Permit , CITY OF TIGARD ELECTRICAL PERMIT
Permit #: ELC2010 -00304
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e
, COMMUNITY DEVELOPMENT Date Issued: 06/18/2010
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
T1G'ARIJ Parcel: 1 S135A601004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD
Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0
Project: Lincoln 3
Project Description: (1) branch circuit and (1) limited energy for fire alarm.
FEES
Owner: •
LINCOLN CENTER LLC Quantity Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 1 crt Branch Circuits 06/18/2010 $56.18
CALIFORNIA ST 49TH FL wo /Purchase Service or
PHONE: Feeder
1 ea Signal circuit or Limited 06/18/2010 $67.84
Energy Panel
Contractor: 1 ea 12% State Surcharge - 06/18/2010 $14.88
CAPITOL ELECTRIC CO INC Electrical
11401 NE MARX STREET
PORTLAND, OR 97220
PHONE: 503 - 255 -9488
FAX: 503 - 257 -7121
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $138.90
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 OA 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: )54/617°–/-1Z— Permittee Signature: en/ 17 /°/c L✓' L'Z6' V
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.
1,1 City of Tigard
Accela Refund Request
TIGARD
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: Capitol Electric DATE: 10/22/2010
11401 NE Marx St.
Portland, OR 97220 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION: Case #: ELC2010 00304
Receipt #: 178375
Date: 6/18/2010 Address /Parcel: 10220 SW Greenburg Rd.
Pay Method: CreditCard Project Name: Lincoln III Lobby
EXPLANATION: Per applicant's request, as no low voltage work was done. Refund 80% of permit fee.
REFUND INFORMATION: Refund
Fee Description From Receipt Revenue Account No. •
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Limited Energy Permit Fee 2200000 -43103 $54.27
12% State Surcharge
1003100 -24001 6.51
TOTAL REFUND: $60.78
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager j ��
If under $25,500 Department Manager � t , , / v
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY U
/ `Case Refund Processed: 1 Date: 1 / ),// e:, I �"
I: \Building\ Refunds \RefundRequest.doc x 09/01/2010
06/18/2010 11:31 5032577121
CITY OF TIGARD CAPITOL ELECTRIC PAGE 01
1u♦6UlU 1l'41 b t13 5 981960
/ y. l ; 7 „ 1 PAGE 01/81
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Community Developm JUN 18 2010
` " ' r, Request for Petmit .Action
CITY ,
TO ' CITY OF TIGA.RD BUft
Building Division Services
13125 SW Hail Blvd. Coordinator
Pbonw 503.718.2430 OR 97223
503.598./960 www.tigard-otgow
PROIII: ❑ Owner mock o
PRO ee) 0 Applicant 2 Contractor 0 City Staff
REFUND OR Name:
INVOICE TO: (Business cis Tndie,thrgj)
Mailing Address: !No ) c MAPS
City /State /Zip: •
o I,t .5
Phone Nr�.; °j7 7-7--0 R� r -2.-�� 47_67
PLEASE TAB ACTION FOR THE
ITEM(S) CHECKED (r)
0 CANCEL PERMIT APPLICATION.
BO ND PST FEES (attach receipt, if avail
.ICE FOR FEES DUE a la).
REMOVE C "T RAC TO R FROM use f schedule ( d o n and el pets Wow).
ON "TRACTOR (do not cancel )
Permit #: lit)
2010 c=oca 0
Site Address or Parcel ##: O Z'Z,p
Project Narxle;• �'''�"�0
Subdivision Nance;
XP PL . • Lot #: z c r
1'i -li�� 1,S � rii Si IAA 4 C-1 t2C.J t �
Signature: Old
Print Name: Date: 6 �/ g 7_01.0 14 t___
1. The Macros at BulttE ego
a) as , fee which was omens* o co ll the refund uf.
b) not mt>sc than �`""Y"'�'� P� or cDlkcbd�
80% of the had use application foo when a»
c) rru more Shan tfo% of the hand use vpRcattoe fdo for issued �, is withdrawn us cvroalai before ny review ef(tht has been expended
d) not more than PO% of Ad building plan roricw fee when an application is canceled before any Plan review effort has
Z c) rat snore Om Hf 4 of the 6 uddilgPgemit fee fur'
Ttoftnuh tai11 he rcmmod M the '� P`r'"Ib1 prior to any Inspection nTgursta, been expanded or original Payer in the some method in which payment it/as =dyed. Mane ono. 1-2 weeks for wearing rcr;mds.
