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Permit ili CITY O I TIGARD GARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELC2008 -00477 DATE ISSUED: 8/18/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S 125CA -04000 SITE ADDRESS: 07410 SW CEDARCREST ST ZONING: R -4.5 SUBDIVISION: BOULEVARD HEIGHTS LOT : 016 JURISDICTION: TIG PROJECT: PACIFIC HOMES Project Description: Installing (2) branch circuits for jetted tub and tub heater. 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: SIGNAL/PANEL: 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: 1 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: PACIFIC HOMES JEROME ELECTRIC 6770 SW ALFRED ST PO BOX 751 TIGARD, OR 97223 HILLSBORO, OR 97123 Phone: 503 - 975 -6560 Contact #: FAX 503 - 648 -9723 PRI 503 - 648 -5144 FEES Description Date Amount Reg #: ELE 34 -119C [ELPRMT] ELC Permit 8/18/2008 $53.50 LIC 158119 [TAX] 12% State Surchar 8/18/2008 $6.42 SUP 2877S Total $59.92 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 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throu•h OAR � 952- 001 -0100 •u ma obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By: ✓� ,0 � s! Permittee Signature: _ . •`/ / .y 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'N: 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. . Ai 08/18/2008 08:01 5036489723 JERMOE ELECTRIC INC PAGE 02 Electrical hermit Annlic ;n EW�,D • b USE ONLY . , i. City of Tigard Received Permit No ; Date/5 : I, :r 12") ; --ail 7 7 u 13125 SW Hall Blvd„ Tigard, OR 9R341E, 1 S not Plan Review Phone: 503.639,4171 Fax: 50:1,597.Y9'60 DatoBy: Other Permit: T'IGARD` Inspection Line: 503.639.4175 � T1GARD Dale Ready/ey, ' 1u . da ' p :� ' � Rf See rap 2 fur Internet: www.tigard- or.gOv Cl . • %. ' 15 Notifi ,, /V-LP Supplemental Information +7+nr r, a ... a . .- .:- .-'nr�s- '-rm ^. , .�...v- -:.- - F m• yr „ - "narc�r� �-n-- , �. • ,.RT T " ' ,. : , � 4 t.,_ ., � :. f , _ � r , , .._ "+ru: rra+t,� •; ` , I .� 1 af. i4: i 1 :1 _7 it it 1 ,' { i i 2 :1. . . ..�; i, t IJL , .. , .tt'� - b , y ltry.. {i 1 } i J: i tip ,..f ri�4 1 � i , :' ill' Fx I / 3, . p ; w w I � t $ J' n '-li , .-.. ,, r. .,, . '• i.w ., ,�7 1 ti't l �;^t,n t r I t� �" � l.: S.; w; Zat+ fjxr,h s i- u... tLil-. da, v:. Ja;. 3s" T,.. /ra,.ti..6.�..�•dlllt:�,,: ... �iw. i.. m�, . <rtrJ.r..�ax„�xbi�ar.,.c.n ..r• a,a i,...nl ...�,._ I >31-r to /.,.eirad,ii;'3it . a.., ,i t,: 0 New construction 1_ • ddition /alteration /replacement Please check all that apply (submit 2 seta of pions w /itemx checked bellow): ❑ Service or feeder 400 amps or more l: building over three etOrieS. D Demolition ❑ Other: where ttte available flaunt current 1] Marinas and boatyards. r .. ,1, ; ,,,.- t ,. 'i war :,:, ;•; ;' ��_� t .., ,, 1'�" ti ,^.r 1'^ " c+',% c't r+ i't; +, ;; ;sir exceeds 10 000 snips el 150 v Fleming uildin tM,l,',, .��, t .. ,. +, ,�, d`'I - . ,:h7 ,n . "; ,,., r . foly , :3 n t" 1l t , A , r!, %^.'I . :: : d o l l:, al ts or r 0 B b s. B pp�� i. ai,, .3 , .�lyv' n, �� ?.y�m y ' - .r,.�l .. �� ,uJ, 1 1 1 " �`ri Iltiur :+;,its: „t�I,11� �LrV:l,o], 1it�'!,i.e, '=, "+:Ik>ti... _w:rT..... h..::12L...r.,7;6e;�.. ,,.. s,,.' 2. 1.,,,..: kt: i`•: w.e1 „MikiE,�l_',G,i::.di i': . •'� lees to ground, or saccade 14,000 El Commercial-use ngt,culhlnl �! 1- and 2- family dwelling 0 Commercial /industrial 0 Accessory building amps for nII other installations. buildings. 