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Permit • CITY OF TIGARD ELECTRICAL PERMIT 1111 m COMMUNITY DEVELOPMENT Permit #: ELC2012 00286 TI TIGA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date issued: 05/16/2012 Parcel: 1 S135CA10100 Jurisdiction: Tigard Site address: 11394 SW 96TH AVE Project: Lanier Subdivision: SOLERA Lot: 10 Project Description: NC or heat pump, service outlet and condensate pump Contractor: BEAR ELECTRIC Owner: LANIER, FRANK S PO BOX 389 11394 SW 96TH AVE DONALD, OR 97020 TIGARD, OR 97223 PHONE: 503 - 678 -1355 PHONE: FAX: 503 - 678 -1108 FEES Quantity Description Date Amount 3 crt Branch Circuits wo /Purchase 05/16/2012 $71.02 Specifics: Service or Feeder 1 ea 12% State Surcharge - 05/16/2012 $8.52 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $79.54 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. At 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 9 01 -0090. You may obttaain copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: W IVS t PA Permittee Signature: + P PPL1 / Q ki 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. MRy- 15- 2012(TUE) 15: 52 Bear Electric (FAX)5036781108 P. 001 /002 . r_EitiEr Electrical Per'Imit Applicat� _ 1 ou. 01 USE ()NIA City of Tigard MAY 1 6 2012 Penh o���•i� 1 .. ' 131:1 SW Hull Dlvd, Tigard. OR 971 pii ltcllow Plume: 503.7111.2439 Fax: 50359 Other Permit: { u r !IGr^lJ iu�le T I G A u lns Line 503.639 ti' tlmc Ruuynly: LI r See Pagel for in'mew: aw.v.ti N>' BUILDING -ot. ^ !' ) t ' : i tiotllledA1 hod: Supplemental Inhumation �' - cvo ❑ New construction El Addillon (Oltc'itlion/rcp1accmcnt PICwechutk all thin appl;• lsubmitjassorph = w.'itums checked below): 0 Service or lbcda.400 amps or more Cl Building over throe modes, ❑ De molition 0 Other: where the available fault semi 0 Marinas and baa>janIa. / ;err;=- -- ' x;` ".x .' O M'aa' mu t& t11 win to twvulos r Cl Minim buildlnp. s:� > : = %; . , « leas 10 round, or tweeds 144810 0 Grrtmetelal -use agricultural rig I- and 2.- family dwelling ❑Commercial/industtial 0 Accessory building amps fin all other installations. buildings, , 9 Multi - fam ❑ Master builder ❑ O 0 rlre pump. 0 installation ,r75 I.'VA or lS, , i<•nu■+iwµ p Y>ti 0 Ernergatcy o a)xl m larger separmdy derived system � (� DAdIGtIllnfnnrmlulxloml Q F,..1.2 , I.3° Job no.: I Job site address: 1��- p� � �h ��Q. 1111111P IK or nr a milk-WO p /toe, occupancy. vehicle pules p S1x or more rc+htcmklt laths. is City/State/ZIP: so.. x 6 e 0 HmIIhs::re Emil him Cl Supply voltage for mom Own O It�Ildoua lu©tions WO voila nominal. Suite/bldgiapt.no.: Project name: AN lea- osevicc feeder Ma amps rrrime. IMEMEMEMIZEISCOMIWIMMIBEEKai Cross street/directions to job site: urerInnou _t_ Qtr. I hew 1 •r«er i • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. 0, cr less - 1611.54 4 • Ea. min 50 ad0 sq. fl. or purtion 33.92 1 Tax maplputcel no,: Limited snag?', residential 75.110 2 MEESCEEIMatigerAMBIKOit (with above sq_ 1L1 Limited energy, multi-family ki e. ilex-h. \ 1C"`(� . rite r o e t N residentlidSwith above sq. 11.) 75.00 2 Services or feeders installation, alteration, and/or remotion 1 .. . tt 4 _.% .. 7 ■I1 ` 200 owe ur ki • r . 100.70 i 1 . . . il7 q el e� a ,�o 1, �„ 1 © d.9 . 1: _. .OI ampstu400amps 13756 • Nume: • 401 unto to 600 amps 20034 2 601 amps to 1.000 ante 301.04 2 - Address: Over 1.000 win or rolls 552.26 2 City/State/ZIP: Temporary services or feeders Installation, alteration, und/ur relocation Phone: I ) I Fox: ( ) 200 amps ar less 59.36 I Owner installation: This installation is being made on property that I on which iS not 201 amps to 400 amps Izs.bs 2 ow amps to 599 amps 168. .}1 2 intended for sale, Izvse, zero, or exchange. according to ORS 447. -049.670, and 701. Branch circuits - nor, a {terndon, or esicuvelno, per panel Owner signature: Date: ' A . Fee for brunch circuits with INIONEMISINIMPIMMENNEMMEgtraittelEMS above service ur fernier fee, 7;12 2 each branch cimulr Basilicas name; It Fee for branch eltolts 1 �^ 1� servlee or feeder Re, tint 56.18 '�t 1 2 Contact name: breach circuit Each uddi branch circus 7.42 2 Address: Miscellaawus (service or feeder not Included) City /State/ZIP: Each manufactured or modular 67.8I 2 dwelling, service andtnr feeder Phone: (. ) l Fax: : ( ) Reconnect only 67.84 Pump or irrigation circle • 67.84 2 H -mail• Sign ar altllnc Iiptldng 67.84 2 Signal Cb uit(s) Cr limited -cnergy • f r Business name: ‘ pane akcratlon or extension J Page 2 12 Each additional inspection over allowable in any or the abov Addles: - 1.4 1 .