISION NW C j 002 /005 . E'.ectrical Permit Application RECE rt)R OFFICE USE ON1.l City of Tiga RECE . i a . , ; Y 13125 SW Hall Blvd., Tigard, OR 97223 ! ' 0�3G�,3 ' I hon: 503.639.4171 Fax: 503.5.1960 � / R Oilieerm I' I Inspection Line: 503.639.4175 JUL 14 2 C Y' Sce Page 2 tor (; ARD c Rcad ttl ! lu,s Internet: www,tigard- or.guv Supplemental Notified/Method: pp mental c information 1 YPE ;f�'ly ! i ❑ N 1C�► . New co nstruction p Please chock 1 heck all Ile, ,,...,. ,. " ' ' �Ad /alterrllton/rc lacernent I >'pply (submit 2 sets of pl:ms w /hams checked below)' ❑ Service or feeder 400 amps or more ❑ Building over linen unnes, ❑ I)emi 0 Other: • - „,, where the eValiable G current Marinas and boatyards. ' ` • C� ' '� �, ('}F`C:01 - exceeds 10,000 :)mps at 150 volts ut ID Plp;ttinl: buildings. �” - " less in ground, or exceeds 11,000 CI Commercial-use de,iaihur;d 1- and family dwelling E] Commercial /industrial ❑ Accessory building ;imps for all other iuxta1I1Iluans. buil dinia. ❑ Multi - family ❑ Master builder _. ❑ Other: ❑ Fire pump h . ❑ ,xtal lotion of 75 KVA a• 013- . §�ITE:I 111. y i "it t l - ? pK 1( 9y91, . larger sepal xtely der v sYs em . T� "•, , 1"'. , „ ,, ..'...4;l, ``K;;j Add of new molar dot c i, Job no.: Job site a(ldress: 1 1 0 S 5v4 COTV , wooO lamp or inure, occupa)ter. ••• ❑ Six O h orn res ident ial units. ❑ Reciea tional vehicle .. ... pants, City /State; / %1P: ^i--' ._ i �l / 1 1 /'� al-1 7, i_,...) i_,...) ❑ health -care facilities. ❑ Supply voltage for more than IJR ❑ Hacarduu lamations. 600 volts nominal Suite /h1dg /apt. no.: Project name: 524 4 41% M A / ❑ Service Of fader6UU amps Or mere, LrASS Strecl /dire(ti - 'a!`" - "'_' ' "'.? ;:+ (<J New residential to single or mniti.fanlfly dwelling unit. ldcludes attached garage_ Subdivision: Lot no.: 1,000 sq. ft_ or less 1614 54 4 . La. ;x1d'l 500 sq. ft. or portion 33.97 I .... '1 ax rnem. parcel n0.: 1 n it - ..._ ........ • • .... MSC ,} `�� .Ii .ed energy, residential : iV t('ll! ' W q>IR f , �n (with above sq. ttJ 67.84 2 Limited enera,multi family residential with above sq. ft.) I 67 R4 FT Services nr feeders installation, alteration, and/or relucatiun _ , _ 700 amps or less 100 70 t� 7 • ❑ I.RO.PERTY Owtio. ..frIL '1. { >;< T>w4 , 1 ; 201 amps to 400 amps 113 16 7 Name: 401 amps to 600 amps 200.34 _.. 2 ...,._._ 60) 8 iO 1.000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps ur less 59.36 - I ._ ......... ............_� 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that 1 own which is not —• intended for sale, lease, rent. or exchange, according to ORS 447, 449, 670, and 701. 401 :imps to 599 amps 168.54 Rranch circuits - new. alteration or extension, per panel Owner signature: Date: A. Fee for brunch circuits with •V9•IXP:fYi.,t' " t above service ur feeder fee, L ATfiI:;TOTI -, • ,. igi; F , {�t G+ f', E t, ; , v 1, ,,. 7.42 2 " ,. each branch circuit RuSittes5 name: B. Fee far branch circuits without service ur feeder tee, first 5b.18 7 Contact name: branch circuit 1 . — Each add'1 haunch circuit 7,42 ' r!7 Address; Miscellaneous (service or feeder not included) City /State /Lll': Each manufactured or modular 67.84 , dwelling, service and/or feeder __ F hone: ( ) Fax Reconnect only : ( ) ....... 