Permit 1)74,1u 1. 23. 2007)10:45AM 5ss1Sh i n da i wa CI1'3t OF TIGARD No. 7126 P. 21oj
, - Building Division REC E\ThD
T I G A R D Request for Permit Action JUL 23 2007
. TO: CITY OF TYGARD CITY OF T i� ' �� ,.
Permit System Ad.*
BUILDING DIVISION
13125 SW Hall Blvd, Tigard, OR 97223
Phone: 503.718.2430 Fs= 503.598.1960 www gard -or gov
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
(check ore;
REFUND OR Name:
INVOICE TO: Ali"' orlfldividua)) VAffill E r c, S r Co
Mailing Address: e lp 1bn Sul) 1 i atb ()
Cit /State /Zip: _ l (2. /L✓j
4 Q f . 4 i vLoa
V Phone No.: [p(pia
7/a 3/0 7 1. .
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
,r CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
0 INVOICE FOR FEES DUE (attach case fee schedule and explain below).
REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: EL C `-007 - 00 375
Site Address or Parcel #: w so. w s k i . c, 4-o n StM 2(8 F-J.
Project Name: , Fore.ge r a J
Subdivision Name: _ J5 t i n g +z in jd t G � . Lot #:
JECPLANATION: lAjor iC - ri[!,cx feArtne ed by 0,4rmffteAr Si g n Co.
F4e,,r wt- secured ou.r perrY 4 •
Signature: ‘1 t Date: -7/ el 7
Fr' Print Name: _mod Fr r k /i�t.
sefamdblgi
1. The Director or BuntSas Of9do1 aryy tutheethe the refund of
a) any fee which war enceeourly paid es col ec el
b) norm= that 80% of the land use cppEeerion foe when so application is withdrawn or em+mlcd before any review effort has been a wended-
4 ale mom dem 80% of the hod use rppLealicei fee fm issued parnira,
0 n ot more moo 80°!e of the buldmgplan review fee when en eppiir eloa is WOW bufoto WI plan review cRost has been eroded.
tE1
not nett than 80% ache !mam pent fee for issued pew poor to any ixvi ecdon xtl a.
2. Refunds w71 be rcoemcd to the origha1 Papa in the serne seedbed in which payment ass moired. Phase afow 1 -2 weeks for proeei3g relmds.
FOR OFFIt:i: 1 :r. t,7..1_Y
' Rte to Sys Admit): Date 7 !t 3 07 Rte m Bldg Admin: Date 7 013 a 7 By
Refund Processed: Date a2 0 ,iii Invoice Processed: Date By
Penult Canceled: Date „Iffigi ?' Parcel Tap Added Date By
# Date X11 • rA Method L Arno. $ l7 ?. o/
I: \Building \Forms R.qr- moadoc 05 24 06 lizcsmsizzoniIiin !— 79L�iF�vi-
t `
. City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
•
TIGARD
July 23, 2007
Young Electric Sign Co.
20100 SW 112 Ave.
Tualatin, OR 97062
Attn: Thad Firkins
Re: Permit No. ELC2007 -00375
Dear Mr. Firkins:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 9601 SW Washington Sq. Rd.
Project Name: Forever 21
Job No.: N/A
Refund: ❑ Check # in the amount of $ .
® Credit card "return" receipt in the amount of $138.41.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as work was done by another sign company after permit was
issued. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Permit Specialist
E nc.
I: \Bwlding\ Refunds\ Administration \LtrRefund- 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 7/23/2007 .
13125 SW Hall Blvd. 2:23:06PM
Tigard, OR 97223 503.639.4171
TIGARD
Refund Receipt #: 27200700000000003396 ,4E/�25 .1 - 4--
Date: 07/23/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
ELC2007 -00486 Reversal - [ELPRMT] ELC Permit 220- 0000 - 431510 (53.44)
.
ELC2007 -00486 Reversal - [TAX] 8% State Surc 100- 0000 - 207020 (4.28)
Line Item Total: ($57.72) •
Refund:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal PHOENIX ELECTRIC DLH Fax (57.72)
Refund Total: ($57.72)
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cReceipt.rpt Page 1 of 1
CITY OF TIGARD 7/23/2007 •
. 13125 SW Hall Blvd. 10:48:02AM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200700000000002468 C ieZ/6-riV }el
Date: 06/04/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
ELC2007 -00375 [ELPRMT] ELC Permit 220 - 0000 - 431510 160.20 -
ELC2007 -00375 [TAX] 8% State Surcharge 100- 0000 - 207020 12.81
Line Item Total: $173.01
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard THAD FIRKINS - YOUNG DEB 039070 In Person 173.01
ELECTRIC SIGN CO
Payment Total: $173.01
Page 1 of 1
cReceipt.rpt
•
111 q
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Rawest for Pem¢t A ction or &fund 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: Thad Firkins DATE: July 23, 2007
Young Electric Sign Co.
20100 SW 112 Ave. REQUESTED BY: Dianna Howse
Tualatin, OR 97062
TRANSACTION INFORMATION:
Receipt # : 2007 -2468 Case # : ELC2007 -00375
Date: 6/4/07 Address /Parcel: 9601 SW Washington Sq Rd
Pay Method: CreditCard Project Name: Forever 21
EXPLANATION: Per applicant's request as work was performed by another sign company after permit
was issued. No inspections request; refund 80% of permit fees paid.
