Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED
g
4APR b 2018
Request for Permit Action 3
CITY 0 TIGARD
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • wiN .tigard i DING n 'ac,sem„
TO: CITY OF TIGARD V 0 1 0
Building Division /'‘/,i ,13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: )Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: (b,.?
INVOICE TO: (Business or Individual) CA05,4„ze `- 7 /'
cy
Mailing Address: /(2 ')? 5g.4) 87 4-/..e._
City/State/Zip: y(r / 9 7(903
Phone No.: 9 7/ - d/ 9- 69-7
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
El ' CANCEL/VOID PERMIT APPLICATION.
I r2 REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
U INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
ry ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: (--(1'20/6P-0,02P—
''. :, Site
1'20/6P-04 P-
Site Address or Parcel#: //2 `/ 54-3 6e/ s.----
''5L ,-
Project Name: 4e✓VG't...I/)'
. Subdivision Name: Lot#:
EXPLANATION: -- -t./JL) /00 Z -=S /9.E72,-91-7— 4/42'
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AA- O nJ
y z /e-c- J �-. -C�7r e f��lfiVc /c�1rr�, f-,3e1 '-
,�S-a,/c-- y 16-0 C'A/ 1,^it 6fS / . —0.7-
Signature: '”, J-1-42_ Date: V,.,.7/.
Print Name: _Z .f= A,, -C—
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
Route to Sys Admin: Date By Route to Records: Date ,,?y /c B
Refund Processed: Date /�sa//i— By Invoice Processed: Date By
Permit Canceled: Date 0 /� By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_pf��23 4.doc
TIGARD
City of Tigard
April 18, 2018
Christine Chongway
11242 SW 815L Ave
Tigard, OR 97223
Re: Permit No. ELC2018-00222
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11242 SW 81st Ave.
Project Name: Chongway
Job No.: N/A
Refund Method: ® Check#228178 in the amount of$112.78.
❑ Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
0 Trust account"deposit" receipt in the amount of$
Comment(s): Permit created in error;work required licensed contractor. Refund 100%
of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
42"?..czjZr7cyj.e__,
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 ELECTRICAL PERMIT
.1111
COMMUNITY DEVELOPMENT Permit#: ELC2018-00222
13125 SW Hall Blvd.,Ti Date Issued: 04/04/2018
rrc;; and OR 97223 503.718.2439lx.l� 9
Parcel: 1S136CB09400
Jurisdiction: Tigard
Site address: 11242 SW 81ST AVE
Project: CHONGWAY Subdivision: HERB AND PEGGIE'S PLACE Lot: 20
Project Description: Service panel replacement(1)200 amp.
Contractor: OWNER Owner: CHONGWAY, FRANK U&CHRISTINE S
CHRISTING CHONGWAY 11242 SW 81ST
11242 SW 81ST TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 971-219-2097 PHONE: 971-219-2097
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 04/04/2018 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 04/04/2018 $12.08
Type of Use: SF Electrical
Class of Work: ALT
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 OAR 001-0090. You y obtain a copy o the rules o irect questions to OUNC by calling 503 32 987 or 1.800.332.23 ..
Issued By: i ����(/l7 rermi tee Signature: /l/ •_---) .4/b
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.
RECEIVE 11Electrical Permit Application
FOR OFFICE USE ONLY
City of Tigard A P R 4 2018 Received _ —
u 13125 SW Hall Blvd.,Tigard,OR 97223 / Date/B : G`�� �, �%
C Phone: 503.718.2439 CITY Of ��GAi . Related Permit#:
T i G R 1) Email: TigardBuildingPermits@ Ti and-or. /
Inspection Line: 503.639.4175Internet www.t gardd--or gov OWL
Notified/MeDate/hod: J�� See Page 2 for
Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ig Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other;
CATEGORY OF CONSTRUCTION where the available fault current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
ig 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
1:1 Multi-family 0 Master builder
0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND J.A1CATION ' 0 Emergency system. larger separately derived
Job#: I Job site address: // y� rr ,Q/j 0 ❑Addition of new motor load of system.
�_ v- w C. 100HP or more. ❑«A„ «E„ <,1_2>, «l_3„
City/State/ZIP: / y ard, 7,01:q...3 ❑Six or more residential units. occupancy.
�T v'e ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: ❑Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: 0 Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description I Qty. I Each I Total
New residential single ormulti-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.add'I 500 sq.ft.or portion 33.92 1
� Limited energy,residential
PJ l* l ( G0� 0C t J eitair (with above sq.ft.) 75.00 2
(J Limited energy,multi-family
/–tcr
residential(with above sq.ft.) 75.00 2
ja PROPERTY OWNER 1 0 TENANT Renewable Energy ❑ See Page 2
/]��, C / Services or feeders installation,alteration,and/or relocation
Name: ( ' J ( ' � (
J -.4Z;€ L 200 amps toro less 100.70 2
Address: j 0 (ra 5� G/ e d/J� 201 amps to 400 amps 133.56 2
City/State/ZIP: ace/ O / q-7oa3 401 amps to 600 amps 200.34 2
`� - 601 amps to 1,000 amps 301.04 2
Phone:(q.1) ,I q
o� 7 p 552.26 2
tJ Over 1,000 amps or volts
Email: n Q„�C��aSd C-041 Temporary services or feeders installation,alteration,and/or
. trelocation
Owner installatio This I allation is ing made on property that I own which is not 200 amps or less 59.36 1
intended for sale,leas- ea t,or exchange,a •era ing to •RS 447,449,670, d 701. 201 amps to 400 amps 125.08 2
Owner signature: _ 41j,41,100_,...,' _ �,e/j/,6.,✓ Date: 401 amps to 599 amps 168.54 2
APPLICANT 1 ' Branch circuits–new,alteration,or extension,per panel
0S CONTACT PERSON
Business name: A.Fee for branch circuits with
above service or feeder fee,
Contact name: acLe n �0 v�
each branch circuit 7.42 2
�`.;-' B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Phone:( ) Miscellaneous(service or feeder not included)
Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR
Pump or irrigation circle 67.84 2
Business name: � Sign or outline lighting 67.84
2
Address: Signal circuit(s)or limited-energy
panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Phone:( )
Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: I Electrical Lic.: I Suprv.Lic.: specifically listed(%hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Subtotal:
Print name: I Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: (IA
. 74S-
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
ONLY: ;n FEE SCHEDULE
RESWDENTI
AL WORK' ' Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved: 5.01 to 15 kva 133.56 2
❑ 15.01 to 25 kva 200.34 2
Audio and Stereo Systems*
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
>100 kva-no additional charge 0.0 3
❑
Vacuum Systems*
Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/z hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
In Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 10/26/2017
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11242 SW 81ST AVE, TIGARD, OR, 97223 April 6, 2018 at 7:38:08 AM
Record Type: Record ID:
Residential - Electrical ELC2018-00222
Inspection Type: Inspector:
199 Electrical final David Young
Result:
FA I L
Comments:
Customer requested refund for permit issued in error.
This permit to be voided, issued in error.
The home owner needs a licensed electrical contractor for a home inspection.
No new electrical work was installed per homeowner.
Violation Summary:
Inspector Contractor