Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Permit
n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT >: COMMUNITY DEVELOPMENT Permit 0: ELR2009 -00155 Date Issued: 06/05/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S 05/200 1100 Jurisdiction: Tigard Site address: 16596 SW 72ND AVE, BLDG# BI 1 Subdivision: OREGON BUSINESS PARK I Lot: 0 Project: Spec Space Project Description: HVAC FEES Owner: PACIFIC REALTY ASSOCIATES Description Date Amount ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 06/05/2009 $75.00 #300 12% State Surcharge - Restricted Energy 06/05/2009 $9.00 PHONE: Contractor: OHAC INC PO BOX 241 DUNDEE, OR 97115 PHONE: 503 - 538 -2953 FAX: 503 -691 -8556 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 $84.00 Intercom/Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N 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. 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 0 001 -r 100. 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: V �tI' / - Permittee Signature: DA/ g/ /Z/ ( 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. CaII 603.639.4175 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 TIGARD Accela Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Oregon Heating & AC DATE: 8/20/09 P.O. Box 241 Dundee, OR 97115 REQUESTED BY: Dianna Howse Attn: Teresa Stupor TRANSACTION INFORMATION: Receipt #: 173864 Case #: ELR2009 -00155 Date: 6/5/09 Address /Parcel: 16596 SAX/ 72nd Ave., BI1 Pay Method: CreditCard Project Name: Spec Space 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:, [BUILD] Permit Fee Example: 245 - 0000 - 432000 $ Amount Restricted Energy Permit 220 - 0000 - 431510 $60.00 12% State Surcharge 100- 0000 - 207020 7.20 TOTAL REFUND: $67.20 APPROVALS: If under $500 Professional Staff 11 I If under $7,500 Division Manager it If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY • Refund Request Reviewed: Date: -'' -- �;- •,> By: � — Case Refund Processed: Date: • as'. By:` 1: \Building \ Refunds \RefundRequcst.doc 04/13/09 • Community Development �C ! _. Request for Perrn><t Action !/ rl�∎A.R J TO CITY OF TIGARD gU IDI TIGARD Building Division Services Coordinator G DIVISION 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: Oregon Heating & AC INVOICE TO: (Buemness or Individual) Mailing Address: P 0 Box 241 • City /State /Zip: Dundee, OR 97115 Phone No.: 503 -538 -2953 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ® 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 #: ELR2009 - 00155 Site Address or Parcel #: 6 / Project Name: 3 Spec Spaces • Subdivision Name: Lot #: EXPLANATION: job cancelled • w dqk Signature: Date: 07/13/09 �l l .r*i>!1 Tere . Stupor 1 Print Name: Refund Policy 1. The Director or Building Official may authorize the refund of a) any fee which was ermncnusly paid or collected. b) not more than 80% of the land us& application fen when an application i5 withdrawn or canceled before any review effort has been expended. c) not more than 14) of the land use application fcc for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effnrr has been expended. c) not more than 80% of the building permit fee for issued permits prior to any inspection rcqu sts. 2. Refund:: will be returned to the original Payer in the same method in which payment was received Please allow 1 -2 weeks for processing refunds. • FOR 01:1- 1cE:L ONLY Rte to S s Admin: Date B Rte to Bld Ailrrti.r Date ,'� r� ®�'- Refund Processed; Date 14�/M B. . invoice Processed: Date B' Permit Canceled: Date ,f "JV B 4 /27,2 Parcel Ta: Added: Date B Receipt # Date Method Amount $ T: \Rwldv \Fomu \Rc Imes 07/26/07 90/E0 39Cd 9NIld3H N093i'10 9558- T69 -E05 bE :TT 6002/ET/LO • Electrical .Permit Appticatioi�C�� • FOR OI -1 I( I. Uhl tl City of Ti and -JJ � ' '� Perm No. r' � 00 /5:r 13125 SW x811 Blvd ,Tigard Olt 97233UN 0 3 lly, Review r ©Q .