Permit CITY OF TIGARD ELECTRICAL PERMIT
Per
COMMUNITY DEVELOPMENT
Permit #: ELC2012 -00274
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/10/2012
Parcel: 2S109DA18800
Jurisdiction: Tigard
Site address: 12706 SW WILLOW POINT LN
Project: Stonebridge Homes Lot 117 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 117
Project Description: Solar Install Lot 117
Contractor: MILESTONE ELECTRIC Owner: STONE BRIDGE HOMES NW LLC
1281 NE 25TH AVE, STE. T 16869 SW 65TH AVE #505
HILLSBORO, OR 97124 LAKE OSWEGO, OR 97035
PHONE: 503 - 645 -5323 PHONE:
FAX: 503 - 690 -4843
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/10/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 05/10/2012 $12.08
Type of Use: SF Electrical
Class of Work: NEW
Type of Const:
Occupancy Grp:
Total $112.78
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 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 : 1987 or 1,800.332
Issued By: J4.i 0 /4 � 2( Permittee Signature: � ApPL e44-17
" `t
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.
May, 10. 2012 12:57PM Milestone Electric No. 2123 P. 3
RECEIVE
Electrical Permit Application FOR OVVICL USE. ONLY
City of Tigard LAY 1 0 201 Recei Cie) 1--
Date/By:
1 N O G F TIGARD . N a:imethod: Permit No.: E a. .. 0 od _. 7
13125 SW Hall Blvd., Tigard, OR 97223 PI= Review
' . Phone: 503.718.2439 Fax: 503,598.1
U6ILTDY Other Permit:
TIGARD
Inspection Line: 503.639.4175 B Dato Ready/By: fiii /1 El See Page 2 for
Internet www.tigard•orgov 1 i y Supplemental Information
• .,....,-; ;:,.:-..,.!.. -,,,-;..., •• • . . • .1 ..- -,-- - - '.:-• TypE OF WORK. :. r . . - . . ....: . '. .;;:1,164,0*.... i..., N;61 PLAN;12WIEWAWiriniegiaiX.t.4'.--
pk u h ut i tia that apply (submit 1 seta :
allslew construction 0 Addition/alteration/replacement of plans w/items checked below)
0 Service or feeder 400 amps or more 0 Btulding over three stories.
0 Demolition 0 Other: where the available fault current D Marinas and boatyards.
-1i.5.Y.f-t.; - • . •sr"
- -' , 4' . • '.. • - ':••••'-`!-:: -• . ....... .:' .. CATEGORY OF CONSTRUCTION ..: 'i . ...... • ..4::','..r: n;•.?:.. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
. .. .. ,. ...
loss to ground, or exceeds 14,000 0 Commercial-use agricuitmal
112(1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire PumP. 0 Installation &IS KVA or
. 0 &IMPEL" sYstere. larger separately derived system.
':'.1'.:'•. - - ''. ' . ., ' .. • JOB INFORMATION AND LOCATION - c ' ':'.', : .....'....:;:, :... . . °Addition of new motor load of 0 "A", "E", "1-2", "1.3",
. . .
100HP or mote. occupancy.
Job no.: 1 )1 9 3 Job site address: v1:7 0 C 5 0 k,,,:li i 1 0% ,, , ..
0 Six or more residential units, ID Recreational vehicle parks.
t... , 0 Healtivtare faces. 0 Supply voltage for more than
City/State/ZIP: T , .. , 0 4., 1 711 ' 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: Project name: s . v vy, c \ c ,. ..i 64 , v oy4 f, 5 a Se:vice ON feeder 600 amps CIT more.
- • .:-..., ,-: .- . . .. FEE SCHEDULE .-' • .. . • , • Cross street/direetionS to job site: i--o i I I 1 Description I Qty. I Fes I Tow 1 •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq, ft. or less 168.54 4
Ea. add'l 500 sq, ft or portion 33.92 1
Tax map/parcel no.: Limited =eau, residential
. . 75.00 2
. • • • ' . • D ' (with above sq. ft)
Limited energy, multi-family 75.00 2
•
r --01 I, 1 residential (with above sq. R.)
Services or feeders installation, alteration, and/or relocation A
200 amps or less j 100.70 100,70 2
: .. • a 40 .. • .. AM. - 0 TENANT '... • . •••1 : .:,.... 201 amps to 400 arnps
.-. . 133.56 2
N 401 amps to 600 amps 200,34 2
ame:
_ . 601 amps to 1.000 amps 301,04 2
Address: Over 1.000 ainps or volts 552,26 2
Temporary services or feeders installation, alteration, acid/or
City/State/ZIP. relocation
Phone: ( ) Pax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
.• :....: :. ..... . • TA;OfIrCANI ..- • . . , ... 1 . • 1:j etiRrAcr ?Ensoiv,..-:.::;'......,-..,:. above service or feeder fee, 742 2
each branch circuit
Business name: B. Fee for branch circuits without
&mice 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)
Each manufactured or modular 67.84 2
City/Stare/ZIP: dwelling. service and/or feeder . -
Phone: ( ) 1 Fax: :( ) Reconnect only - 67.84 2
Pump or irrigation circle 67.84 2
E -mail: • Sign or outline lighting 67.84 2
'.:':?....:.'''...:-. ;'.';i .• ::.,. •;', • CONTRACTOR ;.'', ';'::::: Signal circuit(s) or limited-energy
panel. alteration, or extension. Page 2 _ 2
Business name: Milestone Electric
Each additional inspection over allowable in any of the above
Address: 1281 NE 25th Ave. Suite T Additional inspection (1 hr min) 66.25/ hr
— Investigation (1 hr min) . 66.25/ hr
City/State/ZIP: Hillsboro, OR 97124
Industrial plant (1 hr min) •
78.18/ hr
Phone: (503) 645-5323 a kl/ '
V Fax: (503) 690-4843 Inspections for which no fce is 90.043/ hr
specifically final (i,hr rnin)
/CB Lie.: 153480 tk ' pectrical Lie.: 34-618C 5 Lie.: 7ce3 5 '.