� Additional Inspection (1lir min) 66Z5fhr City/Swl1JZiP: _f Y1 n t P . in hr min) 66:5/ hr ��I 11 ���o �l Industrial plant plaxxt f t hr nxlnj 79.18 / hr Phone: ( 1 t bf g_ a Fax: ( 1 /t '' - j R ' ,a,,,1 inspections for which no fee is 90.00i hr I I' ]• tr a s 'really listed (91 hr mint 5 pCD Lie.: ' t plcctrical Lic.:ZLl - Ica �P • Lim.: '�' v , a :.,; r ,,: , -;, :;., -fir;,: Suply. ELcctriciaull 11 '.'•, required: .7..,.. _ �� l�O ... Subtotal: k'! ' c Plan review (25% or permit feet: WJ( Print name: ` 0, 0 * N .• i),• Alt Date: r S•- State surcharge (12%ofpermitfcc) lit 7 A utholir :d signature: TOTAL PERMIT FEE: Ea , .sr Tab application expires It permit Is not obtained within 180 days atter it lulu b eau mccepted m comlplele. Print name: I Date: • Mantua nfimpealmm allowed per pmnit. I'. Iluildh0PanniNW .1('.1111at2,„ 440- lb15T) LI/a t't.'WE11 • I I II III 1 a T [ GARD City of Tigard August 22, 2012 Bear Electric Attn: Stacey Wisdom PO Box 389 Donald, OR 97020 Re: Permit No. ELC2012 -00286 Dear Ms. Wisdom: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11394 SW 96 Ave. Project Name: Lanier Job No.: N/A Refund Method: ❑ Check # in the amount of $ . ® Credit card "return" receipt in the amount of $63.64. 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 refund 80% of permit fees as a minor label was used for this job. If you have any questions please contact me at 503.718.2430. Sincerely, , d-Mli " . , Dianna Howse Building Division Services Supervisor Enc. I:\ Building \RefundO 2i5i& r aticfid pitlfiga ,a®1tgbn 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 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: Bear Electric DATE: 07/26/2012 Attn: Stacey Wisdom PO Box 389 REQUESTED BY: Dianna Howse Donald, OR 97020 TRANSACTION INFORMATION: Receipt #: 186760 Case #: ELC2012 -00286 Date: 05/16/2012 Address /Parcel: 11394 SW 96th Ave Pay Method: CreditCard Project Name: Lanier EXPLANATION: Refund 80% of permit fees per applicant's request as they used a minor label. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Permit Fee 220- 0000 -43103 $56.82 / y, 20 12% State Surcharge 100 - 0000 -24001 6.82 , � 0 TOTAL REFUND: $63.64 APPROVALS: If under $5,000 Professional Staff 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: Date: ef`7 / /2---- I By: g I: \Building\ Refunds \RefundRequest.doc x 09/01/2010 MAY-23-2012(WED) 15:59 Bear Electric (FRX)5036781108 P. 001 /001 RprFIvED : .. is IN Community Development MAY 2 4 2012 TIGARD Request for Permit Action CITY OF TIGARD b1J1 U '! v+ . ON • 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 FROM: ❑ Owner ❑ Applicant E Contractor ❑ City Staff (check one) REFUND OR Name: YNVOICE TO (Business or Individual) -\- \C' nD. . Mailing Address: P,C) , O City /State /Zip: C^( C , 0 C)2ca Phone No.: ( ali l- \1 E E PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): • • CANCEL PERMIT APPLICATION. El REFUND PERMIT FEES (attach receipt, if available). , ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REM OVE CON CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: F ne)\ Site Address or Parcel #: V3CALA ', Cj0 IN , Project Name: Subdivision Name: Lot #: EXPLANATION: p 3; .il, ■ 5 t <I A. Cl t a i Signature: � ` � � V _ . s!. L. __ Date: 5— 2? ,--0__ Print Name: 1 S 'JJ ':Q i'2i Reru 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 iwued permits prior to any inspection requests. 2 Refunds will be returned to the original Payer in the same method in whit', payment war received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rtc to S • s Admin: Date SEMENIE{��� Rtc to Bid_ Admin: Date PASMAIII orAll ' Refund Processed: Date , igrAs B. <I , A Invoice Ptoca:scd: Date B. Permit Canceled: Date , . is._ B • , ;;, Parcel T. Added: Date B Recei t # ej an Date Method Ga.— Amount $ 1: \ Building \ Forms \Rc gPennitAcrion_doe R 02/23/2011