Loading...
Permit III CITY OF TIGARD ELECTRICAL PERMIT ' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00518 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Date Issued: 09/21/2011 Parcel: 1 S 135DB04000 Jurisdiction: Tigard Site address: 11360 SW 92ND AVE Project: ERVIN Subdivision: DOGWOOD RIDGE Lot: 13 Project Description: Electrical for garage addition. Contractor: GARNER ELECTRIC Owner: ERVIN, ROBERT & KIMBERLY 2920 SE BROOKWOOD AVE A 11360 SW 92ND AVE HILLSBORO, OR 97123 TIGARD, OR 97223 PHONE: 503 - 648 -4552 PHONE: FAX 503 - 642 -7925 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 09/21/2011 $100 70 Specifics: amps or less 2 ea Temp Services or Feeders - 09/21/2011 $118 72 Type of Use: SF 200 amps or less Class of Work: ALT 6 crt Branch Circuits w /Purchase 09/21/2011 $44 52 Service or Feeder Type of Const: 1 ea 12% State Surcharge - 09/21/2011 $31 67 Occupancy Grp: Electrical Total $295.61 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 • a R 952 - 001 -0090 You may obtain a copy of . - ules or direct questions to OUNC by calling 503 232.1987 or 1 800 332 2344 N ,7' •.r Issued By:�, _ 1 — 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. FROM :GARNER ELECTRIC FAX NO. '5036427925 Sep 20 2011 11:37AM P1 �icatioill , :a ‘ \, � ‘‘`'.4' \ 1,(,,,K OFF1(IE: t SF�. (1N1.Y Electr Perm>tt A � p r, � I Raaat � y Vomit �y .1� s City of Tigard e'. � Dntc/n ved `� � ice` ( �� — tx l5 ;i M q 13'125 SW Hall Blvd., Tigard, OR 9r722 �® 1-'\) plan Review other Permit (if)! 4 11 Phone: 503,711-2439 Fax 5°3.598. NO Q � DateBy: . S I i l (` A 11 ttspectlon line: 503,E+30.4175 Oj� ,0 .ira .; , Date Ready /By; darts. e Pago 2 Tor -- ' ' Internet; wwv'.tigard- ur.g0V ' .. • (yqnull 5 tents Information ,,.a S L14 ,.a4,,N. s, � Supplemental a nit t' Nontted /M el od: t '.!.:} °r ..t . .4 ,' • P yt, e. ' ✓ .:. ' ,, p !• ";f , ' r`! ,, • ' .,i .1 ', y l ,,, .,.q � .;;••-• - ) , ' ' Fx , _ __ _ _ __ _ "? ,'` , ' , 1 11 °, ... " t „ 1 , ! . , Ii I " i S { ,' t, ' h „ t s . % ", .: "i r, 1 ' IS , 1 d. „ � 1 . , ; , ,,, .• ; il'; ;, „.;,, -,i ;, '- 1 ., .,II;; }17ij! i4 , .,;( . I )i�r " ; �. "1 W i�•1, ", "+t -, {,,, � 4r C .., IL ' tif' ihrR ,: + P14Jf,i d i, , r „ t3� � �¢l „ tr - I, ��,,,,�,.,,:x, . .rw „•a, , a •. - a C Please check 411 that apply (submit acts of plans w /items checked below); ❑ New construction �, Addition /alterattoil/feplccment ❑ Service or feeder 100 amps or more ❑ Building over three ,atnrles Demolition © Other: where the available fitult cwrcnt Mannas and boatyards. p t rd s. „ gnat i a •'1P1'.1,1‘1!”. ;1; 11 ; ; , 1v , +, exceeds 10.000 snips .1t150 volts or El Floating buildings. 7 5 " 7 ” 1; ? , 0 t rl N'( 'r ,a , tt. o '1 O,,flr; , s ' $ , . t u; { 1• , ■= 4 ' li , n ,,, ., ' r 14,000 ntcrctal -uac Agricultural „1' „ ,1 1,1 li , , " ., ,1(d +, „ w 1 ' 1 yY m M ` ' 0 " less to g round , or o nce& l Cl Cu s lytt 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building a mps for all other installations building!, 0 Multi ❑ Master builder CJ Other: p ,ner p envy system larger setnarn KVA or l ly derived ay:•lcm n,.,.. ^I{a, 1 r Ii,`r,,. {i I ❑1' g Y P ii; )iii d: t ,.,,1!