Subtotal: _ / 0 a 70
Suprv. Electrician signature, required: • ......,....--:000..---
Plan review (25% of permit fec):
_ - ' ...
Print name: c , „ rr / Date: C / e / 2 _ State surcharge (12% of permit fee): / 2, b y
7 - TOTAL PERMIT FEE: /f 2, 7 s'
Authorized signature: This permit application capita Ifs permit is not obtained within 180
days after it has been accepted as complete.
-
Print name: Date: • Number of inspections allowed per permit.
r_tt....;.1 — dn. 1171111n n &AAA! t'tt I 1 ma/rim/wan
May. 10. 2012 12:57PM Milestone Electric No. 2123 P. 1
MiThstone Electric
1281 N.E. 25th Avenue. Hillsboro, OR 97124 CGB #153480
FAX COVER SHEET
Date: 51 t 0 / Fax: 5 — 517 1 74 6
Attention: Number of Pages
p erm + t)-e" 1 , to Follow: v�
Company: C 4-1
From:
Message:
This e-mail and any attachments contain information from Milestone Investments Co. LLC (DBA: Milestone
Electric), which may be confidential and/or privileged. The information is intended to be for the use of the
individual or entity. named on this email. If you are not the intended recipient, be are than any disclosure,
copying, distribution or use of the contents of this email is prohibited. If you receive this e-mail in error,
please notify us by reply e-mail immediately so that we can arrange for the retrieval of the original
document(s) at no cost to you.
Phone: (503) 645 -5323 Fax: (503) 690 -4843
III 1,
TIGARD
City of Tigard
August 1, 2013
Milestone Investment Co.
Attn: Gail Kidby
1281 NE 25 Ave., Ste. T
Hillsboro, OR 97123
Re: Permit No. ELC2012 -00274
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 12706 SW Willow Point Ln
Project Name: Stonebridge Homes
Job No.: N/A
Refund Method: ❑ Check # in the amount of $ .
® Credit card "return" receipt in the amount of $90.22.
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 work was not finished due to contractor going
of out business (Live Light Energy). Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
/12*.4-7,c..7
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Milestone Investment Co. DATE: 8/1/2013
1281 NE 25 Ave., Ste. T
Hillsboro, OR 97123 REQUESTED BY: Dianna Howse
Attn: Gail Kidby
TRANSACTION INFORMATION:
Receipt #: 186678 Case #: ELC2012 -00274
Date: 5/10/2012 Address /Parcel: 12706 SW Willow Point Ln
Pay Method: CreditCard Project Name: Stonebrige Homes
EXPLANATION: Work not completed; LiveLight Energy went out of business. Refund 80% of permit
fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Electrical permit 220- 0000 -43103 $80.56
12% State Surcharge 100 - 0000 -24001 9.66
TOTAL REFUND: $90.22
APPROVALS: SIG RES DATE:
If under $5,000 Professional Staff .4 -
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 ONLY
Case Refund Processed: I Date: I P// /_ I By: I 't�
I: \Building \Refunds \RefundRequest.doc x 09/01/2010
Jul. 2. 2013 11:20AM Milestone Electric No. 3877 P. 1
C,.C�
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT R EC EIVED
Request Permit Action JUL 2 2013
q
-; G A l; 11 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tiga .ORTIGAnp
41 Dj® UVIS
TO:
/ CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov 7/ j/3 44-
FROM: ❑ Owner ❑ Applicant V Contractor ❑ City Staff
(check one)
REFUND OR Name:
,, INVOICE TO: (Business Or Individual) ,a' , • ,,, • . a , 'a ,,
� Mailing Address: 1�g ` 1Q as Aoe _ LAI. -tom .
Cit /State /Zip: \v`rz N OQ, S 1 t 23
Phone No.: So - `Qk -- S323
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL /VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
n INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: _E [1l 1 '0 6 .1 i
Site Address or Parcel #: ().7 0 0.3‘k1.003 Po\ (\i 4A,
Project Name: 'bt lac `Yt St &\\
Subdivision Name: fyt D ' Vl Lot #:
EXPLANATION: r\Q�V Q, c;\ C'1, P A ` vi3Qsj-\.\-- bti" A
l . :1 U c. L► J c 1J
Signature: GIr.‘.-\ Date: — 1 - 2. 1 3
Print Naxne: i V)..), \ ( /00, 70 /.2.0?
Refund Policy . /y a //,/
1. The Director or Building Official may authority the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 811 °';. of the land use application fie when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80° ii of the land use application fee for issued permits. .
d) not more than 4ftia of the building plan revicty fee when an application is canceled before any plan review effort has been expended.
e) not more than 80`: ° of the budding 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 2-4 weeks for processing refunds.
`_ I OR:OI ii .IC U • ,- ..`. ; .. tip ONLY'
Rte to S 's Admin: Date B Rtc to Bid: Admirt: Date d'ANG B _ &MN
Refund Processed: EMS745101111 B 4# Invoice Processed: Date
Permit Canceled: Dare "Aram B A C Parcel T.. Added: B
Dare Method Amount $
1: \Building \Poona \RcgPermirAcrion.doc Rev 05/25/2012