Permit •
. City of Tigard, Oregon a 13125 SW Hall Blvd. O Tigard, OR 97223 •
•
Ii
August 27, 2009 • _ - _ . ...
Atlas Electrical Contractors
4403 SE Roethe Rd.
Milwaukie, OR 97267
Attn: Cathy Munson
Re: Permit No. ELC2009 -00029
Dear Ms. Munson:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 6825 SW Sandburg St.
Project Name: TOC Management Services
Job No.:
Refund: ❑ Check # in the amount of $
• Credit card "return" receipt in the amount of $41.98.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as scope of work changed. 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. •
I: \Building\ Refunds \Administ ration \LtrRefund- Cancelpermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov e TTY Relay: 503.684.2772
J •
" 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: Atlas Electrical Contractors DATE: 8/20/09
4403 SE Roethe Rd.
Milwaukie, OR 97267 REQUESTED BY: Dianna Howse
Attn: Cathy Munson
TRANSACTION INFORMATION:
Receipt #: 2009 -157 Case #: ELC2009 -00029
Date: 1/21/09 Address /Parcel: 6825 SW Sandburg St.
Pay Method: CreditCard Project Name: TOC Management Services
EXPLANATION: Per applicant's request as scope of work changed. Refund 80% of permit fees.
:REFUND INFORMATION:• • , •
: :Fee Description From Receipt: ' Revenue Account No:. Refun'` ;
,Example: [BUILD] Permit Fee , . • - Example: 245- 0000 - 432000.. $"Aiinount
•(ELPRMT] ELC Permit 220- 0000 - 431510 $37.48
(TAX] 12% State Surcharge 100- 0000 - 207020 4.50
TOTAL REFUND: $41.98
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager r '\
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: ,f /ac/d f By: ,�74j
Case Refund Processed: Date: lr�;; � a By:
I: \Building \Refunds \Refundltequest.doc 04/13/09
CITY OF TIGARD RECEIPT
.. 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 175004 - 08/27/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2009 - 00029 $ - 41 . 98
Total: $41.98
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 01597B DHOWSE 08/27/2009 $ -41.98
Payor: Atlas Electrical Contractors
Total Payments: $ -41.98
Balance Due: $41.98
Page 1 of 1
rT ill .
•
CITY OF T.IGARD 12 = –'U:' 3PM
V
13125 SW Ha Blvd.
Tigard, OR 97223 503.639.417 - •
•
T1GARD .
"' Receipt #: 272009000000000001 ex:16 / 6s: y-� --
Date: 01/21/2009
Leo Line items: Amount Paid
c,-, Trap Code Description Revenue Account No
Case No
z ELPRMT] ELC Permit 220- 0000 - 431510
46.85
ELC2009-0002 �
ELC2009 -00029 [TAX] 12% State Surcharge S 00- 0000 - 207020 5.62
•
Line Item Total: $52.47
Payments:
Method Payer User ID Acct. /Check 1V D. Approval No.
Flow Received Amount Paid
O l 597B Fax 52.47 ..__
CreditCard ATLAS ELECTRICAL LS �J
CONTRACTORS
,,, Payment Total: $52 -47
0
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ris
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os C TV O F 1
._ _ TI6ARD, OR. 97223
FERIIIHAL I.D 10173410301111110113055811
,�, 1ERCHAHT 11: B0B3138655
b UISA�e92 *
— SALE
Q RECORD N: 5 IHU: 808005
DATE: JAN 21, 0 TINE: 12:51
SATCll: 218
RUTH: 015916
c _ AUS RESPONSE: V
o CUU2 RESPONSE: P
c .,; ADDRESS AND 5 DIGIT 2IP HATCH
o TOT $52.47
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I AGREE 10 PAY ABOVE TOIL A113UNT
ACCORDING TO CARD ISSUER AGREEMENT
\O RCPAHT ABREETBIT IF CREDIT UO U ER)
\ CUSHIER COPY Page 1 of I •
• --
• Feb. 26. 2009 2:50PM Atlas Electrical Contractors No. 3385 P. 1
• • FAX Co VER SHEET
ATLA5
ELECTRICAL CONTRACTORS, INC.