0 Multi - fami ❑ Master builder ❑ Other: I: Fire pump. p installation of 75 KVn or 13 7 ^ ?p f "" ^ M ':s;!rrtpre , - 'R ,s.,y -, r& ^^4,,w,tritztt it,urt wir:. A7r. BP ,:kt ; .r - ^7','17.7.;717:rrtvr:' 4 © Fmcrgeneysyetem. larger Separately derived system, I,t Aii • ,_ , a• ` /., ":v,in. :: • =h I .l. ;.111 i; it 1` 11 �1 t0 -Iri, @ . 3 0 � , i7' R,,, 1 ",' i i : ''ci, 1 �� ".�1, t ? "i ` i .kw.,.!.3 r.. 't' r.,.,r A i ron •. e A v'. * 7 r .0.?.7a,r.,:Pallla rllr ��N.,...,. IJ I' 11. ,dlll�,�.•_ :14;,i, © Ad d v i anof new motor load of Job no. �.�}-•"'7i� C� Y �{ Job site address: 0 e, furry. ,r ' " 5 i ; IOni•lp ormore, occimanoy, V © Six or more residential ,mite 0 Reerenr;onal vehicle parks. City/State /ZIP: - r I l (� ❑ Health -care ffcilitics. 0 Snppty voltage for more than ` " ! 1 ❑ 14azardous locutions, 600 volts nominal, L .� _ 5crvicc or fcedct 5x10 am s or more. Suitclbld�. /apt. no.: I Projectnarne: C/ L'11� ,..,- ; I.j. ° �.,,• . a •:Yrrs„ , rr { ( - ( r r r,T , Cross streetrdirections to Deac job site: i� )iai ip i tio n l4 .l w : "n llil31i19t fx Iefmi�Y.i r it � ii l t ii: ' . = 11.,,A ,.� fAl411 r y �I' ',} . rlpo Qty. re, Total New residential single- or multi - family dwelling unit. Inc1iides attached garage. Subdivision: 0 f1 ; ( 7 J Lot no.: 1,000 sq, ft. orjless L 145.15 4 Ea, add"1500 sin. ft. or portion 33.40 1 Tax map /paiecl no., �j t '/ TR,' ^7 t r rr. ;al: „:±,,;:,s'vt: "t:tx ^c rnz•, '~` — • r., ;:t w � •c ».7Y ..tr _r p ,1- :;:;.F ^.�:7; Limited ener87�, residential xe? ti,:rl' ''r <;r;,:: M ; , r- :U. r 6r 2 ' :'i'; N. I : .. ;::,•„ . ,_-S'.,i yr. , s ,�t ' a n 'b: 'e „ t : r r,:;ir,:;; v ::: ',,ml u: "!. W ",� a It' . ^� „w .� �',bS;F}n�'C'•)r1d1:- r�. - = o1 „ a�,+� � `:l' ;ik, r •'•...r i ' (with above e�. ft.) } l�� fi�: Irtht�iG „19 {jlili.� .���' I�i�a;L.l� � e!��+k , ... li'_ rla .ei,. a, �utiiyrCn�oao�t `::N;tiUtt.�h;:��;:•J +�'8;a F ; } ! `f . , ,-- 1 � Limited energy, multi- family / ► y j 'T Q, C 7 � t residential (With above eq. fl.) 75,00 2 -1-016 Ck V Services or feeders installation, alteration, a nd /or relocation p �,a -^ , :a.. r,, ; rl,.,.r'.,.w;acrc: ,ta °� '; r; � �` �� rz: w, 200 amps or less 80.30 2 n,!'� . l?,11 a11, 7r rr:. , ; �,:i.”: rmm ; `.�tl'r„. 1..745 ';.i:'.:.: ::,j o 'it: l }:1...., `i�:nS' tl't'.�:�'�Rf}tJ „1IP F' yi'1I:' ,fir!'” 'I;C ':,.r'f1i: R;'i: h '�+;'. 'I.� t „ r ,,, • , _:' , r ,�' . r t:.�:'4gi', 201 ampa to 400 amps l OG.85 2 ft , � (' + t' ilafv. N; uallu�iil '9:o- �'r"r.'Vul�'.71"_L "•:An d'h'ntf >v,' Fl! i> 14k: lY, i. r.. r...,_: So,.. l{''. i:: wiiaM� � r, : Esli°... �.ac:i1113T�.,�•fL'�..POtx., -Ii M:i11nGI..,,:L.W..,l�o.�l _ , Name. I CA .,k C.,, 1.!li # 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 0 Sw Ai Over 1,000 amps or volts 454.65 2 City /State /ZIP: lrtw, G0 7( OR 01+7 3 Temporary services or feeders installation, alteration, and /or relocation Phone: (5C3) CI r 6,56K) I Fax: ( ) p f5-- g.AL -1-3 200 amps or Ices 66.85 l Owner installation: This installation is being made on property that. I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease/ • nt, or exchange, according to ORS 447. 449, 670, and 701. 401 amps to 599 amps 133.75 2 -.--, Branch circuits- new, alteration, or extension, per panel Owner signature: . Date: A. Fee for branch circuits wfrh R ":t ^•:wG,.L" "rrrv- ^ +nM G tl•��,- .•,•1;” -- ; !