Permit Eir
TIGARD
City of Tigard
October 18, 2012
Parkin Electric
Attn: Tonya Vian
14001 Fir St.
Oregon City, OR 97045
Re: Permit No. ELC2012 -00347
Dear Ms. Vian:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 6960 SW Sandburg St.
Project Name: Bus Barn
Job No.: N/A
Refund Method: n Check # in the amount of $
® Credit card "return" receipt in the amount of $302.97.
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
n Trust account "deposit" receipt in the amount of $
Comment(s): Per applicant's request as application was submitted for the wrong site
address. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
L �
: 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: Parkin Electric DATE: 8/27/2012
Attn: Tonga Vian
14001 Fir St REQUESTED BY: Dianna Howse
Oregon City, OR 97045
TRANSACTION INFORMATION:
Receipt #: 187067 Case #: ELC2012 -00347
Date: 06/06/2012 Address /Parcel: 6960 SW Sandburg St
Pay Method: CreditCard Project Name: Bus Barn
EXPLANATION: Per applicant's request as submitted application for wrong site address. 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 220- 0000 -43103 $270.51
12% State Surcharge 100- 0000 -24001 32.46
TOTAL REFUND: $302.97
APPROVALS:
If under $5,000 Professional Staff , ' 1
If under $12,500 Division Manager 11 f,, ; �'
If under $25,500 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: / yj(, / By: �„,dlY
1: \Building \Refunds \Ref indRe s 09/1)1/21111)
From: 08/24/2012 08:02 #640 P.001 /002
L igf City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
! �sTZ
reiz4:. Request Permit Action
�TiGARsD` 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division Services Supervisor
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: Parkin Electric
INVOICE TO: (Business or Individual)
Mailing Address: 14001 Fir Street
City /State /Zip: Oregon City, OR 97045
Phone No.: 503 - 657 -4958
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
❑ CANCEL /VOID PERMIT APPLICATION.
® REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
El INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit # : ELC2012 -00347
Site Address or Parcel # : 6960 SW Sandburg Street
Project Name: Bus Barn
Subdivision Name: Lot # :
EXPLANATION: Incorrect Address permit is for another address in Washington County
Signature: Date:
Print Name:
Refund 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.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2 -4 weeks for processing refunds.
Yg ?s - _%� As` `::Ft�:�. FOR,OFF USE ,,.ONtnaii _.- ,z �°.r .M„.. .._ .: ;,..: /6 a�
Rte to S Adrnin: Date B • Rte to Bld: Admen: Date /a APISM By jf , ff0 ,P-0
Refund Processed: Date , �����:�'� Invoice Processed: Date By 29 4e' 7
Permit Canceled: Date', ,�/'�.7 : t fj' Parcel T.: Added: Date B /
Receipt # Date Method Amount $ 3 a. y4. /d2
I:\ Building \Forms \RegPermitAction.doc Rev 05/25/2012
� p 2.97 �S
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00347
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/06/2012
Parcel: 25101 DD00701
Jurisdiction: Tigard
Site address: 6960 SW SANDBURG ST
Project: Bus Barn Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: (5) branch circuits for TI
Contractor: PARKIN ELECTRIC INC Owner: TIGARD - TUALATIN SCHOOL
14001 FIR STREET DISTRICT 23J
OREGON CITY, OR 97045 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503 - 657 -4958 PHONE:
FAX: 503 - 557 -1059
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/06/2012 $100.70
Specifics: amps or less
1 ea Services or Feeders - 401 to 06/06/2012 $200.34
Type of Use: COM 600 amps
Class of Work: ALT 5 crt Branch Circuits w /Purchase 06/06/2012 $37.10
Service or Feeder
Type of Const: 1 ea 12% State Surcharge - 06/06/2012 $40.58
Occupancy Grp: Electrical
Total $378.72
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 0 52 -001- 90. You ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 0 u A-1 Dr 80 4. , ` u ikt
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 the next available Inspection date.
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.