4403 5.E. ROETHE ROAD
MILWAUKIE, OREGON 97267
(503) 659 -2212 • FAX (503) 669 -4944
To; ..i ` ; � • J � From:
Fax: <5;/ _ ,5 R — , �0 0 Pages:
Phone: Date: � _69)
❑ Urgent ❑ For Review 0 Please Comment 0 Please Reply 0 Please Recycle
• Comments:
•
•
Feb. 26. 2009 2:50PM Atlas Electrical Contractors No, 3385 P. 2
! Pi " Community Development
TIt: ,11:I)
Request for Permit Action
TO: CITY OF TIGARD FEB f 6 2Qr&
Building Division Services Coordinator
13125 SW Hall BIvd. Tigard, OR 97223
Phone: 503.718.2430 1 503, 598..1960 www,dgard- or.gov
FROM 0 ()wiles ❑ Applicant ® Contractor. 0 City Stiff
(cheek ono)
REFUND OR Name:
INVOICE TO: (3ur;nef+ofindlvidt9l) ATLAS ELECTRICAL CONTRACTORS
Mailing Address; 4403 SE ROETHE ROAD
City /State /Zip: MILWAUKIE, OREGON 97267
Phone No.: 50 3_659_2212
PLEASE TAKE ACTION FOR THE ITEM(S) CFZECKED (1):
CANCEL PERMIT APPLICATION.
•
REFUND PERMIT FEES (attack) receipt, if available). •
❑ INVOICE i~ OR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: ELC2009 —.00029
Site Address of Parcel #: 06825 SW SANDBURG ST. , TIGARD, OR
Project Name: TOC MANAGEMENT SERVICES
Subdivision Name: SALEM FREEWAY SUBDIVISION Lot #: 001
EXPLANATION: SCOPE OF WORK CHANGED
Signature:
6:2,e44 s Date: 2/26/2009
Print Name: CATHY MUNSON
BaS,azdlis� •
3, The Director or Building Official may author ee tho refund oft
a) any fee which war ettonoouely paid or collected.
b) not mozc than BOq'6 of the )and use application fen when en application io withdrawn or canceled bcfrxo any revie effort ha been expended.
c) not mote than 80/e of the land we applicadnn fee foe !Wed permits.
d) not more than 80% of the building plan review fcc when an application to canceled bcforo any phn review effort hex been expended.
o) not mote then 80% of the building permit foe for issued pennita prior to any inspection requests.
•
2 .Refunds will be returned to the ovginal Payer the woo method in which payment was received. Please allow t -2 Weeks for processing refunds.
FOR ( ? FrICI. USE ONLY'
Rte to S -e Admin: Date B' Rte to BI- , Admin: Date , -210
•
Refund Processed; Date f/3 cy,- %fir Invoice Proccaeed: Date
Permit Canceled: Date , ' „� qu B r — Parcel I'm Addcd
Datc
Retiei � t # .)37
e Method Araoun( $
f: \Build ng onns\AogPezrni tion.doc Rev 07/ 6 07
.
C ITY OF TIGARD ELECTRICAL PERMIT
1111 ° PERMIT #: ELC2009 -00029
° COMMUNITY DEVELOPMENT DATE ISSUED: 1/21/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 101 DD -00400
SITE ADDRESS: 06825 SW SANDBURG ST ZONING: C -P
SUBDIVISION: SALEM FREEWAY SUBDIVISION LOT : 001 JURISDICTION: TIG
PROJECT: TOC MANAGEMENT SERVICES
Project Description: (1) branch circuit. Connect UPS for server room. Job No. 18296.
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: SIGNAL/PANEL:
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:
TOC MANAGEMENT SERVICES INC ATLAS ELECTRICAL CONTRACTORS
6825 SW SANDBERG ST 4403 SE ROETHE RD
TIGARD, OR 97223 MILWAUKIE, OR 97267
Phone: Contact #: FAX 503 - 659 -4944
PRI 503 - 659 -2212
FEES
Description Date Amount Reg #: ELE 3 -2C
[ELPRMT] ELC Permit 1/21/2009 $46.85 LIC 1532
[TAX] 12% State Surchar 1/21/2009 $5.62 SUP 5009S
Total $52.47 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 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.88
U Issued By: Q �� Permittee Signature: � Q A � 1 C
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.
