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Permit Support Document (5) V7, ( JD p RECEIVED City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JUN 2 9 2017 74Request for Permit Action CITYOFTIGARD q 1 I l,n it i 1 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •www.tigaIING DIVISION TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ® Applicant ❑ Contractor E City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) Vega Architecture Mailing Address: 25107 Genesee Trail Rd City/State/Zip: Golden, CO 80401 Phone No.: 720.390.3891 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): x{ CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). 0 REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: ELC2016-00476, Ib1CC2016-00400, 2010-00295— (/3//.S very i*ire r j Site Address or Parcel#: 13125 SW Pacific Highway;Tigard, OR 97223 -0?Ar ► o •trxytf-7.t' Project Name: Specialty Retailer Subdivision Name: Lot#: 200 EXPLANATION: The developer and tenant have decided against building the pre-engineered metal building that was submitted in 2016 in order to construct the new tenant prototype building that has recently submitted, Signature: Aire*"- ,f►'' Date: 06.29,17 Print Name: • Asher 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. A/C "�u.Cd46* — O &Ey/j )1 Co/"i, - 2 2//t//C. 111111111111111111111111111111111111111111111 Route to Sys Admin: Date By Route to Records: Date By Refund Processed: Date By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By I:\Building\l orms\RegPermitActirm_092314.doc RECEIV Electrical Permit Application um( ()fI1( I I tit ()NI 1 / �j / City of Tigard JUN 7 2016 Received 4 I %. it,l Cef i,(7(/©C/p10 Da Re w k� -a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review i ' Phone: 503.718.2439 Fax: 503.598.1960 ry�tl/ �y1 Date/By: -Z.,0/,t 4 Related Permit eti/0020/i�...eV/93 Inspection Line: 503.639.4175 CITY.� + I lli�61_) Ready Date 13y: ions: FA See Page 2 for T'I G A RI) Internet: wWw.tiga[d-or.gov AAAII,� No Supplemental Information TYPE OF WIIRI DING DIVISION' PLAN REVIEW ®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): El Service or feeder 400 amps or more 0 Building over three stories. ❑ Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. El1 and 2 Tamily dwellin less to ground,or exceeds 14,000 0 Commercial-use agricultural g ®Commercial/industrial ❑Accessoty building amps For all other installations. buildings. ❑Multi-family 0 Master builder ❑Other: 0 Fire pum p.p. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ®Emergency system. larger separately derived Job#: Job site address: 3 Z S S /� ❑Addition of new motor load of system. l r,c(pic F}w y 10011I'or more, ❑"A" "E" "t-2" "1-3" City/State/ZIP: "i'k G,,,a(z r pe616 J...1 q 7 Z Z QETT/t6.0 Aonfogn Six or more residential units, occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: J Project name: �EC(QC,Tti Q TAILED 0 Hazardous locations. ❑Supplylvtsoltageaor more than l. ®.ervice or feeder 600 amps or more Cross street/directions to job site: cSGlkooi. ST'- FEE SCHEDULE ("bu i marelar, ,5/,_ C, ` Description ) Qty. I Each I Total 1 " n/GW .tt��G 7 J New residential single-or multi-family dwelling unit. Subdivision: I Lot#: Z pp Includes attached garage. 1,000 sq.tt,or less 168.54 4 Tax map/parcel#: ZS 10 2,..C..12002,DO Ea,add'I 500 sq.ft.or portion 3392 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 ( (with above sq.ft.) ( 7'(Et..) O04.G.5 TALI cpv�lot.tt1 IZ L P4 tl,,. ( Limited energy,multi-family residential(with above sq.ft.) 75.00 2 PIRenewable Energy 0 See Pau PROPERTY OWNER El TENANT Services or feeders installation,alteration,and/or relocation Name: L�4 c -% 4'i p C-12GL@. L Lc.. 200 amps or less 100.70 2 Address: p, p• F O� 2 34 201 amps to 400 amps 133.56 2 1 401 amps to 600 amps 200.34 2 City/StateiZIP: YVL61..kTCLeg E ( t{0 2. 601 amps to 1,000 amps 301.04 2 Phone:(CJ'7p) 2.419 —73/$ I Fax:( ) Over 1,000 amps or volts I 552.26 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 20o amps or less 59,36 1 j{{{ intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125 08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 (.APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: REAt ,e_504 EA 6,1,1/41E (�,1 1,1/41 C above service or feeder fee, 99 7.42 734,58 2 each branch circuit Contact name: Kz41n4 4 ---roJ►-►g A e 4- B.Fee for branch circuits without [�^s service or feeder fee,first V 1 S �. ,E`k 1, l(J;� .50 IT'E 3dry branch circuit 56.18 2 Address: City/State/ZIP: L-.lex4 KS Cr,(�'LI Each add'I branch circuit 50 7.42 371 2 Miscellaneous(service or feed t ncluded) Phone:(°ll3)142 5517 Fax: :( ) Each manufactured or modular CA1 dwelling,service and/or feeder-- � -` 67.84 2 Email: IK.EX►n1. St Elnr►.gelc,N rCi)l-EE I - EA/C rh 2 7• C c7 Reconnect only 67 84 CONTRACTOR Pump or irrigation circle 67.84 2 Business name: '1'g.v> - pO-r T o "31D Sign or outline lighting 67,84 2 Address: Signal circuit(s)or limited-energy *See Page 2 ,Z2S,fl0 2 panel,alteration,or extension. City/State/ZIP: Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr Industrial plant(I hr min) 78.1 8/hr Email: Inspections for which no fee is 90 00/hr CCB Lie.: Electrical Lie.: Suprv.Lie.: specifically listed('/hr min) \ ELECTRICAL PERMIT FEES j,f J 2 j fl Suprv.Electrician signature,required: Subtotal: 1657.8 I Print name: Date: 14 Plan Review Required(25%of permit fee): 61-114 '5 '�,�� State surcharge(12%of permit fee): Authorized signature: z�"�,� - TOTAL PERMIT FEE: ~�" This permit application expires if a permit is not obtained within 180 Print name: Kevin Stambach Date: 06/01/16 days after it has been accepted as complete. Number of inspections allowed per permit t:\Building\Permits\ELC_Permi tApp_ELR_ERE doe Rev 06/17/2015 440-4615T(I t/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Description I Qty. i Each 1 Total I • Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 Check Type of Work Involved: 5 kva or less 100.70 2 501to15kva 13356 2 n A• udio and Stereo Systems* 15 01 to 25 kva 200 34 2 Wind generation systems in excess of 25 kva: E 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 with OAR 918-309-0040) 552 26 2 I I Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7 42 3 l l Vacuum Systems* >100 kva-no additional charge 0.0 3 Each additional inspection over allowable in any of the above: Other: Each additional inspection is 66 25/hr charged at an hourly(I hr min) Inspections for which no fee is 90 00/hr specifically listed(%hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES 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 n B• oiler Controls r Clock Systems ❑ D• ata Telecommunication Installation ® Fire Alarm installation HVAC Instrumentation 12< Intercom and Paging Systems n Landscape Irrigation Control* n M• edical Nurse Calls 4 (— O• utdoor Landscape Lighting* I I Protective Signaling L Other: Total number of commercial systems: e_ 75:00 _ c2 a2 0-0 *No licenses are required. Licenses are required for all other installations 1:\3u,iding\Permits\ELC_PennitApp_ELR_ERE.doc Rev 06/17/2015