From: 06/04/2012 15:46 #468 P.002/002 .-
r pnr:
Electrical Permit ApplicatidbAlig.1 V CI) FOR OFFICE USE OSIL.1' 5 e/
1.)‘
City of Tigard JUN 0 4 2012 Received
Date/B : C' is i i, 5,-f Remit Nog Le „, ■ 14.- ato m i
N • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.59e OF TIGARD Date/B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By:
TIGARD Mil lif See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
tgiV giai;:f:40; kOtigatlIV4V40, fit**.i
0 New construction X Addition/alteration/replacement Please check all that apply (submit a sets of plans wAterns checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
o Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
i::::• tygeiTi3laiSNAY417:04) exceed., 10,000 amps at 150 volts or 0 Floating buildings.
— '"`'-':‘ kss to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling pcommercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family in Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
S7 . ... m ,......,--....,.6. 41% .,,,,,,„",. , ,,.. ,. ,...,,, y °Emergency system. larger separately derived system
Job no.: Job site address 47‘e1
'. .;,-.: ,,.,,,:a.45ilf::g...fsi.::::.;:ilaki.j.s,14',,,,4,,g,'„::14,te 0 Addition of new motor load of 0 "1-2",
Job :‘ 2,e,5%/7/21/rthis 100HP or more.
- (3 six or more residential units. 0 °cc tummy.
Recreational vehicle parks.
City/State/ZIP: -- rigar d. cii . 0 Health-care facilities. ' a Supply voltage for more than
0 Hazardous locations. ' 600 volts nominal
Suite/bldg./apt. no.: J Project name: 82 °Service or feedu 600 amps or more.
liP02:§3310141$3taRani:aa.,:,=
Cross street/directions to job site: Deseription I Qty. I Fee. I Total I •
New residential single- or multi-family dwelling unit.
• Includes attached garage.
Subdivision: • Lot no.: - 1,000 sq. ft. or less 168.54 4
Ea. adcrl 500 sq. ft. or portion 33.92 i
Tax map/parcel no.: . •
Limited energy, residential
75.00 2
6.•;:..‘-9.V:,:rAj'.B;U:41**7Rt*HILIi)).7.A10*-at:h'''*.i4..e7:Igt-411--,51;;R (with above sq ft)
Limited energy, multi-family
$1-6 //) Fel 5cAs 7g I e € / 1 I e j residential'(with above sq. ft.) 7500 2
/ Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 4e. V 2
•- : = ::;..:;. ' g. : . 3, n,q.t*.qt*:*tgg:O.*-- - $ 8 4,Zi.t ' t' - fEISgatEZR:ig;fVWA'a : -t'lt°?'. ' A 201 am t° 4°° amPs 133.56 2
Name: 401 amps to 600 amps / 200.34 2CIP4V 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 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 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, r panel _
Owner signature: Date: A. Fee for branch circuits with
. ■ M , dil 53 ' AM r ATOCk*Stgi..*:4:t ',0i abovebsranerVhceolr jfeeder fee 5 742 37/0 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add' I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
_, Sign or outline lighting 67.84 2
. ',':‘ : :.. - ,:6.0.i .. ..:.;:' , . : :".•;: : ::‘ . ':;.;. , '::- . ..'04'Y , '..:'::‘ , 4,K0.014_. TRACTORR sig circuit(s) or limited-energy
Business name: Parkin Electric panel, alteration, or extension. Page 2 2
_ Each additional inspection over allowable In any of the above
Address: 14001 Fir Street Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Oregon City, OR 97045 Investigation (1 hr min) 66.25/ hr
- , -Inustrial plant (1 hr min) 78.18/ hr
/Phone: (503) 657 ,y ... i )v.. 159 Ins.— ions for which no fee is
i X 4- - sa 1/2 ll listed hr mm
A% n 90.00/ hr
" w 'B
CCB Lic.: 3515/ Electrical Lic dIE::nTtlI Lic.: • • • 1-S % '
i,
Subtotal: win
Suprv. Electrician signature, required: , fr'7 - ,.-
Plan review (25% of permit fee):
Print name: David B Parkin Date:6, if /2 State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 378.12 ../
Authorized signature:
This permit application expires if a permit Is not obtained within
days after after It has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit.
IABuilding‘PermitAELC-PermitApp.doc 07/01/10 440-4615TO 1/05/COMPNEB