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Permit CITY OF TIGARD ELECTRICAL PERMIT s COMMUNITY DEVELOPMENT Permit #: ELC2010 -00604 TI G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/28/2010 Parcel: 1 S 135AB01002 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 601 Subdivision: LINCOLN THREE Lot: 0 Project: Matrix Absence Management Project Description: (8) branch circuits for TI Owner: FEES LINCOLN CENTER LLC Quantity Description Date Amount BY SHORENSTEIN PROPERTIES LLC, 555 CALIFORNIA ST 49TH FL 8 crt Branch Circuits 10/28/2010 $108.12 wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 10/28/2010 $12.97 Electrical Contractor: COCHRAN INC 7550 SW TECH CENTER DR. #220 TIGARD, OR 97223 PHONE: 503 - 234 -6564 FAX: 503 - 238 -2098 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $121.09 Required Items and Reports (Conditions) • This permit ' ' . - • •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done ' accordance with = .proved 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. TTENTION: Oregon la re. ' -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -0' -0010 through OAR 952 -00 100. ay obtain a copy of the rules or direct questions to 0 6699 or 1.800.332.2344. • Issu . d By: ; =__\ / / / Permittee Si • ZI1V,/ 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 ior- ' Date: /08A LICENSE NO. (3/ 1 / 75 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 7 December 1, 2010 Cochran, Inc. 7550 SW Tech Center Dr., Ste. 220 Tigard, OR 97223 Attn: Bo Singleton Re: Permit No. ELC2010 -00604 Dear Mr. Singleton: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 10220 SW Greenburg Rd., Ste. 601 Project Name: Matrix Absence Job No.: N/A Refund: ® Check #96.88 in the amount of $ ❑ Credit card "return" receipt in the amount of $ ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as job was cancelled. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, A. , ; (1/ . . " :S- -- Dianna Howse Building Division Services Supervisor Enc. I: \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 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: Cochran, Inc. DATE: 11 /23/2010 7550 SW Tech Center Dr., Ste. 220 Tigard, OR 97223 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 180155 Case #: ELC2010 -00604 Date: 10/28/2010 Address /Parcel: 10220 SW Greenburg, Ste 601 Pay Method: Check Project Name: Matrix Absence EXPLANATION: Per applicant's request as job was cancelled. Refund 80% of permit fees. REFUND •INFORMATION: Fee Description. From Receipt • : Revenue Account No Refund Example: Building Permit. -Fee Example•.; :2300000 - 43104:.: : $Amount Electrical Permit 2200000 -43103 $86.50 v /' 12% State Surcharge 1003100 -24001 10.38 ar S TOTAL REFUND: $96.88 APPROVALS: • If under $5,000 Professional Staff If under $12,500 Division Manager 1 If under $25,500 Department Manager t If under $50,000 City Manager � " _ k If over $50,000 Local Contract Review Board • FOR:TIDEMARK.SYSTEM ADMINISTRA_ TION;USE ONL Case Refund Processed: I Date: I AV/ /C2 I By: I: \HLlIdil \ItcfunJs \RcfunJI .ucstJoc x09,o,/,010 • DCT /29 /2010 /FRI 10:49 AM COCHRAN TECHNOLOGIES FAX No.971 205 4268 P. 001 RECE IVED ommur>l><ty Development 2010 TI l �, A a D . Request for Permit Action OCT 29 . d Community D -- -- ._...... TO: CITY OF TIGARD BUILDING DIVISION 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 ® Contractor ❑ City Staff (check one) REFUND OR Name: Cochran, Inc. INVOICE TO: 0314ia u oe I°eh°"dua Mailing Address: 7550 SW Tech Center Drive Suite 220 City /State /Zip: Tigard, OR 97223 Phone No.: 971 - 205 -4242 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): V 0 1 ® CANCEL PERMIT APPLICATION. E ❑ REFUND PERMIT FEES (attach receipt, if available). r /// INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel pe n it). Pexxwit #: ELC2010 -00604 Site Address or Parcel #: 10220 SW Greenberg Rd. Suite 601 Project Name: Matrix Absence Subdivision Name: Lot #: EXPLANATION: The job is cancelled for us. Some other elect ical contractor will be awarded the contract. Signature: Date: 10 -29 -10 o Singleton Print Name: $gfi nd Policy 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 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. a) not more than 80% of the building permit fee for issued permits prior to any inspection requests. a Refimda will be returned to the original Payer in the same method in which payment was received Please allow 1 -2 weeps for processing refunds. FOR OFFICE USE ONLY - Rte to Sys Admix: Date Rte to Bldg Admix: Date 7,L /i jv By Refund Processed: Date /.Z / /0 MI Invoice Processed: Date By Pcznit Canceled: Date B r ig. Parcel T.: Added: Date By Receipt # /,F-G/SS Date / / -/'0 Method /�� - Amount $ I: wilding \Foans\RegPecmitAcuon.doc Rev 07 /26/07 Ill CI TY OF TIGARD RECEIPT a . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 180572 - 12/01/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2010 -00604 $ -96.88 Total: $ -96.88 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 67868 DHOWSE 12/01/2010 $ -96.88 Payor. Cochran, Inc. Total Payments: $ -96.88 Balance Due: $96.88 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 180155 - 10/28/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2010 - 00604 Branch Circuits wo /Purchase Service or 2200000 -43103 $108.12 Feeder ELC2010 -00604 12% State Surcharge - Electrical 1003100 -24001 $12.97 Total: $121.09 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check • 10112 DADAMSKI 10/28/2010 $121.09 Payor: Cochran Inc Total Payments: $121.09 Balance Due: $0.00 • Page 1 of 1 Electrical Permit Application FOR OFFICE USE ONLY of Tigard Recei Date:ny: / 0 /'�fI /O �, PcmtitNo.: -co q 13125 SW Hall Blvd., Tigard. OR 97223 nn Plan Review Q . Phone: 503.639.4171 Fax: 503.598.196(Y 2 8 2010 Date /3y: Other Permit: h T I G A R D Inspection Line: 503.639.4175 Date Ready /13y: )axis: la See Page 2 for Intentet: www.tigard- or.gov �� C ti ITTY OFTIGARD Notified /Method: Supplemental Information TYPE OF ) IN(i DIVISION PLAN REVIEW P lease cheek all that apply (submit 2 sets of plans w)items Checked below ❑ New construction ddition /alteration /replacetnent P below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. El Demolition ❑Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings. less to ground. or exceeds 14.0(X) ❑ Commercial -use agricultural ❑ I - and funily dwelling �Conunercial /industrial ❑Accessory building amps for all other installations. buildings. ❑ Multi - family /❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. 1?Q5Jn ❑Additiunof new motor load of ❑"A ", °E ",'I- 2 "."I -3" Job 110.26.- r 1 Job site address: /4020. I(XI or more. occupancy. �����.�/ � . ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: �C.AAX� O � ��] 7 T ❑Health -care facilities. 0 Supply voltage for more than c�cv ❑ Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: l ❑ Service or feeder 600 amts or more. Cross street /directions to job site: FEE SCHEDULE Description 1 Qty. 1 Fee. 1 Total 1 ' New residential single- or multi - fancily dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. 11. or less 168.54 4 Ea. add 500 sq. 11. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. 0.) 75.00 2 Limited energy, multi - family 75.00 2 ,72p Q /�� V- Gi6A/2? �� ,_c-rww residential (with above sq. 0.) Services or feeders installation, alteration, and /or relocation I. 200 amps or less 100.70 2 ❑ PROPERTY OWNER I TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name:77 ,X 60) amps to 1,000 amps 301.04 2 Address:/e700, .1-A, aitP - :f�•et,„e„, �v , Over 1,000 amps or volts 552.26 2 City /StateiZll: / / ‘?",e4p• ' .?,iZ / 22 r Temporary services or feeders installation, alteration, and /or 9 relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended tin 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, er panel Owner signature: Date: A. Fee for branch circuits with above service or feeder fee. ❑ APPLICANT ❑CONTACT PERSON each branch circuit 7.42 2 Business namme: )O.. Ck,S C 1 A C � 13. Fee for branch circuits without service or feeder fee, first 1 56.18 i 4 2 Contact name: branch circuit Each add'I branch circuit Z 7.42 I, 9 ' 2 Address: Miscellaneous (service or feeder not included) / Each manufactured or modular City/State/ZIP: dwelling, service and /or feeder 67.84 2 R econnect only ( ) Fax:: ( ) Y 67.84 2 Pump or irrigation circle 67.84 2 E snail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy Business name: `� panel, alteration, or extension. Page 2 2 n� `� Each additional inspection over allowable in any of the above Address: 1 550 5YV _ � h ( /� � r *220 Additional inspection (1 hr min) 66.25/ hr (� `� Investigation (I hr min) 66.25/ hr ` 4 City/State /ZIP: l 6C, t- l 1` 72_Z 3 �/ Industrial plant (I hr min) 78.18/ hr Phone: 603 2 / / Fax: ()3 3 ) 2 z0 O Inspections for which no fee is L � specifically listed ('/2 hr min) 90.00 / hr CCB Lic.: - 7 2 p/c'42_ Electrical Lic.: L� C Suprv. Lic.:31 115 ELECTRICAL PERMIT FEES Subtotal: - /G° Suprv. Electrician signature, required: Plan review (25% of pennit fee): /� Print name: KA, r \Q Ystko Date: State surcharge (12% of pennit fee): /Z. 77 - TOTAL PERMIT FEE: /L/ 0 9 Authorized signature: This permit application expires if a permit is not obtained within MO - days after it has been accepted as complete. Print name: Date: + Number of inspections allowed per permit. I:•nuilding Penn its II.0 -Pei Mit App.doc 07.01.10 440 - 46151(1 I,05d'OM•WfR