. r • 'JP.n, 19. 2009 4:35PM Atlas Electrical Contractors No.2411 P. 1
Electrical Permit AimlicatioIPECEIVED u it OFFICE U51? uri.1'
City of Tigard Received
Dalelliy: - 2 -0 P111 Me
II r< 13125 SW Hall Blvd., Tigard, OR 97223 J N 2 2009 Plan Review
Phone: 503.639,4171 Pax: 503.598.19 Datell3 . Other Permit:
T 1 G A It. D Inspection Line: 503,639.4175 Dale Ready/By: Eliall 121 See Page 2 for
Internet; www.tigard or.gov CITY OFTIGARD Notified/Method: Supplemental Information
NG DIVISION..,,
. -
.. TYPE 0 .. .. :,, ` P ax:'REY9 .
❑ New construction tEl Addition /alteration/replacement Please check all that apply (submit 2 acts of plans Wilms checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: r where the available fault current ❑ Marinas and boatyards.
'. _
CAT/GORY ''f'`t ;3 :. h lr:' ; i - exceeds 10.000 amps at 150 volts or ❑ Floating OF CONSTRUCTION :.:. ,,. Ps B buildin
•
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling ® Commercial /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 syst
EIAddirionor new motor toad Cl "A". "E'. "1- 2 ". "1 -3".
Job no.: 18296 . Job site address: 6825 SW SANDBURG ST. 100HPormore. occupancy.
IZI Six or more residential units. ❑ Recreational vehicle parks. .
City /Seale /ZIP: TIGARD, OR 97223 ❑ Healthcare facilities. ❑ Supply voltage for more than
❑Hazardous locelions. 600 volts nominal.
Suite/bldg. /npt. no.: Project name: TOC MANAGEMENT SERVICES ❑ Service or feeder 600 amps ormore. .
FEE SCHEDULE '
Cross street/directions to job site: Pttcrlpilon I Qtv. I Pee. I Told I •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. Il. or less 145.15 4
• - Ea. add'l 500 sq. fl. or portion 33.40 1
Tax map /parcel no.: _ . - Limited energy, residential 75.00 2
DESCRIPTION OF WORK • (with above sq. ft,)
•
CONNECT A UPS FOR SERVER ROOM. Limited residential (with i t3ultt-f e sq. fl 75 2
residential (with above eq. ft.) _
Services or feeders installation, alteration, and /or relocation ,
200 amps or less 80.30 2
. ❑ PROPERTY OWNER . • I • ❑ TENANT • 201 amps to 400 amps 106.85 • 2
Name: 401 amps to 600 amps 160.60 a
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 -.
~
City/State /ZIP; Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax; ( ) 200 amps or less 66.85 I
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 ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 _ 2
Owner signature: Dale: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch Circuits with
• ® APPLICANT I ❑ • CONTACT PERSON : . . above service or feeder fbe,
6.65 2
Business name: Atlas Electrical Contractors each branch circuit
B. Fee for branch circuits
Contact name; Cathy Munson Ivilhouf service or feeder fee I 46,85 46.85 2
first branch circuit
Address: 4403 SE Roethe ltd Each add'I branch circuit 6,65 _ 2 .
- Miscellaneous (Service or feeder not included) _
City /Stale /ZIP: Milwaukie, OR 97267 Each manufactured or modular 90.90 2
dwelling, service en .. feeder
Phone: (503) 659 -2212 Fax: ; (503) 659 -4944 Reconnect only 66.85 2
E - mail: Cathybd@atlaselectrical.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2 •
Business name: Atlas Electrical Contractors Signal circuit(s) or limited .-
energy panel, alteration, or .
Address: 4403 SE Roethe Rd extension. Describe; Page 2 2
City /Slate /ZIP: Milwaukie, OR 97267 Each additional Inspection over allowable In an of the above
Per
Phone; (50 Investigation 659 -2212 Fax: (503) 659.4944 inspection 62,50 -
n per hour (I hr min) 62.50
CCB Lic.: 1532 I Electrical Lic.: 3 -2C Sup v. Lic.: 5009S Indbrstrial plant per hour 73.75
ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: .r�l Subtotal: 46.85
La a . 1. r.'.