- .9 Y .r.;it�:A t l '1;: - " r 1 r "�.., i 11':,:' aap� i1t 1 m'.t r s :. f ...,.. „n {R^' rs . ,s ,, l l ' i m! .' , ' r above service or feeder fee. N SS' ,IMM;zw }loW'��91 :rYxx �6 , ,4 ; , , AZ-ry; ".t;' VIE ;a7.7::. 1 .": i. r .,.. ,. ! ax :al•.d t.' 11 Lk . .4, , . 11. s ; ' " I i' `� i;4 -- :�:IZr ;r, ti.ana '�� r- �.I,.�( 6.65 2 each branch circuit Business name: / k- C -r A I. A �. >� � r ' (Cj' B. Fee for branch circuits without service or feeder f Contact name P`-----t(,..4.1 without 1 r,, 2 fiat branch circuit 46.85 ie.n� Address: Each add'I branch circuit 1 6.65 (AaGs . 2 Miscellaneous (service or feeder not Included) - City /State /ZIP: Each manufactured or modular dwelling, service and /Or feeder 90. ?0 2 Phone: ( ) I Fax: ( ) RceonneCt only 66.85 2 E-mail: Pump or irrigation circle 53.40 2 " � f Mt � : :° i . ;ay MU. „r �truv rs LT /e -1;'J town..;rl,r4r L I” TI 'w .l`'1'it "`. % 1 l II1t�iSSIB «a.��rEv., '.,,.a. -..,+.1,. ,';,;,.0 ,� ?« `" =,KCR aatk, ,r>.:,r,,l'diC�w1.�2LW.lIL.GE' _i a:i:t„iwP .,.u.n.� ,', :t5_I I Si outline lighting 53.40 - 2 C . VrOM e � C , _ ` ` ��� e ngn i gy pane, r limited- al e Business name: r ) CJ (�Y `• �J 4 r cast anal, oltemtion, or � r extension. Describe: Page 2 2 Address: []`�.. - 1 4 l - (� },..- { ' ' ' - i Each additional inspection over allowable in any of the above 1 6 CJ Per ins! ction 62.50 Phone: ( 503) C - 114H Fax: ( 5 0 . v `'1 7 investigation per hour (1 hr min) 1111 62,50 CCB Lic.: t5 „it Electrical Lic.: 31.41, G Suprv. Lie.: (4 S Industrial .iant ,cr hour •- 23 . 75 1 ii r ? ` ! lai.ttM is i, l r "`''l' i i, ^1,7].,��c' ' i ir1,i, 1 "r �{'i i2'J i)l :.�f1 fl ,i;i i rN;�a Ar`:� a,ir L:,, w . S I ., ,;:r;R. _, a Suprv. Electrician signature, required:,'';' � Subtotal: 5 1 Print name: T t • t A , 3. C 1 Date: . (g._ t Plan review (25% of rermit f I State surcharge (12% o f permit fee): • Au thorized signature: TOTAL PERMIT FEE' Ct ,i - 7hix permit application expires if a permit is not obtained within 180 Print name: Date: • Antic pfrnr it has hem yrr.ntrrl Pig rnna nlrer City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 • / . ." • • . TIGARD August 26, 2008 Jerome Electric Inc. P.O. Box 751 Hillsboro, OR 97123 Attn: Christopher Mahoney Re: Permit No. ELC2008 -00477 Dear Mr. Mahoney: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 7410 SW Cedarcrest St. Project Name: Pacific Homes Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $47.94. ❑ 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, Dianna Howse Building Division Services Coordinator Enc. I: \Building\ Refunds \Administ ration \LtrRefund- CancelPemiitdoc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 • 08/20/2008 06:31 5036489723 JERMOE ELECTRIC INC PAGE 01 • c0 *°1C) 11 lic a • *ecjw � 1oo Building Division P \\G , 0 `JRequest for Permit Acton a to G TO: 3' a P TIGA.RD % ' omit System Administrator . 13125 SW Hall Blvd, Tigard, OR. 97223 Phone: 503.7182430 Fax: 503.598.1960 www.tigad:d- or.gov FROM ❑ Owns Applicant ❑ Contractor ❑ City Staff (cheek e, t) REFUND OR Name: �� INVOICE TO: (Bo''''ws eR lndltiduat) c) ab ..../t f.171 Y ,,,r ti G 1,11-c- . M;tiiing Address: '70 -B0}, 15 ) V 0 1 I City /State /Zip: 14 Lt Sb6a OR 0 11 1 3 �. /a e. Phone No.: ici3 — C1 LW 51 144- PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (le): Er CANCEL PERMIT APPLICATION. REFUND PERMIT PEES (attach receipt, if available). INVOICE FOR FEES I)UE (attach case fee schedule and explain below). REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: 1,..