• a m � J { Y . Phone: 503.639.4171 Fax: 503.598.1960 1 001 DateB : Other Permit[- ilig00 9 --000 97 7 t � : - ;- i .: Inspection Line: 503.639.4175 CITY OF Tr Date Ready/By: Avis Fa Set Page 2 for Internet www.tigard-or.gov B f rI • I I G ARD Notified/Method: 776' Supplemental information 1 c?r' - k 4 }� ti \� h 1, : $.,i- : R., ,r. L f - s :r ... y r .,.I . l+ o r ''rt t.�,. � ?'t t• r� - � a ` :i� ,, . ., t E , \ \ , vi 4 *i - •v 1 M c i _t t u + . 9t t 'ti (' "f a 1 f-, �. � ""S� � `.' - ' . �,�,t 1 la., C ti ¢ �� }, •+., , M..c � �- ,��, �T r: } u + .. ,� �rL`.: t: «s�v � '�i� WC'4'�� . � �I.S' x � .. _,_ c., _�.,. _'S ,. , `S. 4:_ 5;.:.. �..:_s {� ...._ .._ _ _ _ ..._____... -_ . � � '- .#L _ r -._r .r.... _ ❑ New construction . ® Addition/alteration /replacement please check all that apply (submit 2 sets of plans w/items checked below): ❑ Demolition OLhef 0 Service or feeder 400 amps ur mutt 0 Buildiug over three stories. where the available fault current ❑ ht iirsss and boatyards. .- "t t(7,, °" `` P M71' ;. R3, " , ` ` r _ e ? ' r^ t C 1 5 ' I ' }, , #,': exceeds 10,000 amps at 15U volts or ['Floating buildings. ..a.. `?S` ..�`.:, `'. > h . : - :.r t . ._._, :cL_ _ . : k;)3' , -. -1.: less to ground or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1 - and 2 - family dwelling 0 Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or Nnnx^i.4 sb' •\ � h4 �'s`:\ ,c - - K v ' ` ; 4-x.:� w� : , ; :,.-� 's %r f i<a +,r �,": f", .( li ❑ ,mefgency system. larger separately derived system. • r.n,. ,'�, S.. .s5 .,1a5� ; ;v:.. , ., �•.:::.' .,..2 s-:,:.«i '..J., cW ... ,.f 4 s l w .,.� w 0 Addition of new motor load of (J A. "E", t:1 . <.1 Job no.: 09 - 0208 Job site address: 16596 SW 72n Ave 1001iP or more. occupancy. . 0 Six or more residential units. 0 Fteeroationat vehicle part'. City /State/ZIP: Portland, OR 97224 0 Health -care facilities. 0 Supply voltage for more than ❑ Hazardous locations. 600 volts nominal Suite/hidgJapt no.: I Project name: 3 Spec Spaces (t 0 Service or feeder 600 amps or more Cross street/directions to job lff #rryiNu " ` ' Q p. pee To tal s • • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: [ Lot no.: 1.000 sq. ft or less 145.15 4 - Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 Y 1 Limited energy, residential 75.00 2 i - 1 a-� :\t. - \i , may \.&.: y , -;': ".. .7 w. i,,,, < . � MF� ,(" , 7.. t .;c' yn 4•t:. .'IR.ti1 �._� ",VtkR S' tii,?.,r_';::" - �L.:.:' .:. '......J., ....; _ ., .,._ : tiiIr :!: 1 n �{ : ;. k t+' 1 (with above 6A• ft.) HVAC Limited energy, multi - family 75.00 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80,30 2 J z \ ¢x: x, c . r. "� y '.^.�) t 1 5 1 , } ';� ,-" \ L.: -. . sa .t t� t `- :,a.:u its :1 i.., -- ., . ::,..:.. ;.:.... ... "..n. .�zrN.. : , 1 '. `• .t:. f i -'-. . ,a 20l amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts I 454.65 I 2 • City /State /ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to OILS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits new, alteration, or extension, per panel Owner signature: Date: ,.t A. Fee for branch circuits with iC 'n z 7 r t \ i 2 , nr, ? .; ?1 hb- �c C cs` Q ! J , i c , • . .1 . ,i.. •.,: f r about service or feeder fee s..• s...a r „ ",w..,h .: _,.c, s .::.... 11 i t . c.,... _t . n each branch circuit 6.65 2 Business name: B. Fee for branch circuits - Contact name: without service or feeder fee. 46.85 2 first branch circuit Address: Each adds branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular • dwelling, service and /or feeder 90 - 2 Phone: ( ) . 