}i11 ;,;tili 1 IC e ,,, S ; p f t r,, , , ' , 1 ❑ Additinn anew motor of 0 „ „ „ 1.7.. ..1,3 " • " r 'I!S " "' "i!l u d if flClh ,,,, <,,.. ,,,„, t ""w II „ "� r� k � y � � -. { uceu anc Y 1{ CU , . �)U I � Il t � ❑ Ri 1 a or more mute e Job no.: Job site address: ) residential units, ❑ Reorouional vehicle parks �- ' t ! q � ❑ I leldth -care facilities ❑ Supply voltage for more than � City /State /ZIP: 1 J ❑ Huanr<lnuc Iec ations , sou n+ volt; rrl+lltal. 0 g. /apt. no,: Project name: e r„ „ ;,.!,,,,, 5L11tC/bld Service or feeder 600 amps or more Cross street /directions to job site: noscrt tion Qty. Fee, Totot - - . - New residential single- or multi- family dwelling unit. Includes attached garage. „ hubdivisinr,: 1101. no.: 1 sq ti or Ices _ 168.54 4 `., • - Ea, add') 500 sq. ft. ur portion 33!12 1 Tax map /parcel no.: Limbed oncrgy, residential 75 00 2 .� C ( hull • )' " ;1 . ��Ahe( �°'t �y , ",, n , ., ° {�d� 9" .a rr J ( L � y' i, Id + ,rY ;, , l ,;i'{ ; "r{,I I " (with above sq. it) I, I:,' 1 ; l d l 1;,111 1'n ; ,,,- 1;11,'' l �I'.rl,�M e ,,. ' .' ' „, . o, I;hh'Fx ^ "'�' , '1 , :..:" ' ,1 � � �,1„i � Limited , i i ., l ii. i i ii i ajtl { „�,,r',;!,,,�� �n 1 •.,t,d nr„9 °�;'1'+... r J t A l �ie - . L,1),1:'„.: r 1, Services es Or feeders above, o vc al nth _ 75 (10 2 1 e Al- r i �a l - - L_ ' I nit 1116 , . a residential (with above s It.) _ ►n, alteration, and /nr relocation 200 amps or less irm 100.70 1_, , it 2 pp . ii - . ,, I1 d1. 1; ;( �' ' 1 11 l i7 , : nA 11' (2 l k� i , I '''' ' �iI3'' 4 . { a „ 1 ,;';'74, ' , ^ ,F,R I �t11� � 1.1 , 1 , "{ au i, t ,+ a ,,,i � ,, , ,,S,1P� , i !,a f s1' ' ,..,,� 1 i l' : ,.-761 �;' I� 201 amps to 400 amps 133, 5G 2 1 { t! o „ „� it 41 a '' ,, ','I I + ,1 „ ", loll::: , it ,_,. _. - ^W' 41)1 amps to 600 amps _ 200.34 2 Name: %j w u (1 snrp or vo - 601 amps to 1,001) amps - 301. _ 2 Address; Over 1,00 _ 552.26 2 -- - Temporary services or feeders installation, alteration, and /or City /State /ZiP' relocation Phone: 1 I Fax: ( ) 200 amps or less mm I a 59,36 , I Qj, 7e- I - 201 amps to 400 amps 125.08 2 Owner Installation: This installation is being made on property that i own which is not -.— -- 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; , Fee for blanch circuits with tiny 1, +h� 4 A t , ,,,,, ;,,,,,,, ,,, cn ; ;;r °� ,,,,,M1,.� at dY' , , ,, {;; ° ahnveacrvicaurfcederfee :, , L } 2 1 fii + i� lr r''IG�iF �� 1 in'141' �' { ; {'` 1'(1111 I'r}�{ '!�, „! I,a iI "� 7,42 �, t "C � L each brunch circuit +,r „I , ' ,l Rosiness name:___ l /' ►mil II, Fee for branch circuits without 1, � • service or feeder fee, (il.l 56 I R 2 Contact name: 4 / branch cur;uit _ 1 b1 a � -• "•• Each add'I branch circuit �� j 7.42 ?W JO 2 Address: P t ' - Miscellaneous (service or feeder not included) „ _ + Each manufactured or modular 67 2 City /State /ZIP; PO C r1 r 9 7 0V dwelling, service and /or feeder • Phone: ( A C 1' ..- Fax: ' ( limited-energy ,^ {]}� Reconnect only 67.84 2 I' w✓ pump nr Irrigation circle 67,84 2 E- mail: ti. p Si or o utline lighting ,. 67,84 _ 2 174 ,,,1 ell ' ,�- „1f, "tr�lrvt' , '101)1,4.;,.., ..,.�j1.,l Wl ii %.(1ru1 "1;:.',1,ni,,, ^; 1 ,nli, ru' ! /r �,h� -- - ,cp:pdult,m,'! . „, , '. °' ,' �,';:''��iem »!M',',h,loa,. ,'; " "' , c vu.� . ' � r, ��� „ IP „ tln(S) 01' �o r ° Signal Clre panel, alteration, of extension. Paxc 2 2 Business name: I i"(''l 1 - 1 Each additional Inspection over allowable In an of the abov TAddreSs: aZ_c () f- j 1` V,' Additional inspection (I hr min) 6625/ hr �-/ Investigation (1 hr min) IMES City/State/ZIP: t f - �_,• r \ ,,`� _. Industri plant (1 hr min) - 78 18/ lir Phone: 4 LOU n - " )1.