67,54 Pump or irrigation circle 67.144 4 2 1: -mail: -- Sign or outline lighting 67.54 2 •' ( W 0 ' •, . ,,, ;"l.,n, ' •.' I , ";Fr , t , ,i:. Signal circuntsI ur limited - energy panel, alteration, or extension. Page 2 2 Business name: __...... __... _ �'� _ _... -.... Ea ad ditional insectinn over allo wable in Any Of the ahnv Address: t 7 Q S \s tc i t.. cr Additional inspection (1 hr min) — fir, 25/ hr -- City/State /LIP: s, ( ) 5 ' 0 - '10i3 01 Investigation (1 hr min) (,h 25/ hr ., � _ industrial plant (1 hr min) 78.18/ hl _ P ne: ( r te r� � C1� Fax (513. / r , Ing l .... oo for which no tee is 9 0 00/ hr p, ✓///U V / "r �� •.±±�� (d)CallVlssied(' /.,hrmm) .� i CC31.ic.:1ki33f U Electrical Lic.: C � Suprv. Lie.: S +2 I f iti� 5 ' a I 1 : .a•'- y', :,ll,E,R •'T (ijFllk :k v , Suprv. Electrician signature, required: - V Subtotal; +��` marl review (25 /o of permit fee): Print name. Ctatc, 14,,,-- `u State surcharge (12% of permit roc): i 0 TOTAL PERMfT FEE: Authorized signature :‘ S./CAI/0 .JA _ This permit npplientinn expires it'll permit is not obtained within 181) -' - ((( days after it has been accepMd as complete, / Print name �� p Date; J _ 1 yr ' • NLL II). of inspections allowed per permit 2 I:1 Building ,Permits \ELC- ftiinl /A It iIAlin` 01119 440 --451 T(1 1 JJJ /e5 /(:QM/WF'.H 1 1 P_ 1 Si 06/23/2010 03:50 FAX pFrcIl!co PRECISION Ni 003/003 Papined PPrmlt ApplIcati . FOR OFF1(.:F. I iSE. ONLY JUN 2 3 Received — ©0,30=3 City of Tigard l� t,it `n.E LC X f0 uatc/i3v il r 13125 SW I tall Blvd., Tigard, OR 9 t'T , f ,, _ , 2010 1 Pla Review qur r Permit' • g' '. Phone: 503.639.4171 Fax: 503 „5y:�t196O ()r' f `,�r A11L) Rece Inspection Line: 503.63941175 ?Al lIl 1, • RR ' 1 ,, . i Date ReatIvicly: »r. ES Sec Pnge 2 for IntemeL 6vww.tigard- 0r,gnv /:-IL I'1GAAL� LA.rr_:�rrs1 tad Notified/Method: Supplemental Information d _ !`XAJ3 bit Fil �” p r ,. Ple. c,c e eCk t eeder 100 amps Y f pa .. "' ' y "" r ii 2 acts o f ln w /It t:hCCkCd bel ow ): ID New construction Addition /tilter•atiol /re `accouter 0 erv(C or r urore ❑ Iinrlding over throe stone ❑ Demolition ❑ Other: where the nvartable fault current ❑ Marinas and h mraids. exceeds 10,000 amps a t 150 volts or 0 Hosting holdings. Cd7 F ('QRY . QF [lilvT�):4 ?>r1 , , IC33 to ground, Of CXCCCAS Ia,000 0 C'ommercml - uC agricuu I - and 2 - family dwelling 111 Commercial industrial ❑ Accessory building amps for all uthcr installat tins. buildintts ❑ Master b uilder ❑ Other ❑ Fire 1:1111111,. i ❑ lnstnllanm of 75 K V A ur El Multi - family 3tlllly rr ❑ Emergrmy system. larger separately denved system �1 + NLI�!' ` (,�, i r ' ' r 1.'d '' ❑ Addition a ricw morn. load of ❑ "A • - :' I _Z .. 1 -Z $ • lyl`t ;Ii. . iJ 1 e lT�QIR,.1� $ l T i � .;, '�:Iiflt"IP,;� ?. e)r i, ' " ceuupancv r 10011P ur 1111 Job no.: Job site address: l 0 5v4 .Q� CIN \(�(DQ ❑ tiiv or more residewial units. ❑ Reurcational vnhiulc parks. City /Scu tt. /71 cll./1.'5 L ❑ 1leahh -taro fnciliIicz. El titipply volWae lin more than f Lt.,) I lazardous locnt art... t,00 volts nominal. Suite/bldg./apt, no.: Project name: l ❑ Servant or feeder 600 amps or muro lne: �V..I1� � Li.�.� , '; r ts , t I N1.4 ; >FF01gtYa ' Cross street/directions to job site: Nag riptlon - Olv. I Mee- I 'r ntoi 1 New residential single- or multi- family dwelling unit, Includes attached garagri. _ ., I sq. fr or less � — 16R Si 4 i 1.ca no.: I ..' Subdivision: Fa. add'I 500 sq.