1 Fax: : ( • ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 ' a r i� e i 1,. 1 , .� c ` .•. , ' ∎ s ? } W is ;' >• 1l. F,v k7z.n, �: {�"Trt. -,S' .> _ ^�t., "vr \.. `, a _ si.t -- ., 5::: cs. :..a .v:i, :�u•.�a Ji, n w�4�. % rYss. r.: SIgr outline lighting J3.40 2 Signal circuit(s) or limited - Business name: Oregon Heating & AC energy panel, alteration. or Address: P O Box 241 extension. Describe: 1 Page 2 75.00 2 City/State/ZIP: Dundee, OR 97115 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (503) 538 -2953 Fax: (503) 691 -8556 Investigation per hour (1 hr min) 62.50 CCB Lic.: 172126 Electrical•Lic.: LHR40 Suprv. tic.: 1798LEB Industrial plant per how 73.75 Suprv. Electrician signature. required: r ii2p(i ii nr. J,n; 3y.. of r ?i:r.< .•.' = Subtotal: 75.00 - ./ Print name: Greg Boone / 06 - Plan review (25% of permit fee): ✓ State surcharge (12(Y0 of permit fee): 9.00 Authorized signature: 1 , TOTAL PERMIT FEE: 84.00 This permit application expires if a permit is not obtained within 180 Print name: Teresa Stupor Date: 06 days after it has been accepted as complete . 6 Number of inspections allowed per permit. 1. ins \permttsTAX- permhApp.dx OS/ 23/06 440 -461 ST( I1 /03 /C0M/WEB L0/90 39tid 9NIld3H NO93210 9998- 269 -E0S 9b:6t 600Z/E0/90 • Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: • t l� i . �` ) i t�r t ,1 yi'ir if) itCji lihi �1•� j1;r t. �'�� " �1 'h iu ° � jl.hp,�""r' Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Aix Conditioning System* ❑ Vacuum Systems* ❑ Other: • t z l .- i 1>� @Cl"i_`"'j.: 1 ) f�3:� 4.ti�.: � Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ® HVAC ❑ Instrumentation ❑ Intercom and Paging Systems [] Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ protective Signaling ❑ Other Total number of commercial systems: 1 • *No licenses are required. Licenses are required for all other installations IAlluddineermitel lt-PennitApp.dce 03/23/06 L0 /L0 30Vd SNIld3H NO93d0 9558- I69 -E05 90 :Et 600Z/E0/90 City of Tigard, Oregon ° 13125 SW Hall Blvd. o Tigard, OR 97223 I1 August 27, 2009 . . Oregon Heating & AC P.O. Box 241 Dundee, OR 97115 Attn: Teresa Stupor Re: Permit No. ELR2009 -00155 Dear Ms. Stupor: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 16596 SW 72n Ave., B11 Project Name: Spec Space • Job No.: Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $67.20. ❑ 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, L Dianna Howse Building Division Services Supervisor Enc. 1: \ Building \ Refunds \ Administration \LtrRefund- CancelPemtit.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 CITY OF TIGARD RECEIPT a . 13125 SW Halt Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 175007 - 08/27/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELR2009 - 00155 $ - 67.20 Total: $ -67.20 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 07395A DHOWSE 08/27/2009 $ -67.20 Payor: Teresa Stupor - Oregon Heating & AC Total Payments: $ - 67.20 Balance Due: $67.20 • • Page 1 of 1 • CITY OF TIGARD RECEIPT +. �. 13125 SW Hall Blvd., Tigard OR 97223 503.639.417 TIGARD • • Receipt Number: 173864 - 06/05/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID • ELR2009 -00155 . Restricted Energy Permit 220-0000-431510 $75.00 ELR2009 -00155 12% State Surcharge - Restricted 100 -0000- 207020 $9.00 Energy • • Total: $84.00 • PAYMENT METHc�D CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card • 07395A DHOWSE 06 /05/2009 $84.00 Payor: Teresa Stupor - Oregon Heating & AC • Total Payments: $84.00 Balance Due: $0.00 • • • • • .Page 1 of 1 • 90/170 39Vd ONIl203H N093d0 9558- T69 -E05 17E:TT 6002/ET/L0