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Permit
• t /± f l CITY OF TIGARD ELECTRICAL PERMIT 74 ° PERMIT #: ELC2007 -00756 COMMUNITY DEVELOPMENT DATE ISSUED: 11/8/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 102AB - 04800 SITE ADDRESS: 12454 SW MAIN ST • ZONING: CBD SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: COMMAND CENTER STAFFING Project Description: 1 branch circuit. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED. ENERGY: 401 - 600 amp: SIGNAUPANEL: MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: CAPISTRANO, NICOLAS N + CHRISTIN CROWN VOLTAGE 6646 SW 35TH AVE DANIEL TUCKER PORTLAND, OR 97221 12607 NE 199TH ST BATTLE GROUND, WA 98604 Phone: Contact #: PRI 360- 666 -0995 FAX 360- 666 -4673 FEES • Description Date Amount Reg #: ELE 37 -984C [ELPRMT] ELC Permit 11/8/2007 $46.85 ,LIC 153934 [TAX] 8% State Surcharge 11/8/2007 $3.74 SUP 4116S Total $50.59 • REQUIRED ITEMS AND REPORTS This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 thro gh OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By: • Permittee Signature: 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'N: 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. :-aim, ,Nov 07 07 06: 29p CROWN VOLTAGE, INC. 1 360 666 4673 p. 2 Electrical Permit Appli ,., 1,, FOR OF ICF_ L'SG ONLY City of Tigard ` 1 ° ' "� anamimer. , .. _D. - 13125 SW Rill Blvd., TiyiM, OR 97723 , P n - Plan Reew Phone. 503.639.4171 Fax 503.598.1960 ...- -4- ; _ - 1 psknRY OlhaPamd: ^� laspcction Line: 503.639.4175 Nov � . ' .:I .:_, Dale I•IdYiBY ®nee race 2 for lnternet: www.ci,liyard.or,us NNotified/Mdhod: 7 J .ppletne.rollafarmalm TYR' VIRIO.r I LUARD Q New * CI..W ALR5Ten5 lruetion A;,�.. ;1 . ' "vi—ii' QQjj Please .1. . �' % , �UlO� Osavice over 225 amps, control ❑1•Ureadous location [] Dcmt)lilion ❑ amps t dngover 10 .000 ❑ tali ❑Boil sq. I. C ATE(ORT OF C•'ON sTRIKT1ON of 1 - aed 2-e milt' dwellings 4 or mom new residential ❑System over volts nominal units in one stractwe 1 -tool 2 dwelling ❑ Commercial/industrial ❑ Memory building OBuiilding ova three stories Glaeeders. 400 amps or more ❑ Mulli Gamily 0 Master builder ❑ other OOroupant load over 99 persons ONlanofaxrwed structures or Joe tiTrE INFORMATION AND LOCATION ❑Egress 1ighdag plan RV park Job no.: Job site Oddri: I L Uv `/ ❑Health - care facility ❑Omer. . r � Submit sets of plans wilh any ofmne above. C;tty/State/ZIP: • 1 • • • The abovearc not appl etble to temporary eunstnrdion service. .. 1 Suitclbldgfapt. no.: Project name • v _, K' Diti.B ' -- �.... L J re- TW, Doss s rcct/direeti0ns to job site: New residential sing4e- or multi- fataey dwdbaR mit. leetades attached ;;ar e. - 1,000 sq. f1. or less 145.15 4 Subdivision: - 1 Lot no.: La_ add, 500 sq. R or portion 33.40 1 Tax tnap/pareel T10 • Limited atcrgy. residential 75.00 2 Limited energy, non-residential r 75.00 2 DINCSUPTION OP IN ORk Each nan►nfacoued or modular I-4J Vi davelhn6 service and/or feeder 90.90 2 VO I Services or feeders inset U alioR alteration, and/or relocation 200 amps or less 8030 2 ❑ PROPERTY OWNER 1 STfr& -%NT 201=Into 400 amps 106.85 w 2 . � tM - � 401 amps to 600 amps 160.60 2 Name: L h 601 =paw 1,000 amps 240,60 2 Addstiss: Over 1,000 amps or volts 454.65 2 Reco nnect only 66.85 2 City/State/ZIP: • Temporary services or feeders installation, alteration, and/or Phone_ ( ) I Fax: ( ) re-location 200 amps or less 66.85 I Owner installation: Thin iraiall� ion is being made on property that 1 own which is not 201 amps to 400 amp "~ 100.30 2 intended for sale. lam. rent. or exchanger:. according to ORS 447. 449, 670, and 701. 401 actors to 600 amps 1 33.75 • 2 Owner simuttee: - e- Brooch eircnits- new. dteralioa, or eserosion. per panel _ ❑ . rru _4NT • © C'ONT.CCT PFR.4ON A. Fee for branch circuits with - -- service or feeder fee, each Business name: branch circuit 6'6 2 B. Fee far branch circuits Contact name: without service or foxier fee, e�*� each branch circuit 1 46.85 b -s Adrlrccs: each addi brands chair 6.65 2 City/State/%,1P: I Mueellaecoas (service or feeder not included) Phone: ( ) I 3x:: ( ) Dump or irrigation. crtde 53.40 2 11�� Sign or outliuc lighting 33A0 2 E -mail: Signal earwigs) or limited- CONTRACTOR energy pond- alteration, or Rusin= ne me• C{o� _ V () ' 'R s �1� extension. 