RtCtoS Sys i �I.; (1 .rfl r, i s :;I. 1 ,Ni
Y d
,: Date
Refund Piece 9; D ite /. 2 ' o „ R to 131. _ ddm : Date
Date Date VIMINNI
Date .47 /d Method Dare s. .
TAFio eling1 onft'TpgPcmlioloion.•- • • O7t2G /o7 C
g
06/17/201p 13:15 5032577121 CAPITOL ELECTRIC PAGE 02
: IFA Permit A riiication 1„�uar(tT I ic-`l S
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":,,, �4�,A " ,._,,,.,..�_tt.k"ars'Ps City o r igard 1. 1 0�o Dare /By: Pemntno.;� �oIO -'• .00 ,a
"r 11125 SW Half A1s&., Ti ar'd, OR 9722 lF r- Flan Rcvicw
•
Phone' 503,639,4171 Fax: 503. .
5987 `t � Other Permit:
•` ' �y®DnterBy:
A., 4..' Tnspectidn T.ine: 503.639.4175 t ``
T .\ list Read /3i 2for • �twi'4.0ssr +eN Internet www.tlgatrd- or.gov , 4\,..." �.CJ • .' Y 7ur.s � e 5�� r,;
\ Notified/Method:
� Su plemenlnl Information
TYP WO
E OP RK � - 1 t�� PLAN RSVIEW
-
(.. _ Nc constr uction ❑ Additionla1tcration /rcplaccmcnl � �`\+ Please check ell that apply (submit g sets of plans w/Iterrla checked below):
n Demolition Other; ❑ Service or loader 400 amps or more ❑ Building over three storir_s
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
I 1 • and 2- family dwelling a Commercial /industrial L. Accessory building exceeds 10.000 amps et 150 vols or Floating bullmngs
LJ Multi-family n Master Builder LI Other less to ground, or exceeds 14.000 Commercial -use agricultural
108 SITE INFORMATION AND LOCATION amps for all other Inatanttlons, ❑ buildings
lob no,; 100926 soh site address 10220 SW n Place Rd- ❑ Fire Pump ❑ Installation of 75 KVA or
Ell Emergency system larger separately derived system,
(
City /Sfate/L1P Tigard OR 2,E eve a z& n Addition of new moi2r load of ❑ "A ", "E". "1 - 2" "1.3
10011P ormere. n occupancy
-
Suile/hldg /apt. no.' Lincoln 3 P roject name; Lobby Lighting Lincoln 3 Ci Six or more residential units ❑ RoCr9eibnal vehicle parks.
L Health -care facilities Li Supply voltage for more than
Cross StreetlUircctions tn job site. n Harardous locations Li 600 volts nominal.
Service or feeder 600 amps or more
Subdivision; hot: no.: FE8 SCHEDULE
Description
(I_ ty. I pee. Tatnl j ""
Tax map /parcel no: New residential - single or multi - family dWtlling unit
DESCRIPTION OF WORK Includes attached garage.
Install new Linear lighting in lobbies 1000 sq. ft or less 5 166.54 4
En. Add'l 500 sq, ft or portion S 33.92 1
L PRO.PFRTY OWNER 1 1 ( TENANT Limited energy residential
Name: (with above sq, ft.) $ 67.84 2
Limited energy, multi - family
Address: residential (with above sq, ft) $ 57.84 _ 2
-
Service or feeders Instillation, alteration, and /or relocation
Chy /Statc/ZTP; 200 am11a or Icsa $ to0.70 2
201 amps tQ 400 amps S 133.56 2
Phone; hare: 401 am�.a 10 600 amps $ 200.34 _ 2
601 amps to 1000 amps 5 301.04 2
Owner Installation; This installation is being made on property that T own which is not Over 1000 amps or volts $ 552.26 _ 2
inlcnded for sale, lease, rem or exchange, according to ORS 447, 449, 670. and 701 Temporary services or feeders Installation, alteration, and/or
Owner signature; Date: relocation
LI APPLICANT 200 amps or less $ 59,36 �
I
Lf CON'S ACT PERSO Z01 amps 20 4U0 ads 5 125.08 2
Business Nanic: 40 a m stn 599 amps $ 168 54 _
Branch circuits - ncw�alrer,dion, er extension, per anti
Contact name: A, Fcc for branch circuits with
service or feeder feet each
Address; branch circuit: .5 7.42 2
15, Fee for branch circuits
City /State /ZiP: without service or feeder fee,
first branch circuit 1 5 55.18 56.18 2
Phone; Fax;
Each additional branch circuit:
Miscellanequs (service or fccdcr not included) "
E-mail:
Each manufhcturcd or modular
CONTRACTOR dwelling, service and or feeder 5 67.84 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only 5 57.84 2
Pump or irrigation circle 5 57.84 2
Contact name: Sign or outline luting $ 67.04 2
- _- Signal circuit(s) or limited-
Address: 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: Fire Alarrn 1 5 67,84 $ 67.84 2
City /state/ZiP: PORTLAND, OR 9722 0 -1 04 1
Ruch additional inspection o ver allowable In any of tits above
hoot: 503 - 255 -9488 Fax 50 51.7121 Pm inspection $ 66.25
# Investigation ler hour (1 hr min) $ 66.25
CCA Lie.: 48748 Electrical Lic. 26 -496C Su rv. Lic.: 3112 - Industrial plant per hour $ 78.1a
Suprv. P.Iretrician nignnturc, requires,; /t ._ ELECTRICAL PERMIT PEES" �
. �+ : -a, Subtotal 5 124.02
Print Name: DARRELL M Dots: 06/17/1i Plan review 25% of •crrnit fee)
Authnrixcd signature; State surohar�c ( 12% of .crmit fee $ 14,88
_ r .. TOTAL PERMIT FEE $ 138.90 d .�
Print NOM: DARRELL MCNEE,L Thl. permit sippllcsnnn expire* lr n permit H not nhlninnJ within IRO
day.. sitter 11 hat been accepted n. complete.
• Number of incpeetion, per permit ellowc4.
L I L T/ CO ,3c-e-t
City of Tigard, Oregon 13125 SW Hall Blvd. ® Tigard, OR 97223
11
.11.1(cG3l )Zl]
October 29, 2010
Capitol Electric
11401 NE Marx St.
Portland, OR 97220
Attn: John McNeel
Re: Permit No. ELC2010 -00304
Dear Mr. McNeel:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 10220 SW Greenburg Rd.
Project Name: Lincoln II Lobby
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $60.78.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as no low voltage work was done. 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 \Administrat ion \LtrRefund- Overpay.doc 01/16/07
Phone: 503.639.4171 ® Fax: 503.684.7297 0 www.tigard- or.gov ® TTY Relay: 503.684.2772
,.
CITY OF TIGARD RECEIPT
II . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 180212 - 10/29/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2010 -00304 $ -60.78
Total: $ -60.78
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
- Credit Card 018145 DHOWSE 10/29/2010 $ -60.78
Payor: Johnathan McNeal, Capitol Electric Inc.
Total Payments: $ -60.78
Balance Due: $60.78
Page 1 of 1
CITY OF TIGARD RECEIPT
I,
E _ 131 S W Hall Bl vd., Tigard OR 97223
503.639.4171
TIGAR
Receipt Number: 178375 - 06/18/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2010 -00304 Branch Circuits wo /Purchase Service or 2200000 -43103 $56.18
Feeder
ELC2010 -00304 Signal circuit or Limited Energy Panel 2200000 -43103 $67.84
ELC2010-00304 12% State Surcharge - Electrical 1003100 -24001 $14.88
Total: $138.90
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 018145 DHOWSE 06/18/2010 $138.90
Payor: Johnathan McNeel, Capitol Electric Co.
Total Payments: $138.90
Balance Due: $0.00
Page 1 of 1