Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELR2010 -00077
T i GAR i 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/04/2010
ray.
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 900
Subdivision: LINCOLN TOWER Lot: 0
Project: NW Mortgage Expansion
Project Description: Low voltage for HVAC
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 05/04/2010 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 05/04/2010 $8.14
PHONE:
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST
PORTLAND, OR 97202
PHONE: 503 - 239 -4600
FAX: 503 - 239 -7038
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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. ATTEN • : Oreg• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 • throu•h OAR 952 -'01 -010!. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800
Issue. By: � ��L � Permittee Signature: }C Er 1/1 %c
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 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.
Electrical Permit Application . '• s `I OR:O1 I ICE.LS1 ONLl _: �,'
, r ,tiz
City of Tigard Date/By: 0 P v C 6 Permit No.: Ekkge)/ � evD 7 '7
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ((( �
' C '' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for
..:1; I., AI.I� Internet: www.tigard- or.gov Notified/Method: Supplemental Information
,_, / T ' YPE OF WORK PLAN REVIEW
❑ New construction L ' 1dition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEG9RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling C ommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION ❑ Emergency system. larger separately derived system.
4 , ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: /001_40 5W t "P'Ceh b f/l7J I ixHP or more. occupancy.
❑
J 0 Six or more residential units. Recreational vehicle parks.
City /State /ZIP: a i OR M ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 7E0 Project name: NW M 0 r 7 y j e ❑ Service or feeder 600 amps or more.
J FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 1 '
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 67.84 2
/Q vv V o / / 7/ 1/ e.. VI// r' 1 /J G� �-" 5 t� 7L residential (with above sq. ft.)
J J Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT `. ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: Amery e',1 Hen � i 1 n C B. Fee for branch circuits
/ � / �- without service or feeder fee,
Contact name:
gr - o /" ,7ch C first branch circuit 56.18 2
Address: /33 9' 5 E 6 / cle 0 /1 5 1-- Each add'I branch circuit 7.42 2
� Miscellaneous (service or feeder not included)
City /State /ZIP: / v -/- 14' cJ ) lK ?72 02. Each manufactured or modular
67.84 2
_ dwelling, service and/or feeder
Phone: (503 ) 231— 1 6 0 o Fax: : (ro 3 ) 23-? -70 3 a Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
/� Signal circuit(s) or limited -
Business name: Amer 1 / / c 4 , 7 e4 -/
-/� energy panel, alteration, or
Address: /33" 5 E 6 /G /CO' S- extension. Describe: 1 Page 2 2
City /State /ZIP: J90r f /4 OR 8 720, Each additional inspection over allowable in any of the above
so Per inspection 66.25
Phone:
( 3 )Z 3c '-' -/'OQ Fax: )2 -7038 Investigation per hour (1 hr min) 66.25
CCB Lie.: 33 /3 5 Electrical Lic.:26 3 (RE Suprv. Lic.:26 1 Q LE5 Industrial plant per hour 78.18
ELECTRICAL PERMIT .FEES .
Suprv. Electrician signature, required: Subtotal: ; 87
Print name: T 5+e v 1. / o v r1 c Date: 12:1 \ 10 Plan review (25% of permit fee): c,
J State surcharge (12% of permit fee): / V
Authorized signature: c_.‘s�- TOTAL PERMIT FEE: 1.5 / 8'
This permit application expires if a permit is not obtained within 180
Print name:gr— / / ")CAe5 fie."' Date: 11/2-7h0 / 0 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits'ELC- PermitApp.doc 10/01/09 440.4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:'
Fee for all residential systems combined .. $67.84
Check Type of Work Involved:
❑ A udio and Stereo Systems*
❑ B urglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ V acuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system •
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ M edical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
•
n O ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \Building\Permits\ELC- PermitApp.doc 10 /01 /09
(. - `(-4 2 0 4)- 671
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
.
