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Permit `/i /fig a S'eogP -e- (�u� CITY F TIGARD ELECTRICAL PERMIT ° PERMIT #: ELC2008 -00236 COMMUNITY DEVELOPMENT DATE ISSUED: 4/29/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 104AD -04500 SITE ADDRESS: 12617 SW WALNUT ST ZONING: R -4.5 SUBDIVISION: TVF &R FIRE STATION LOT : JURISDICTION: TIG PROJECT: TUALATIN VALLEY FIRE AND RESCU Project Description: Temporary power. 5/1/08, ADD (1) TEMP FEEDER FOR JOB TRAILER. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 2 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: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 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: TUALATIN VALLEY FIRE & RESCUE MANZURA ELECTRIC ' 20665 SW BLANTON ST 13023 NE HWY 99 SUITE 7 -147 ALOHA, OR 97007 VANCOUVER, WA 98686 Phone: 503 - 649 -8577 Contact #: PRI 360- 772 -1321 FAX 503 - 210 -1558 FEES Description Date Amount Reg #: ELE C137 [ELPRMT] ELC Permit 4/29/2008 $66.85 LIC 168391 [TAX] 12% State Surchar 4/29/2008 $8.02 SUP 5184S [ELPRMT] ELC Permit 5/1/2008 $66.85 (additional fees not listed here) REQUIRED ITEMS AND REPORTS Total $149.74 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 Ala NTION• Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0. 0 through e R • . -0)1-0100. You may obtain copies of these rules or direct questions to OUNC at 503.246. 699 or 1.800.332.2344. 1 'I / < Issued By: - � Permittee Signature: OWNER INSTALLATION ONLY a 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. I rl_T CITY OF TIGARD ELECTRICAL PERMIT • ° a COMMUNITY DEVELOPMENT PERMIT #: ELC2008 -00236 DATE ISSUED: 4/29/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S104AD 04500 SITE ADDRESS: 12617 SW WALNUT ST ZONING: R -4.5 SUBDIVISION: TVF &R FIRE STATION LOT : JURISDICTION: TIG PROJECT: TUALATIN VALLEY FIRE AND RESCU Project Description: Temporary power. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 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: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 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: TUALATIN VALLEY FIRE & RESCUE MANZURA ELECTRIC 20665 SW BLANTON ST 13023 NE HWY 99 SUITE 7 -147 ALOHA, OR 97007 VANCOUVER, WA 98686 Phone: 503 - 649 -8577 Contact #: PRI 360- 772 -1321 FAX 503 - 210 -1558 FEES Description Date Amount Reg #: ELE C137 [ELPRMT] ELC Permit 4/29/2008 $66.85 LIC 168391 [TAX] 12% State 4/29/2008 $8.02 SUP 5184S Total $74.87 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 • - • • • • n accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspen. - . or more than 80 days. ATTENTION' Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Thos- rules are set forth in •A ' ' -00 -0010 through OAR 952 -001 -0100. You may obtain cop • these rules or direct questions to OUNC at 503 46.6699 o 1 800.332 / • . Is ed By: • = A I/ / ` _ Permittee Sign : j / ( — 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: NFRACTOR INSTALLATION ONLY .• SIGNATURE OF SUPR. ELEC'N: _1"- ��A . ✓// .0 e--- 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. • City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 ' - ;: u • TIGARD May 9, 2008 Matthew W. Hubel 29075 SE Fir St. Eagle Creek, OR 97022 Re: Permit No. ELC2008 -00236 Dear Mr. Hubel: The City of Tigard has processed a refund for fees on the above referenced permit(s) for the following: Site Address: 12617 SW Walnut St. Project Name: TVF &R Job No.: Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $59.90. ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as work was not done for additional temporary service. Refund 80% of permit fee. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse • Building Division Services Coordinator Enc. I: \Building\ Refunds\ Administration \LtrRefund - RefundOnly.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 CITY OF TIGARD 5/1/200.8 a. rt 1311; SW Hall Blvd. 4:2!: 12PM ,4! } ' ' Tigard, OR 97223 503.639.4171 " BL`EAR Receipt #: 27200800000000001456 0 / 2 i Date: 05/01/2008 Line Items: Case No Trail Code Description Revenue Account No Amount Paid ELC2008 -00236 [ELPRMT] ELC Permit 220 -0000- 431510 66.85 ELC2008 -00236 [TAX] 12% State Surcharge . 100- 0000 - 207020 8.02 Line Item Total: $74.87 Payments: Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid CreditCard MATTHEW W HUBEL DEB 04580D In Person 74.87 Payment Total: $74.87 • rRtcripi.rp� 1',t_c. I of I ( , BEG E ED APR 2 gZ"S Electrical Permit Application °�` of YG .Ii (N,, City of Tigard na l i g (�q �,. -„ 13125 SW Hall Blvd„ Tigard.OR 97223 QU1L 1 p i'd °V 1 � '' r t R$ O g /' Per mit No. a O p - 60,234 Phone; 501.6394 /71 F 503.598.196V Ochre Pcmui : Plan Review l�s rte: Datant 1' .j ;j..l pe on L,ne: 503,639.4175 rlste Internet: vm•w,bo rd•Or.gat' lNod, 7ur I Sapple i a ' — i _ Norific ®gee P� e t [ (� mmtal information �( 3(YPE OF WORK /�Nc" CQnstrut Rion PLANT REVIEW ❑ Addi [ lon/alteration lrepla cemetrt Prance cheek 41 that tliply (submit 2 sets of plane wiiram checked bolrw)y ❑ Demolition ID Other; ❑ Series or feeder 400 amps or more Q Building ever three storms, CATEGORY OF C whets QM available fj ea man El as Tdario and bonryards CONSTRUCTION exceeds 10,000 amps at 1 sn volts or O f loafing bother ❑ 1- and 2- family dwelling Commercial /md ustnal ❑ Accessory buildi I°'t"e 8ro rn er" eccd s t4,DDO ❑ Commereial,t¢ apriculhrtrl ❑ Muiti- fan) ity ❑ Master builder Fires ra a0 oili sbdloti b ❑ �Q' O Fire pomp. ❑ Installation of 75 xva of L7 JOB SITE INFORMATION AND LOCATION Emergency system. Lugar acparaiely derived system. Job no.: s ❑Addition of new motor load or ❑ "A•, "E"'. "1.2 , "1 - 3 ". Job he address: %� ° �� f ' 9I_�ff, fj -' looxa arnR, occ City /State/ZIP: /r/ 6R ❑ Six a acre facilities ua ❑ Recr +Rfnale Wes. ,� �2G � 7 � aHe�e- rare l nonage i �e y rhr Dora than $Y iteIbldg. /apL no.' OHamrda locations_ ❑s 600 voles nominal, Project name ' . /e " 5j CW . Sq.) ❑ Sconce or r Rieder 000 Dnepr or more Cross sl.rcet/dircctions to job site; £ SOTEDITLE a ' . den Cunu1i4 i. _ New residential single- or multi- fomity dwelling unit. Subdivision Lot no.: 1,000 eq, Includes ft. or foss wage. Ea a sq 500 or Iss ��� Tax map/parcel no.: Ea add'1 500 sq ft, or portion 3's.40 1 DESCRIPTION OF WORK Limited energy, residential 75.00 GG,, �„ vrialatra \Y 1• f[ 2 Tamil '/A�'r T" Limited energt•, multifamily residential with above ,. R, 75,p0 MI Services or feeders installation, alteration and/or re/neatlon PIEto IY OWNER 200 amps or less MI sun _ q �� TENANT 201 amps to 400 n1115-1 IIII1 Name: ;747)::-Via------------ V 106. �d 401 maps m 600 Ramps _ 160.60 �© Addres /_ , �T 601 amps to 1.000 gimps 240.60 i City/Statd7Tp A y O /� I (/� • - - _ Over 1.000 amps or volts NM 454 63 mai /� rev 7 Temporary sun - ices or feeders installation, s erti�o an, nod/or Phone. ' �.3 ) 1 9 0 57 7 ( relocation v i i fink: ) 200 rums or IM9 ���� Owner installation: This installation is bean made on �i.7 66.85 �Jil:� intended for salt, lease. rent. or exchange, g , according g t property that I own which is not 201 amps to 400 amps 100,30 Q ORS 447, 449. 