-1 R Fax: ( 0 n s.eci T lnapeations for which no too is 90,00 / hl (� fl i H ated 14 hr m CCB Lie.: t Electrical Lic.: % .: f� i :.{ ,s. ,,, I n+ �;,.",;.y;;,l;l,,, , 1_ %.. r Suprv. L ' ;till , i } { r , i i ' n?! ' ° ' , ... „ a I li +l subtotal. .„,_,., sum. Electrician signature, require(); — P K N ,4 , Plan review (25% urpefnllt fee): 1. • f M_ _ State surcharge (12% o permit fee ..,el I �•. ; Print Hama l 0 - , e c A us . � �a e ( P )' 1, h7 - _ TOTAL PERM IT HEId, Fi A , r loi Aulhori7ed signature; hermit application expires I a permit is no n tamed within Igo ” """ "° — days after It has been accepted as complete. Print name: Date; • Number of in,pectiuns 4Iklwed per permit. I'1Bulldloa \Permit. \p.1.0 "PcrmitAppdoe WWI (10 4404515T(III05 /COM /WBB id s IIc ast, •' City of Tigard September 30, 2011 Garner Electric Attn: Melanie 2920 SE Brookwood Ave. Hillsboro, OR 97123 Re: Permit No. ELC2011 -00518 Dear Melanie: • The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11360 SW 92n Ave. Project Name: Ervin Job No.: N/A Refund Method: ❑ Check # in the amount of $ . ® Credit card "return" receipt in the amount of $169.77. Note: Please allow 2 -5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account "deposit" receipt in the amount of $ , Comment(s): Per applicant's request as scope of work changed and was completed under MST2011- 00144. Original fees paid = $295.61; amount transferred to MST = $125.84; refund balance of $169.77. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. I: \ Building \ RefundsladalSnWntiaillfabacAPTcrigaitdasarAg011 97223 ® 503.639.4171 TTY Relay: 503.684.2772 ® www.tigard- or.gov ! fi N C City of Tigard T I G A R D Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Garner Electric DATE: 9/30/2011 2920 SE Brookwood Ave. Hillsboro, OR 97123 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 183980 Case #: ELC2011 -00518 Date: 9/21/2011 Address /Parcel: 11360 SW 92nd Ave. Pay Method: CreditCard Project Name: Ervin EXPLANATION: Transfer scope of work and payment to MST2011 -00144 and refund balance to applicant. REFUND INFORMATION: V Fee Description From Receipt Revenue Account No • -Refund Example: Building Permit Fee • Example: 2300000 -43104 ,$'Amount Electrical Permit Fee 220- 0000 - 43103 $151.58 12% State Surcharge 100- 0000 -24001 18.19 TOTAL REFUND: $169.77 APPROVALS: If under $5,000 Professional Staff r . aae--44^-x:1-ki If under $12,500 Division Manager If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONL Case Refund Processed: I Date: I 7 /% By: I 'C 1:\ Building \ Refunds \RcfundRcqucst.doc x 09/01 /2010 • 1 114 e ° Community Development TIGARD Request for Permit Action SEP 3 ® 20t1 CITY op Trr, CIILDING D I AuAR L I VISION 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 fgt. City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) 0 �4, , ,� t �2� ` c 2. )•�2,�.�i. �. gL r ?2 i c Mailing Address: b199,0 6c_. ()EDC "Y.-JAL c'c:Th I-) v City /State /Zip: 141 Lt Ior2v 02- Q`7 12, 5 Phone No.: i:50 - LEL/ - 4 19 9-- PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( • 0- CANCEL PERMIT APPLICATION. It I D . REFUND PERMIT FEES (attach receipt, if available). '❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). 