October 29, 2010
American Heating
1339 SE Gideon St.
Portland, OR 97202
Attn: Brad Manchester
Re: Permit No. ELR2010 -00077
Dear Mr. Manchester:
The City of Tigard has processed a refund for overpayment of permit fees on the above
. referenced permit for the following:
Site Address: 10260 SW Greenburg Rd., #900
Project Name: NW Mortgage
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $61.78.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as permit was not required for pnuematic control that already
existed in building; 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 \LtrRcfund - Overpay.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
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: American Heating DATE: 10/22/2010
1339 SE Gideon St.
Portland, OR 97202 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 177790 Case #: ELR2010 -00077
Date: 5/4/2010 Address /Parcel: 10260 SW Greenburg Rd. #900
Pay Method: CreditCard Project Name: NW Mortgage
EXPLANATION: Per applicant's request; permit not required as building has pnuematic controls. Refund
80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 - 43104 $ Amount
Restricted Energy Permit 2200000 -43103 $&4 r
12% State Surcharge 1003100 -24001 6,&t 4
✓z"
TOTAL REFUND: $61.78
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager
If under $25,500 Department Manager yr` / ` ���
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: 1 /L' /Zf //C By: 1 ,4
I: \Building \Refunds \RefundReguest.doc x 09/01/2010
MAY. 10. 2010 3:11 PM 5032397038 NO. 9328 P. 1
REC8VED
1 1 11 4 ,� ' Community Development MAY 1 1 2010
T 1 C: A l: D Request for Permit Action CITY OF TIGARD
BUILDING DIVISION
TO: CITY OF TIGARD
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 X Contractor ❑ City Staff
(check one)
REFUND OF Name: ll
INVOICE,TO: (Husincae nrindividual) A met 1 c '1 1-leq-rbri
Mailing Address: /33' S E G i c,)e o n .5
City /State /Zip: / r-1I44 d 0 972 O 2-
Phone No.: 503-7560- (0`117
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED V):
❑ CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE, CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: E L R 2o10- 0 0 0 7 7
Site Address or Parcel #: /0200 S A) CO ree,i 6 u f q 1R c 9 0
/ Project Name: V or#' 4 �l
Subdivision Name: Lot #:
1 •
EXPLANATION: b U 1 161
l �q � 1 3 Y7 V C' 1'Y19 , ) G CO /l r/O IS
pe(rn -� )'70 rneedic.1 _
Signature: Ze ' 1�76 Date: _ gilt" 1 l D - 7 -
Print Name: // O' / r
R PoLcv
1. The Director or Building Official may authorize the refund of
a) any fee which was ermncoualy paid or collected.
b) nor 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 and vse application fce for issued permits.
d) nor more than 80° /u of the building plan review fcc when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building pest fee for issued permits prior to any inapecuon requests.
2. Refund will he returned to the ooginal Pays' in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USF, t)NL,l
Rte to Sys Admin: Date B • Rte to Bi.1 Admin: Date /, 2v i. B • r f'-'
Refund Processed: Date d 2V /d B • *7- Invoice Processed: Date B •
Permit Canceled: Date / / n By Parcel Tag Added: Date B
Receipt #f 77 qa Date j p Method re_ Amount $ 75. R ,
l: \Building \Forms \RegPermitA.ction.doc Ecv 07/26/07
CITY OF TIGARD RECEIPT
q
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
C /'a/I0
Receipt Number: 180194 - 10/29/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELR2010 -00077 $ -61.78
Total: $ -61.78
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 979817 DHOWSE 10/29/2010 $ -61.78
Payor: Bradley Manchester - American Heating
Total Payments: $ - 61.78
Balance Due: $61.78
Page 1 of 1
• CITY OF TIGARD RECEIPT
13125 SW HaII Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 177790 - 05/04/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELR2010 -00077 Restricted Energy Permit 2200000 -43103 $67.84
ELR2010 -00077 12% State Surcharge - Electrical 1003100 -24001 $8.14
Total: $75.98
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 979817 DADAMSKI 05/04/2010 $75.98
Payor: Bradley Manchester - American Heating
Total Payments: $75.98
Balance Due: $0.00
•
•
Page 1 of 1