670, and 701. 401 amps to 599 amps 133,75 Owner sign ature: Da te :' _ © APPLICANT » A. with Fee for branch circuits rwith 1 , 1l i" rtel Q CONTACT PERSON above service arfeeder fee Business name: each branch circuit ~�- B. Fee for branch circuits Contact name. wLl,ou service _ or kcc1G7 f¢ NM Address; first branch circuit 2 — Each add] branch circuit 6,63 City /St/ZIP Vliacellancous nervier or feeder not inctaded Rath manufactured or modular Phone: ( ) ' { ) twain. service and/or feeder 90.90 CI E -mail: - Reconnect only MI 6¢.85 2 Pump or irrigation circle 53.40 i CONTRACTOR El 7I � /h A Sig vs outline Iighlin: 53.40 2 Business name: eLr7 �� Signalcrctrt(s)orl,rr,• Address: 0Z 3 He fief"; 9n S , v c cncig ic,.. D , c reme ited j' C!� 7 4; 7 extcnsron. Deernb Pasc z City /State/ZIP: // /9/frCeiif ** 'hl Phone. (Z.0)772_ 3 � .8itd Per inspection Z i Fax: ( Z o f 5 S r 62.50 �� cCB Lie.: /4 �" = 62.50 ' A1 7 / Electrical Lic: C �� 7 Suprv. tic.: C %8'4 -S tadnstrial plant bout MI 73 =MN Suprv, Electric] •tom l a tire, required: Z(iQ�r / ELECTRICAL PERMIT FEES b -tff/ /� Print name; `�, Subtotal. �9•S ' 2- Date: 25 04. Plan review (25%of permit fee): w E 2 Authorized cignatura, • Stone surcharge (12 %of permit fee), Print name: TOTAL PfiRM1T FEE; '2 E Date' Thin WWI application expire, i1 a permit 1, not obtained within 180 ' r 1HuildingtPermltRS[,C.P days elks it hit been accepted as complete e rmiNpa,Cac 0527lD4 • marlin. Number of intentions allowed per pau. 410441ST(I liOsjcOMANEB a•d seta SBB 09E eunyzuei e6 BO ea .add • 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 or Refund 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: Matthew W. Hubel DATE: May 7, 2008 29075 SE Fir St. Eagle Creek, OR 97022 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 2008 -1456 Case #: ELC2008 -00236 Date: 5/1/08 Address /Parcel: 12617 SW Walnut St. Pay Method: CreditCard Protect Name: Tualatin Valley Fire & Rescue EXPLANATION: Additional temp service not done under this permit (see ELC2008- 00245). Refund 80% of permit fees for this work. REFUND INFORMATION: • • Fee Description From Receipt Revenue Account No.. . Refund Example:. [BUILD] Permit Fee Example: 245- 0000 - 432000 - $ Amount . [ELPRMT] ELC Permit 220- 0000 - 431510 $53.48 [TAX] 12% State Surcharge 100 - 0000 - 207020 6.42 TOTAL REFUND: $59.90 APPROVALS: 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 ON Y - Case Refund Processed: I Date: I .. �"99_r /.- I By: I y o�its- 6 I \Building \Refunds \RefundRequest doc 05/23/07 I K CITY Of' TIGARD 5/9/2008 r • '1` '� � " 13125 S\\ hall Blvd. 13AM - , �'.: � ''' Ti OR 97223 iO3.G39A171 TiIGAR±D) Refund Receipt #: 27200800000000001571 /0. f/;4. - - 74:-- . Date: 05/09/2008 Line Items: Case No Tran Code Description Revenue Account No Amount Paid ELC2008 -00236 Reversal - [ELPRMT] ELC Permit 220-0000-431510 (53.48) ELC2008 -00236 Reversal - [TAX] 12% State Sur 100- 0000 - 207020 (6 42) Line Item Total: ($59.90) Refund: Method Payer User ID Acct. /Check No. Approval No. l-ION Received Amount Paid Credit Reversal MATTHEW W HUBEL 04580D In Person (59.90) Refund Total: ($59.90) V a c • i\ •• o o v o � g -v ...,, o l m ix ^ u a, w y cd w' q v O .. 