-C, A 00`6 — 00L Site Address or Parcel #: ( (€4 `. Project Name: �� ' Subdivision Name: BDV k✓ - 4. -p tt ,,�.� 7 Lot #: b (p EXPLANATION: DWkg C a ( s ?L4 j In.Pt �/o I 1 '11 kw. //, ,,/ / Signature: Y Date: T. a () , OZ Punt Name.: i/ . i ��._ / f/./l1f/ ... RrAmd Pnliry • 1. The Direr or Building Clffleinl may authoevr the tcftnd of a) any il•e which was erroneously paid or collected. b) not more than R11% of the and upe eppldednn eke when an application is withdrawn or canceled before any review effort has been expended. e) not mine than R(1% of the !and ure appliamion fec for Owed. paroles. c) not more dun tll1% of the bvudingplrn review fcc when an npplic tian is canceled before any plan review effort hat been =Tended. d) not more then Few of the building permit f for ;mtetl permit, rim ,.+ any inpcerinn regwst.. 2, itefunde on11 be returned to ncc grienal Payer in IN) Aama method In which ptyrneftt war received. Plcaic allow 1. -2 wceita for psoconing c. rode. FOR OFFif.:l -: l.! -. ONI.' Rte to Sys Adtnin: Date ,IRI ATJ B . bra Rte to Bid: Met : Date , - a 6 0... B • 'J Refund Processed: Date 8 Mr, S . 2 .iawicc Processed: Data B Permit Canceled Date , 'ZiWiall B - •4i Pared Ta• Added: Date lii... Receipt # dr- . 9„Q ' Dace .' 7 fie Method e.('_ A. rnouxit $ I; \Buildma erme\ReriPem,itActirnt.clnc R v115 /24 /11G 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 orRefund 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: Jerome Electric Inc. DATE: 8/26/08 P.O. Box 751 Hillsboro, OR 97123 REQUESTED BY: Dianna Howse Attn: Christopher Mahoney TRANSACTION INFORMATION: Receipt #: 2008 -2924 Case #: ELC2008 -00477 Date: 8/18/08 Address /Parcel: 7410 SW Cedarcrest St. Pay Method: CreditCard Project Name: Pacific Homes 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 • [ELPRMI] ELC Permit 220- 0000 - 431510 $42.80 [TAX] 12% State Surcharge 100- 0000 - 207020 5.14 TOTAL REFUND: $47.94 APPROVALS: p a If under $500 Professional Staff If under $7,500 Division Manager 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: Date: °` " B 1: \ Building \ Refunds \RefundRequest.doc 05/23/07 -i CITY OF TIGARD . 8/26/2008 .1 - 13125 SW Hull Blvd. . Tigard. OR 97223 5113.639.4171 '7:I Refund Receipt #: 27200800000000003016 %c r /Sy c_, Date: 08/26/2008 Line Items: Case No "f ran Code Description Revenue account No Amount Paid ELC2008 -00477 Reversal - [ELPRMT] ELC Permit 220-0000-431510 (42.80) ELC2008 -00477 Reversal - [TAX] 12% State Sur 100- 0000 - 207020 Line Item Total: ($47.94) Refund: !Met Paper User ID Acct. /Check No. Approval No. I-low Received Amount Paid Credit Reversal JEROME ELECTRIC INC 018165 Fax (47 94) Refund Total: ($47.94) • • 0 IA 0 0 v , 0 0 �' v .a 0 v ct 6J , ( ' w .I� e4 L+ V C O L .• Q [� as A cd a+ C R A 'C a+ x C 41 Q ii ': o t6 v W o eett k `- i a ki y Q H G� rx 5 m r.•. ••q n or] I LE CITY OF TIGARD 8i26/200 • • 13125 SW hall Blvd. 9:54: );AM Tigard. OR 97223 5113.639.4171 Receipt #: 27200800000000002924 C /?iE., iV C_ Date: 08 /18/2008 Line Items: Case No Tran Code Description Revenue Account No Amount Paid ELC2008-00477 [ELPRMT] ELC Permit '0-0000-431510 53.5( ELC2008 -00477 [TAX] 12% State Surchar��c I00- 0000 - 207020 6.42 Line Item "Total: $59.92 Payments: :Method Payer. User ID Acct. /Check No. Approval No. Dow Received Amount Paid CreditCard JEROME ELECTRIC' INC. BIT 018165 Fax 59.92 Payment "Total: $59.92 • • of 1