9 /q /// El REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). 49 ' Permit #: elCAC// -oa5/ Site Address or Parcel #: 1 1 3 (oe.) L S a61 � E- Project Name: e 2t), Subdivision Name: "Doc t Ja 1) --- 0....., -Da E Lot #: I ?> EXPLANATION: u t ,,+r s,2 P p 07, }--i..€_ ) / 1 2l S : $y , .Ta ► 15 . c i I — oo i U L/ — T 'r2ri tJ 5 P - 12_ `'L PIND 7 T e 2 i c. w t_ `SCe, G G F 1 u, d 1. HSrell -c:16/ 4 JeI F.D EL /I - 5r<3 q )%ttJy � i 1p %.77, Signature: , „214 jg 1 1 ( ,,/i(Aok.t. Date: 9 /47//, Print Name: 1.15°c /-P -)/ . Q. 4'r - /L /',(./ 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 ' 3c // 1 y . .J2 Rte to Bldg Admin: Date f j,3�r/� By Refund Processed: Date 9/5 B Invoice Processed: Date By Permit Canceled: Date By - Parcel Tag Added: Date By Receipt # /9 ;9,r) Date g/2. / Method 6` e___. Amount $ ‘0.9 ( f I: \Building \Forms \RegPermitAction. oc Ili. 07/26/07 CITY OF TIGARD n RECEIPT 2 . ,. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 • TIGARD A Receipt Number: 184100 - 09/30/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID E-- E•`'-T/2i C ,E72../v, 7- '2 2c9 - 0000 -- y3 /O-3 /S /• -- > $- 169.77 ELC2011 -00518 /2R, Sim - u2Ch!9.QG- / V - DODO ---Q4/80/ /�• /> Total: $- 169.77 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 901281 DHOWSE 09/30/2011 $- 169.7 Payor: Chuck Garner /Garner Electric Total Payments: $ - 169.77 Balance Due: $0.00 Accela System Administration , , , Finance Department Request • • Date: /./// To: Liz Lutz • • . . le' Kathy Gende • • From: Dianna Howse/ Re: Receipt #:/ /e:F 95, /f Wr Please process this request as follows: Journal Entry (route copy of JE to Dianna How Reversal (fees have been reversed on Revenue Account Report). Credit Card Return (fees have been / reversed on Revenue Account Report). V Other /Explanation: %/19ivS, • "6.0 -f /cN O/z >°e9y,EV7 7 ,,' /ov a( 0195 ( /LFl i./.) 450344 . Thank you! ,-- I: \Building \Forms \RteSlip -Fin anceReq.doc Page 1 of 1 CITY OF TIGARD RECEIPT 11111 uI n . 13125 SW Hall Blvd., Tigard OR 9722 503.639.4171 • TIGARD — 71 /45 �/ .7?j 'Y.S'% U // OQ / % Receipt Number: 184095 - 09/30/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2011 -00518 CLc c: i2'G / i a0 • eeoe y.3icL-7 %42 -4 /2`7 J7 .S --t. /or -D000.- , IS/CO/ /3. y� > $- 125.84 Total: 5- 125.84 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Fund Transfer DHOWSE 09/30/2011 $- 125.84 Payor: Total Payments: $ - 125.84 Balance Due: ($169.77) • Page 1 of 1 4. III II. OF TIGARD RECEIPT 2 . . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TEGARD O4/ /t Receipt Number: 183980 - 09/21/2011 • CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2011 -00518 Services or Feeders - 200 amps or less 220 - 0000 -43103 $100.70 ELC2011 -00518 Temp Services or Feeders - 200 amps 220- 0000 -43103 $118.72 • or less ELC2011 -00518 Branch Circuits w /Purchase Service or 220- 0000 -43103 $44.52 Feeder ELC2011 -00518 12% State Surcharge - Electrical 100- 0000 -24001 $31.67 Total: $295.61 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 901281 BTAGGART . 09/21/2011 $295.61 Payor: Chuck Garner / Garner Electric Total Payments: $295.61 • Balance Due: $0.00 Page 1 of 1