& or portion 3392 1 I Tax map /parcel no,: Limited energy, residential 67.84 2 ' ----T 1'?,: „' (with above s9. n.) (4E 'iP1}t�1... .» '' :,.. ...,:r' t L im itedener , multi - family 1 67 R4 ? less 1 energy, .• 1.* (' N �� C ` � 1 residt ntidl (with above sh ti.) • —...3 . A , — ` �•-•eY Serv or ers inalallntion, r relocation . ‘401- 1O -1 �, t r vaedemps alteration, and /o r 1.56 2 . � 200 1 amps 6 40 f ❑ PROPERTY 'a'i"?PR. 3a 2 ,, 0 t 401 amps l0 0 amps 000. Name t //t!`r' 601 amps to 1,000 amps 301.04 2 • t� G Qvcr 1,000 amps or volts 552.26 2 Address: (((/// �,l t 1�� ' ; Temporary services or feeders installation, alteration, and /ur City /State /Z1P' (r" relocation I Phone: l ) 7 t ( 200 amps or less 59.36 C� Fax: l2. 8 201 amps to 400 amp Owner installation: This installation is being made on property that l own which is not rt • - � 401 amps to 599 amps 1 168.54 2 intended kir sale, lease, rent, or exchange, according to ORS 147, 449, 670, and 701. Branch circuits - new, 4Itcrallon, or extension, er and Cure' C' Fc r blanch circuits with Owner Slgna ._ Date: A f0 �1 � I r'� , ��, ,,,. 0� qw,. "xt ),Ii above service ur feodcTtrr.. 7,42 2 [].. 47±;t 'Wilt,1 �` .. 4 t i ti , , • ;i ;' "' fl r ' 'If each branch circuit I . B. Fee for branch cuc:uits lvithorir Business name: service or feeder fee, nisi 56.18 : 2 branch circuit _i (:onlact mime: _ - Each udd'l branch circuit _ 2- 7 - i r Address: Miseellanecus (service o Reeder not included) 11 IT _.. - - Each manufactured or mo}lular ,7.84 2 City /State /ZIP: dwelling, service and /or feeder Reconnect only 1 67.84 2 l'ax:: ( ) -I 67.84 2 Phone: ( ) Pump of irrigation c:ndc I E - mail: Sign ur outline lighting 1 67.84 2 — . C:(U111 ZAf? 4 ' .'r r !Ir,. f;> i ' 5 Signal circuu(s) or hmueill energy e 2 2 panel alteration. or e>•tcn'hion. Page [3usines name: g! 0,...) kh l '..G - Each additional inspection over allowable in any of the ahoye cyr Additional inspection (1 hr min) 66.25/ hr - Address: 1]'Z,C7Z. -U� �" � � Investigation (1 hr min) ' 66.25/ hr City /StateiZIP: '(• \) S 1 0� ` Industrial plant (1 hi niin) - 78.1R /hr _ 144 � I F tJr ( ) GC/ a � 7 3 inspections for whii,h noifee is 90.00/ hi Phone: ( a - (,� / (� s caf)eall fisted '/a hr rain Electrical Lic.: c (.,� Sup,. I ,ic.: Grill J (I', ,i ' +al §!'! : " �" J r ! . ! ,. - .. CC Lic.:�4 Subtotal: vv Suprv. Electrician signature, required: • Ala. • LI Plan review (25% of permit fee): i ti c D _ _ D ate: ' � � X, ‘ State surchir'ge (12% of pertrlit fee): 72 Print name` w d Fr YV� [�1 JUYV�+�L1L ".�r�� p � TOTAL. PE FEG: ` 1 �.o Authorized signature: �� ,�✓" C,,, ,�� / 0 �/'�,/ ` .4"/6 . This p ermit appucatiui e xpires it permit it not o ' with' days aftcnit has been ueeeptcd a -coraplKta- 1W 1P nate:( Z S._ , 6 _ -, Print name: Neither pee pcnnit/ i � / t:\ Duilu.nwtPennity ,r'.t.C:- PernwAppdm: IWuuU9 44U4C15T(11 /U } /C(1M/Wtti ( 1`n/ • 06/16/2010 21:55 FAX PRECISION NW X001/002 Electrical Permit Applicati v` ECEIVE voR of i ic:1: l;sl`: °Nu City of Tigard ll Ails,: , /f/4 ;: I'emniNO. '� 0/0 10 n. q 13125 SW hall Blvd., Tigard, C)R 972.pq 1 7 Plan Review - - - - -. • • - Phone: 503.639.4171 Fax: 503.598. l7 L�U 1l, Date /n : Other Permit: Inspection 1.ine: 503.639.4175 Date Ready /fy luris g Sec Page 2 for TIC. K I ) CITY TIGARD Noiii'ied/MnlhuJ: Supple Information lntCl'nct: www ti and nr nv _. 