1:3 - 40 Q a. E , O 6J u fi 2 8 a A \ ^ „, g y Ix e Q t13 -g rn a o v W o `.' ,, o k 1 �\ w x u 0 Iu nu - cI.ceIi)I Q P4 is .. IL \ 1 !pi Page I or I e ° Community Development REC8VED Request for Permit Action MAY ,$2C( TIGARD CITY O TIGMAJ TO: CITY OF TIGARD IK 471 ';'' , T4 VPSiON 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 Nt Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Mal+ /4v6- I Mailing Address: 29 075 $C fi• r S City /State /Zip: &aflt crre k c 91cM Phone No.: .51)3-39i - 6 PLEA E TAKE ACTION FOR THE ITEM(S) CHECKED (1): g-Asara dive E'cr / "1 / T . � � CANCEL PERMIT APPLICATION. pv r, us 7 kg REFUND PERMIT FEES (attach receipt, if available). 6 fNS" --- 4 ER, ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). 5/7/tr' Permit #: £L C loo8" ODA ` .3�D Site Address or Parcel #: /e?c / 7 4w �f9•L.veiT Jr / u 9- /� Project Name: ' tritrT,J Uf LLEy Subdivision Name: /4" Lot #: /1110- EXPLANATION: efr;,,,h) A rai 7amiere- s t"AIb 6N 5 / / /D$• 4vDi77e),.F}L 4)v2&i /k414.2 /A4,667 • AM ON6 ui✓d Eie. tc _c ;y •ELeaaoce DO Z 95 Signature: Date: 4 //j,9 Print Name: iicc* /- Refund Policy 1. The Director or Building Official may authonze 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 pnor 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 50 f Rte to Bldg Admin: Date By Refund Processed: Date 7/ By Invoice Processed: Date By Permit Canceled: Date it/ By l•'• Parcel Tag Added: Date By Receipt # Date / 4,F. Method C Amount $ 7y, J7 I: \Budding \Forms \RegPemvtAcuon doc Rev 07/26/07 iy 540 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2008-00236 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/29/2008 Phone: (503) 639 -4171 A Inspection Requests (24 Hrs.): (503) 639 -4175 , ! °7 I _L. INSPECTION WORKSHEET FOR DATE: 511/2008 TIME: 7:00AM PAGE: 84 SITE ADDRESS: 12617 SW WALNUT ST CLASS OF WORK: SUBDIVISION: TVF&R FIRE STATION LOT #: TYPE OF USE: PROJECT NAME: TUALATIN VALLEY FIRE AND RESCU DESCRIPTION: Temporary power. OWNER: TUALATIN VALLEY FIRE & RESCUE, PHONE #: 503 - 649.0677 CONTRACTOR: MANZURA ELECTRIC PHONE #: 360- 772 -1321 Inspection Request Scheduled For: Date: 5/1/2008 Pour Time: C' - -- • • - - 'e • l escription Contact # M 199 Electrical final 069151 -0 503.341 -7634 Y Cor - - ,.� - -- - - - _ • ions: 11 4 Ate- o\ Nk`C b A 1 (--__________________ Q ca.4 D l'' Ib I g ..,.. \)\-- G-4664 L 6/1 I p l4 .q PA'S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS •---Ak --- - , ..WALL ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G--"N N€ L Date: 61 tt 61 Phone #: (503) 7181106 - - CITY TIGARD BUILDING DIVISION PERMIT #: • ELC408.00236 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11211120013 Phone: (503) 639-4171 Ate ert lt Inspection Requests (24 Hrs.): (503) 639-4175 :— INSPECTION WORKSHEET FOR. DATE: 4/3J00 TIME: 7:DpAIVI PAGE: 27 SITE ADDRESS: 1261 .:SIP Mag.) I" SF. CLASS OF WORK: SUBDIVISION: T VF.R FRE STA lION LOT #: TYPE OF USE: PROJECT NAME: TUALATIN VALLEY' FIRE AND PESCU DESCRIPTION: Icinporaly OWNER: TUALATIN VALLEY FIRE & RESCUE, PHONE #: 503 CONTRACTOR: MANZURA ELECTRIC PHONE #: 3O f7 . Inspection Request Scheduled For: Date: 4/3012008 Pour Time: Code # Inspection Description /Confirm Contact # Message • "fen iNrary electricz3lserylce: 0076-01 60"3-152-096S N' Corrections/Comments/Instructions: • P(ka . 1 r_15 wo ot.E) R6136 e ,. ART. 1 110,3), • VEto\i‘g PekisnA fut, f 10 Ib - • • • • • Li PASS El PARTIAL APPROVAL 111 CANCEL 111 NO ACCESS - CI CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED 1* Date: