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Permit City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 T I GARD October 7, 2008 Ross Electric, Inc. 2870 SE 75 Ave., #203 Hillsboro, OR 97123 Attn: Stephen Ross Re: Permit No. ELC2007 -00777 Dear Mr. Ross: • The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 7080 SW Clinton St. Project Name: Taylor Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $75.13. ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as customer cancelled job. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. 1: \ Building \ Refunds \ Administration \LtrRefund- CancelPermit.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 - . - -- CITY O T' I G A R D 1 0/6/2008 • I , s 13125 SW Ilan Blvd. I I :30:17AM ,.• "1 igard, OR 97223 5113.639.4171 TTPAAPa . Refund Receipt #: 27200800000000003465 Al6--c &g.5 y. Date: 10/06/2008 Line Items: Case No Tran Code Description Revenue Account No .mount Paid ELC2007 - 00777 Reversal - [ELPRMT] ELC Permit 220-0000-431510 (69.56) FLC2007 -00777 Reversal - [TAN] 8% State Sure 100- 0000 - 207020 (5.57) Line Item Total: ($75.13) Refund: Method Payer User ID Acct. /Cheek No. Approval No. How Received Amount Paid Credit Reversal CHRIS MILLER - ROSS 452071 Fax (75 ELECTRIC • Refund Total: ($75.13) V it A c • 6J h 0 O y i ,� Z 6 - R ` o t> • a I .v " 3 2 y v 1 g cr, 0 u 'V ri :t..,' b' d a d o > cd 0 1 3 -< L H q V .. cd .4"... . A 4, y a 5 a 1--1 '3) 5 v O , , v • to `g" a s $ 4 1 w 0 cl k 0 � i 43 6 1 5 v O � w ' t 1 • \ . x if y 9 v g 8 r AQga:V ;;O u. 6. () a: o il • Q H w P4 a \ '3 09/30/2008 08:56 5036425815 ROSS ELECTRIC INC PAGE 01/01 01 . Community Development TIGARD Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Pax: 503.598.1960 www.tigard- or.gov FROM: ❑ Owner ® Applicant ❑ Contractor ❑ City Staff (cheek one) REFUND OR Name: Ross Electric, Inc INVOICE TO: (Business CC Individual) V 0 J fJ Mailing Address: 2870 SE 75 Ave # 203 /WO City /State /Zip: Hillsboro, Or 97123 Phone No.: 503 -642 -2800 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ® CANCEL PERMIT APPLICATION. >< REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONNIKACTOR FROM PERMIT (do not cancel permit). Permit #: ELC2007 -00777 Site Address or Parcel #: 7080 SW Clinton St Project Name: Ta for Subdivision Name: Isaacs Subdivision Lot #: EXPLANATION: Customer changed their mind, do not want to do the work now Signature: / t= /1 11173 Date: 9/30/2008 Stephen Ross Print Name: nd Edi 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. e) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review (cc 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 S s Admire: Date B • Rte to Bid. Admin.: Date /p (p B ► � Refund Processed: Date /0�0, B y Invoice Processed: Date Permit Canceled: Date /aA,71 7 B , •,; Parcel Ta: Added: Date B. Receipt #Q 7- /9 Date // /4 c 7 Method CG Amount $ l: \Building \Forms \RegPernritAction.d c Re 07/26/07 c � r • v 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: Ross Electric, Inc. DATE: October 2, 2008 2870 SE 75t Ave., #203 Hillsboro, OR 97123 REQUESTED BY: Dianna Howse Attn: Stephen Ross TRANSACTION INFORMATION: Receipt #: 2007 -5093 Case #: ELC2007 -00777 Date: 11/16/07 Address /Parcel: 7080 SW Clinton St. Pay Method: CreditCard Project Name: Taylor EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% of permit fees. 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 $69.56 [TAX] 8% State Surcharge 100- 0000 - 207020 5.57 TOTAL REFUND: $75.13 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager If under $22,500 Department Manager A V,,A/ 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 /Op? e I By: I: \ Building \Refunds \RefundRequcst.doc 05/23/07 i CITY OF TIGARD 9/3c)pt)t)8 F i . 13125 SW Ilan Blvd. 9:01 :36.AM 3 -,ti 1 Tigard. OR 97223 5113.639.4171 Receipt #: 27200700000000005093 C %6 =1 s�, /L - Date: 11/16/2007 Line Items: Case No "I ran Code Description Revenue Account No Amount Paid ELC2007 - 00777 [ELPRMT] ELC Permit 2 -0000 - 431510 86.95 ELC2007 -00777 [TAX] S% State Surcharge 100 - 0000- 207020 6.96 Line Item Total: S93.9I Payments: islethod Payer User II) Acct. /Check No. Approval No. Ilow Received Amount Paid C'reditCard CHRIS MILLER - ROSS DEB 452071 Fax 93.91 ELECTRIC INC Payment Total: S93.9I 011 �t ... CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2007 -00777 COMMUNITY DEVELOPMENT DATE ISSUED: 11/16/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S136DC -03800 SITE ADDRESS: 07080 SW CLINTON ST ZONING: MUE SUBDIVISION: ISAACS SUBDIVISION LOT : 005 JURISDICTION: TIG PROJECT: TAYLOR Project Description: Panel change and (1) branch circuit. 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: SIGNAUPANEL: MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W /SERVICE OR FEEDER: 1 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: CHUCK TAYLOR ROSS ELECTRIC INC 5285 SW MEADOWS RD #369 • 2870 SE 75TH AVE #203 LAKE OSWEGO, OR 97035 HILLSBORO, OR 97123 Phone: 503 - 635 -1513 Contact #: PRI 503 - 642 -2800 FAX 503 - 642 -5815 FEES Description Date Amount Reg #: ELE 34 -436C [ELPRMT] ELC Permit 11/16/200' $86.95 LIC 157891 [TAX] 8% State Surcharge 11/16/200' $6.96 SUP 4232S Total $93.91 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 fo re t - , 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rule are set forth . • 9 901 -0010 through OAR 952 -001 -0100. You may obtain c pier orthese rules or direct questions to OUNC at 503.246. 699 or 1.800. A.2 Issued y: 1 �� /� Permittee Signattk : 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: • RACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC : -- -- - .v ( // 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 requited on the job site at the time of each inspection. ` '11/15/2 -007 12:52 5036425815 ROSS ELECTRIC INC PAGE 02/02 Electrical Permit A,n lic EE . FOR OFFICE USE ON I.1' City y of TiTx a nd j 1 Received 1 1 . 1 6 - 6 7 ru,mttrto.: fzej 13125 SW Hall Blvd., Tigard, OR 2 plan Review Phone: 503.639.4171 Fax: 503.598. I WO V 1 5 /Ill / k" '``' M1'v`A�' I" Date/By Other Permit: Inspection Line: 503.639.4175 L. Data ReadyBy: 64 See Page 2 for internal: www•ci.tigard.or.us � OF of IM m pleeotsa reformation II G .. , .. ..... -. •:::. ._.. ...... , - ..•. .. .. ... • • . .. ................ ..... rirdc�u�' �iky' •t��.. P! if I. 1 D,1 ,:: ....; •„ ..: ...lit ;,,::;, ❑ New construction X Addition /alteration /replacement Please check all that apply: 0 ❑Service over 225 amps, comm'i ❑Hazardous location El Demolition : - rating ..:• .:: .... .:... .... ... .:. :::.:.: .... , �' . OF:: .. C.b'15(5't!�t�C'L'IOS1 . 'r ' ° r• , of 4 n ormorenewlresident RI 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure ©Building over three stories ❑Feeders, 400 amps or mort 0 Mu1ti- family 0 Master builder 0 Other: load over 99 persons OManufactured structures or • .... ...... .. ... ?OB`;S 1EN3FjR ���;L ., . ❑ Eetiss /I ,> >...,.., ... 1►'�:1<7'Ulv;� �iCa�7iIi41Z:'. �;�; ighting plan RV Park T ❑Health -care facility er. Job no.: J Job site address: 10 fo Chigthlet Submit 2 sets of plans with any of the above. City/State /ZIP: •l,91-22 _ The above are not applicable to temporary construction service, Suite/bldg. /apt. no.: Project name: Mawi Yilryq ui 4 d,:.. D acrtntioo I Qty . I Fee. :.... ( -_' rout , .. Cross street/directions to job site: New residential single- or multi- family dwelling unit includes attached garage. 1,000 so. ft. or less 145.15 4 Subdivision: Lot no.; Ea. add'l 500 sq. ft. or portion 33.40 1 - - Limited energy, residential 75.00 2 Tax map /parcel no.: . 7500 • 2 ,. .;: :. ..... ......... .... ....:,� Limited rncrgy, non-residential .1D1�S,CftI�:1`�Ql`t OF':�WO�ttc':: ' Each manufactured or modular dwelling, service and/or feeder 90.90 2 C { V % (LC' L V• � IL. services or feeders installation, alteration, and/or relocation 200 amps or less i , 80.30 $o -.3v 2 ,.:. „ ::..... „ - ..... ,...... v,.(1!'CL'lt 201 amps to 400 amps 106.85 2 ` ' " 401 amps to 600 amps 160.60 2 Name; C i v1/4c. 7cA. J -% r 601 amps to 1,000 amps 240.60 2 Address: ¢� �� W 3 L�`1 Over 1,000 amps or volts 454.65 2 J' Reconnect only 66.85 2 City/State /ZiP: LA ks • aS •vNi y 97035 Temporary services or feeders installation, alteration, and /or Phon I Fax: relocation — (5 J3) 6�� S.- I �, �� _ ( ) 200 amps or less 66.85 1 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, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 _ 2 Owner signature: Date: _ Branch circuits - new, alteration, or extension, per panel : . :..: Fee for branch . � : >r tiSOIY � . A. circuits with service or feeder fe each Business name: branch circuit ' 6.65 c ISS 2 B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'I branch circuit 6.65 2 City/State /ZJP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax: ( ) Sigo or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- enerIgY TM or .. ..�::;... •.. .. ..... ..... extension. Describe: Page 2 2 Business name: ° Pa c Each additional inspection over allowable in any of the above Address: e2 g 70 5e 7 ,5 1 e 4t 24,E Per.inspection 62.50 City/State/ZIP: WO 15•CpQ) r O r` 9 7 f ;2 '- Investigation per hour (1 hr min) 62,50 Phone: (5 ) L izi- Z 2 $• 00 Fax: (spa) cilia s i, - Industrial plant per hour y��11��.yy�� 73.75 - CCB Lic.: 1 57gq ( Electrical Lie.: 3c -'. 36 C Suprv. Lic.: 1 123.1. 5 Subtotal ,'6,9s Suprv. Electrician signature, required: „.8,,."--( ! 'CJl �" Plan review (25% of permit fee) Print name; S-Fe,P �••L j Z 0 S $ Date: State surcharge (8% of permit fee) 6_4- TOTAL PERMIT FEE C]3 Authoriz.t:d signature: This permit application expires if a permit is not obtained within ISO days after it has been accepted as complete Print name; Date: ' Fee methodology set by Tn -County Building industry Service Board Number of inspections per permit allowed