13 I, OF T �t� Please check an that apply ruh s i of plans W /it - 7 YNir'. t �uI 1011. R 1 M�1�A'Ht fit'PTL . ❑ ?slew construction G1 Addiliur , /ulleri>.tioti /replaeernent Pi y ( p ems checked heh,w): ❑ Service or feeder 401) amp‘ , more ❑ Building over three sror,e. ❑ r enutliliof ❑ Other: where the available fault r'.urrent ❑ Mni inas and boatyards. iC.nTl.vUtty (711 f f)Id115'l1 k�tG1?ti)iCd exceeds 10,000 amps at 1 50 v ote s ur Floating buildingF i� ' , ' .. l ee to gmmid, or exceeds 14,000 ❑ L'om»te,Ci91 -use agricultural :4 1- find 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all uric( installations. buildings. 0 Muhl-lilmily ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or , r,i.c ❑ Emergency system larger separately de ved system, 4 zr 0 , ! n , V�a rr ii ❑ Addiliun of uew ctletoi load Of ❑ .. .. „ z .. l �.. rte"' ]OOHP or more occupancy. Jnb rill.: Job site Y1ddres : Q C i� I 1 ( Op / ❑ Reereitonal vehicle arks. 1 ` 5 J � ❑ Six or more residential minus P C1tV /Sltlle /ZIP: �. I r.C.�+ 0H aza o se aii Hazardous c on . 6 lit i .1. �� dour locati Sup voltage nominal. �Cf� L � ... ' 1 � GZ � ..... ❑Hazat Suite /bldg. /apt. no.: Project name: o 0 /4.-Ni e :,: feeder G00 amps or more _ - ,..,ncenrr,nJ'7.:' ' r.) Sf -'4 W . • Cross slrc LAIlrections to job site: - t nn 1 Qty. 1 Mee. • 1 . Total 1 " - - New residential single.- or multi - family dwelling unit. includes attached garage. — Subdivision: Fa. edd' 15UU st l LOt no.: less 168.54 4 1111 I ,OOO s ft or l 4 i. 0. or portion 33.92 1 Tpx reap /parcel no.: Limited energy, residential 67.84 2 D,'LSCRIGB^i 1064. :, )Fit p1!l pg.., , R (with above sq. It 1 . Limited energy, multi-family 67.84 140 r T ulp fNvvU' 4— residential (with above sq. 0.) Services or feeders installation, alteration. and /or relocation C, p." alt C A 5 8 J 7— vv J 1 200 amps or less 100.70 2 201 amps to 4UU amps 139 Su 2 p Pltt)ri RTY awvl EL. (4 i SiVi i( r, .. •- 401 amps to GOU amps Zili/ 34 Name: _. _ _.. _. _ .. 601 amps to 1.000 amps 301.04 Address: Over 1,000 amps or volts 552.26 - - Temporary services or feeders installation, alteration, and /or City/State/ZIP: relocation 200 amps or less Phone: ( ) Fax: ( ) _.. ....- 201 amps to 400 amps 125.011 2 Owner installation: This installation is teeing made on property that 1 own which is not 401 amps to 519 amps 168.54 2 intended for sale, lease. rent, or exchange, according W ORS 447, 449, 670, and 701. Branch Circuits- new. alteration, or extension, per panel Owner signature: -- _ Date. A. Fee for branch circuits with 1 . 1 r rye • 1 rl ^, w . ;, ;! +� above service or feeder fee, 7.41. 