Print name: TY W. SHEPERSKY U 11. 46.1 19/09 Plan review (25% of permit fee);
State surcharge (12% of perm fee): 5.62
Authorized signature: TOTAL PERMIT PEE: 52.47
Print name: TV W. SHEPERSKY Date: 1/19/09 This permit application expires ir a permit is not obtained within 160
days after It has been accepted as complete.
' Number of inspections allowed per permit.
I: Wuilding 'Permin\E1.C- PennitApp.dac 05/23!06 490.4615T(11 /05 /COMIwco
•
A City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
•
TIGARD
August 27, 2009
Atlas Electrical Contractors
4403 SE Roethe Rd.
Milwaukie, OR 97267
Attn: Cathy Munson
Re: Permit No. ELC2009 -00029
Dear Ms. Munson:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 6825 SW Sandburg St.
Project Name: TOC Management Services
Job No.:
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $41.98.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as scope of work changed. 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.
I: \Building\ Refunds\ Administration \UrRefund- 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, 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: Atlas Electrical Contractors DATE: 8/20/09
4403 SE Roethe Rd.
Milwaukie, OR 97267 REQUESTED BY: Dianna Howse
Attn: Cathy Munson
TRANSACTION INFORMATION:
Receipt #: 2009 -157 Case #: ELC2009 -00029
Date: 1/21/09 Address /Parcel: 6825 SW Sandburg St.
Pay Method: CreditCard Project Name: TOC Management Services
EXPLANATION: Per applicant's request as scope of work changed. 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 $37.48
[TAX] 12% State Surcharge 100- 0000 - 207020 4.50
TOTAL REFUND: $41.98
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager 9 �\ 0•--01
•
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 -a ;
Refund Request Reviewed: Date: ,f By:
Case Refund Processed: Date: ' • "•, 4s` �'
., �"� , s'� ' s � By:
1: \ Building \ Refunds \RefundRequest.doc 04/13/09
Feb. 26. 2009 2:50PM Atlas Electrical Contractors No. 3385 P. 2
; ,
IN .
Community Development
T I t: /l l2.1, Request for Permit Action RECEIVED
TO: CITY OF TIGARD FEB 2 6 2009
Building Division Services Coordinator CITY OFTIGARD
13125 SW Hall Blvd., Tigard, OR 97223 BUILDING DIVISION
Phone: 503.718.2430 lax: 503, 598.1960 www,tigard- ox.gov
FROM: ❑ Owner ❑ Applicant ® Contractor. 0 City Staff
(chick ono)
REFUND OR Name:
INVOICE TO: (Business or Indhridval) ATLAS ELECTRICAL CONTRACTORS
Mailing Address: 4403 SE ROETHE ROAD
City /State /Zip: MILWAUKIE, OREGON 97267
Phone No.: 503- 659 -2212
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
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 #: ELC2009 -00029 '
Site Address or Parcel #: 06825 SW SANDBURG ST. , TIGARD, OR
Project Namc: TOC MANAGEMENT SERVICES
Subdivision Name: SALEM FREEWAY SUBDIVISION _ L #: 001
EXPLANATION: SCOPE OF WORK CHANGED
Signature: t9
Date: 2/26/2009
U
Print Name: CATHY MUNSON
$pfitn •
1. The Director or Building Official maywthosiae tho refund of
a) any fee which war enoneoudy paid or egllecred
Is) nor more than 9ll4ro of the land use applialtion fen when an application ie withdrawn or canceled before any :view effort has been expended_
c) not more than 8(M /e of the land une applicadne fee foe issued permits.
d) not more than 80% of tho building p eeriew fcc when an application le canceled Dcfo,e any plan =view effort has been expended.
o) not mote than 8(r/ of the Meting permit foe for isaucd peen is prior to any inspection revers.
•
2 .Refunds will be retooled to the ocginal Payee in the AMC method in which payment was received. Please olloar 1 -2 woelu for processing refunds.
FOR (?FI ICI . (,itil: ONLY
• Rte to S -e Admit]: Date B 1.tc to El- : ,Amin: Date , ��U„
Refund Processed: Date s�yfAQ Invoice Processed: Date B
Permit Ca nceled: Date , ,- 7 , B ar,�—� ! arcel 'T : ridded: Date B.
Receipt # Danz Method _Ammo' $
TA BaildinivormokogPamitliction.d itcv 07/26/07