13esaibe: E'agc i 2 Address: `'") f, Berets :Miaow isa�reetior avertdWwuhir icy ofthe above `- t�� M qq Per inspection 6250 ali/Slblc/ZIP: Q Ci t & Ina fionperboar(1 62.50 Phone: ad) )69 (,6 -O q tax: (gyp )U069-'1/67:3 lralustrial plant per boor -- I 73.75 ELECTRI'C'al. I•ERhI T FEES'''. r - CO3 Lie.: l S3 k 3/ I Electrical t Lie.: 1{ { tic Suprv. : y11�S Sub tota l y L ,F.6 uprv. Elcctrittian signature. required: s Plan review (25 %ofperuse fee) _ Pri gn 1 �lL� �717nic: li Smtc n review surcharge (25% of permit fee) L( TOTAL, PERMrr MB S Au(hurired rid► iatnitC: / , 'th . pe rmit apphcmia. expires if. permit it not obtained ninon' 180 �" days again brit be= .cc pred as eowplele Print name: a , C A C!s-� e • ti : e — 1 Date: I • Fee me thod ology set by Tri ty Bulldog Industry Scr eo Board -\ +• Nlamberofbnoectioas owmenin allowed F► City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 • T I GARD December 10, 2007 • Crown Voltage • • 12607 NE 199 St. Battle Ground, WA 98604 Attn: Stacy Lacombe Re: Permit No. ELC2007 -00756 Dear Ms. Lacombe: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 12454 SW Main St. Project Name: Command Center Staffing Job No.: N/A Refund: ❑ Check # in the am ount of $ . ® Credit card "return" receipt in the amount of $43.48. ❑ Trust account "deposit" receipt in the amount of $ . Notes: Per applicant's request as low voltage permit was required. • Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, ed ) 1 ){17(17-e— Dianna Howse • Building Division Services Coordinator Enc. • • I:\ Building\ Refunds\ Administration \LtrRefund- CancelPermitdoc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov •• TTY Relay: 503.684.2772 j • City of Tigard TIGARD Tidemark Refund Request This form is used for refund requests of land use, engineering and building application fccs. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Tidemark System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Crown Voltage DATE: 12/10/07 12607 NE 199t St. Battle Ground, WA 98604 REQUESTED BY: Dianna Howse Attn: Stacy Lacombe TRANSACTION INFORMATION: Receipt #: 2007 -4982 Case #: ELC2007 -00756 Date: 11/8/07 Address /Parcel: 12454 SW Main St. Pay Method: CreditCard Project Name: Command Center Staffing EXPLANATION: Per applicant's request; required low voltage. Refund 80% of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount [ELPRMT] ELC Permit 220 - 0000 - 431510 $40.48 (TAX] 8% State Surcharge 100- 0000 - 207020 3.00 TOTAL REFUND: $43.48 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager �G If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: I � // 7 7 I By: I AJW 1: \Building \ Refunds \RefundRequcst.doc 05/23/07 Nov 21 07 06:24p CROWN VOLTAGE, INC. 1 360 666 4673 p.1 Building Division ,4 I I Request for Permit Action or Refund City of Tigard _ TO: CITY OF TIGARD Permit System Administrator 13125 SW Hall Blvd., Ti_ar. • : Phone: 503.718.2430 Fax: )6503.598.19• 1 FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff (check me) . Name: CROWN VOLTAGE, INC . (Business or Individual) O I D Mailing Address: 12607 NE 199 STREET / O / ' 4W-7-city/State/Zip: BATTLE GROUND, WA 98604 Phone No.: 360- 666 -0995 PLEASE TAKE ACTION FOR THE ITEMS) CHECKED V): ® CANCEL PERMIT APPLICATION. ® REFUND PERMIT FEES. Pd`10 ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: ELC2007 -00756 Site Address or Parcel #: 12454 SW MAIN STREET Project Name: COMMAND CENTER STAFFING Subdivision Name: Lot #: EXPLANATION: PERMIT WAS PULLED AS MOD 1 CIRCUIT INSTEAD OF LOW VOLTAGE Signature: �� __ r i Date: 11 /2 / a 1 07 STA LAC C E Print Name: • Second Policy I . The Building Official may authorize the refund of: a) rmy fee which wns emmeously paid or collected. b) not more than 80 percent of the permit fee for issued permits prior to any inspection requests. c) not more than HI) percent of plan review tee when an application is canceled before any plan review effort has been expended. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Sys Admin: Date r ' Ve? Rte to 5 Y I I /07 By B Rte to Bldg Admin: Date By 3 OT) Refund Processed: Date By Invoice Processed: Date By ' Permit Canceled: Date By Parcel Tag Added: Date By V a.•:.tnr !i MAN aAps4bn.1 D 7 - / /t /� 7 1� • CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007..00766 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/13/2007 Phone: (503) 639 -4171 /Omol O Inspection Requests (24 Hrs.): (503) 639 -4175 'I _ �LC o2®07 66 7 -5 INSPECTION WORKSHEET FOR DATE: 11/9/2007 TIME: 7 :00AM PAGE: 33 SITE ADDRESS: 174.4 SW MAIN ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: COMMAND CENTER STAFFING DESCRIPTION: 1 branch circuit. OWNER: CAPlSTf 2ANo, NICOLAS N + CHRISTIN, PHONE #: CONTRACTOR: CROWN VOLTAGE PHONE #: 360- 666 -0995 Inspection Request Scheduled For: Date: 11/9/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 069395.01 36066 •0995 N Corrections /Comments /Instructions: • I $ 'N - ''4 1 3� r (2- -- o m m e ( A / o Pp., ttr n PASS PARTIAL APPROVAL n CANCEL I l NO ACCESS N yc FAIL 1 CALL FOR INSPECTION H ADDITIONAL FEES ASSESSED Inspector: 6 ) Date: V i' .' fl Phone #: (503) 718 - �,.