2 © Al'h1�xf Ab i 1 9 : ' g i , w u i1r. each brutCh circuit pR. Fcc for branch circuits wlthcpr ie Business name: service nr feeder fea. f rst (o, 2 1 k S�IH branch tarCU it Contact name: . � � 2 • � F,ach a dd'1 bran circuu 7.42 1f Address: .. %` Misecllaieotls (service or feeder not included) .. , teach manufactured ur modular 67.84 - ( :ity /SLtifeiCll °: dwelling, t only 4 2 and /or feeder l only 67,8 Rcconncc — Phone: ( ) Pax:: ( ) b7 R4 2 • Pomp in irrigation c:irCle - 67.24 E- (nail: Sign or outline lighting tOl / 1 1 ,' (5 it. , N . / iii '/ li g4 „„, , : -,rr vr, .u;C,. t ,(�, signal circmt (S) orlimited - a nel'py � • ..... • • Pa e 2 panel, alteration, or extension. g Business pr %.,. w, 0 j 1C.. Each additional inspection over allowable in any of the abov Address: k-7,0-1.,0 6 ‘.. k-,4tv per Additional inspection (1 hr min) 66.251 hr - - Investigation (1 hr min) ,{ 66 25/ hr City /Stan /LiP: ��h S (, ) .5 0 � s 1 Industrial plant (( hi min) 78.115 / hi Fax: ) � _ - Inspections fur which no lee is 900/ hr ?hone: ( � C( C �r • (, v j ecd.Jty hated (h hr min 1 33 � r � � 5llprv- Lie.: �/ �i " ,,'i . i 1 , I) t ��, yr Ql 1 a U a o � U CCA Lie., Electrical Lie.: Subtotal: 1 t l U0 -- Suprv. Electrician signature, required: ! • — Plan review (25 ° %i of permit tee): Print name 7atc: 'E n —\l -- 10 State surcharge (12% of permit tCC): r 10TAL. PEKMIT FI- : e t y {� 1(� .,� � E: Authorized signature: /�/�.� l'hia permit upldication expires If a permit is not ahlai a within i / a..�1 ,rA� days niter it has been accepted a. complete. Print name: } i ht 2 � Uate; r 1r, O • NI ibCr of in Specl10u1 allowed per pCrtPit / t agrt- a61iT(I1/USII;(1M/WEB ���...JJJ 1,Huildint11% /nnu\ELC -11/4 n,n App.dac 10101/00 EL c 26 /° -co 3u3 City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 • October 29, 2010 Precision NW Electrical 12020 SE Anna Ct. Damascus, OR 97009 Re: Permit No. ELC2010 -00303 Dear Sir /Ms.: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 11105 SW Cottonwood Ln. Project Name: Martin Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $54.61. ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as paid for electrical service which reduced amount of branch circuit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna » > > Howse Building Division Services Coordinator Enc. 1: \ Building \ Refunds \ Administration \LtrRefund- Overpay.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 City of Tigard T l G A R D 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: Precision NW Electrical DATE: 10/22/2010 12020 SE Anna Ct. Damascus, OR 97009 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 178371 Case #: ELC2010 -00303 Date: 6/18/2010 Address /Parcel: 11105 SW Cottonwood Ln. Pay Method: CreditCard Project Name: Martin EXPLANATION: Per applicant's request as paid for service which reduced amount of branch circuit fee. Refund difference. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Electrical Permit 2200000 -43103 $48.76 12% State Surcharge 1003100 -24001 5.85 TOTAL REFUND: $54.61 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager If under $25,500 Department Manager /420t /4 c' If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: INNITA M1 B : I: \Building \Refunds \RefundReguest.doc x 09/01/2010 v Community Development Request for Permit Action TIGARD TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ` Oity Staff (check one) / REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State /Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): El CANCEL PERMIT APPLICATION. n P REFUND PERMIT FEES (attach receipt, if available). INVOICE FOR FEES DUE (attach case fee schedule and explain below). El REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: ELe2 -0 / O — 0 303 Site Address or Parcel #: Project Name: Subdivision Name: Lot #: EXPLANATION: ,Z)i/ ; /d� of-t— `c z - & ig' Ce C (R-& rS /f}7/J r-TJ Signature: : 477 _ Date: 7/ ‘,7/1) Print Name: , / , /-7v) C r Refund Policy 1. The Director or Building Official may authorize the refund of: 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 than 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 returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE: ONLY Rte to Sys Admin: Date By Rte to Bldg Admin: Date /rlZ 7/p By d' " Refund Processed: Date /0/2.531/0 By Invoice Processed: Date By Permit Canceled: Date ! By ,arcel Tag Added: Date By Receipt #. Method C C. Amount $ '7/. o25 I: \Bwlding / o , ansR 3 7/ tAction.d c at07/26/07 n CITY OF TIGARD RECEIPT 1 1 4 C . 13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TI GARD gc Pit N, Receipt Number: 180201 - 10/29/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2010- 00303 $ -54.61 Total: $ -54.61 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 018085 DHOWSE 10/29/2010 $ -54.61 Payor Michael P McDonald, Precision NW Electri Total Payments: $ -54.61 Balance Due: $54.61 Page 1 of 1 CITY OF TIGARD RECEIPT l » . 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 178371 - 06/18/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2010 -00303 Branch Circuits wo /Purchase Service or 2200000 -43103 $63.60 Feeder ELC2010 -00303 12% State Surcharge - Electrical 1003100 -24001 $7.63 Total: $71.23 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 018085 DHOWSE 06/18/2010 $71.23 Payor. Michael P McDonald, Precision NW Electrical Total Payments: $71.23 Balance Due: $0.00 Page 1 of 1 111 CI TY OF TIGARD RECEIPT 2 13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 178453 - 06/24/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2010 -00303 Electrical Permit 2200000 -43103 $14.84 ELC2010 -00303 12% State Surcharge - Electrical 1003100 -24001 $1.78 Total: $16.62 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 024395 BTAGGART 06/24/2010 $16.62 Payor: Michael P McDonald Total Payments: $16.62 Balance Due: $0.00 Page 1 of 1 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL 'WORK ONLY: • Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC n Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ❑ Other Total number of commercial systems: *No. licenses are required. Licenses are required for all other installations 1: \ Building \Permits\ELC- PermitApp.doc 07/01/10 Invoice # Assessed Fee Item Quantity Unit Fees 159747 6/18/2010 Branch Circuits wo /Purchase Service or Feeder 2 Circuits $ 63.60 159747 6/18/2010 12% State Surcharge - Electrical 1 Each $ 7.63 159828 6/24/2010 Electrical Permit 14.84 Dollar Amt $ 14.84 159828 6/24/2010 12% State Surcharge - Electrical 1.78 Dollar Amt $ 1.78 160098 7/16/2010 Electrical Permit 100.7 Dollar Amt $ 100.70 160098 7/16/2010 12% State Surcharge - Electrical 12.08 Dollar Amt $ 12.08 160267 7/28/2010 Electrical Permit 108.12 Dollar Amt $ 108.12 160267 7/28/2010 12% State Surcharge - Electrical 12.97 Dollar Amt $ 12.97 6L' TO Ye c (Z G 3. a ". G3 InC/ 2� % y , Fy /, 7P t e4c CI) / , '7o /2 -od ��- � C') ,' i - /x . 97 6 3. 4P 5 /y. (Fy /, CJ- a��� y t , 2 4-