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 $128.16
[TAX] 8% State Surcharge 100 -0000- 207020 10.25
TOTAL REFUND: $138.41
APPROVALS: -
If under $500 Professional Staff
If under $7,500 Division Manager
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
V,/ Case Refund Processed: I Date: I ;.,Z .V4 i By [ ..
I: \Building \Refunds \RefundRequest.doc 05/23/07
..., _ CITY OF TIGARD ELECTRICAL PERMIT
.$11 PERMIT #: ELC2007 -00375
COMMUNITY DEVELOPMENT DATE ISSUED: 6/4/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09601 SW WASHINGTON SQUARE RD L -1 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
PROJECT: FOREVER 21
Project Description: Installation of (3) sign lightings.
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: 3
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: 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:
WASHINGTON SQUARE LLC YOUNG ELECTRIC SIGN CO
BY THE MACERICH COMPANY 20100 SW 112TH AVE
9585 SW WASHINGTON SQUARE RD TUALATIN, OR 97062
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 612 -6672
FAX 503- 612 -0914
FEES
Description Date Amount Reg #: ELE 37 -51CLS
[ELPRMT] ELC Permit 6/4/2007 $160.20 LIC 69308
[TAX] 8% State Surcharge 6/4/2007 $12.81 SUP 661SIG
Total $173.01 REQUIRED ITEMS AND REPORTS
This Permitisissued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
wor be done iridccordance wit. - pproved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
m e than 180 days. ATTENT s : Ore. en law requires you to follow rules adopted by the Oregon Utility Notification Center. Those r s are set forth in
O R 952 - 001 -0010 through JAR • -, e ' 1100. You may obtain copies of these rules or direct questions to OUN at 03.246.669 r 1.800.332.2344.
%/ ,
1 ued BY: , Permittee Signature: X Q
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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard
Date/By Received i ji Q �/
III / Permit No Gl„e 7 -00 37 0
° 1 3125 SW Hall Blvd , Tigard, OR 97223 Plan Review
7 ' Phone 503 639 4171 Fax 503 598 1960 Date/By Other Permit
TI GARD w InspectionLtne. 503 639 4175 Date Ready /By Jun El See Page 2 for
Internet ww tigard - gov Notified/Method �Co Supplemental Information
TYPE OF WORK PLAN REVIEW
® New construction El Addition /alteration/replaccment Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- 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 system
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "l -3 ",
Job no.: Job site address'-9585SW. Washington Square Rd. IoOHP or more occupancy
I: ^ Six or more residential units ❑ Recreational vehicle parks
� City /State /ZIP: Tigard, OR. 97223 Y Q! ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: Forever 21 ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 145.15 4
Ea add'I 500 sq ft or portion 33 40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq ft )
Limited energy, multi -family 75 00 2
Mfr. and Install 3- Internally Illuminated wall signs inside mall for new tenant residential (with above sq ft )
Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER g TENANT 201 amps to 400 amps 106 85 2
Name: Forever 21 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240 60 2
Address: 9585 SW. Washington Square Rd. Over 1,000 amps or volts 454 65 2
City /State /ZIP: Tigard, OR. 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (209)481 -3517 Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
® APPLICANT ® CONTACT PERSON above service or feeder fee,
each branch circuit 6 65 2
Business name: Young Electric Sign Co. B Fee for branch circuits
Contact name: Thad Firkins without service or feeder fee 46 85 2
first branch circuit
Address: 20100 SW. 112 Ave. Each add'I branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Tualatin, OR. 97062 Each manufactured or modular 90 90 2
dwelling, service and /or feeder
Phone: (503) 612 - 6672 Fax: : (503) 612 -0914 n
Recc only 66 85 2
E - mail: tfirkins @yesco.com Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 3 53.40 160 20 2
Signal circuit(s) or limited -
Business name: Young Electric Sign Co. energy panel, alteration, or
Address: 20100 SW. 112 Ave. extension Describe Page 2 2
City/State /ZIP: Tualatin, OR. 97062 Each additional inspection over allowable in any of the above
Per inspection 62 50
Phone: (503) 612 - 6672 Fax: (503) 612 - 0914 Investigation per hour (I hr min) 62 50
CCB Lie.: 69308 5 p /Electrical Lic.: 37 -5 I CLS Suprv. Lie.: 661516 Industrial plant per hour 73 75
i ii /I$ job t og ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required Subtotal 160 20
Print name: Brian Warren Date: 0 /0-1
Plan review (25% of permit fee)
A urcharge (8% of permit fee) 12.81
Authorized signature: `���� . : :0 0 TOTAL PERMIT FEE 173 01
Print name: Thad Firkins � :(i v Date: �/J 1 This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete.
* Number of inspections allowed per permit
1 \Building\Permits\ELC- PermitApp doe 05/23/06 440- 4615T( 1 1/05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #:SW1001 00 nr
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 �..'il�..
INSPECTION WORKSHEET FOR DATE: 6 • Q'1 TIME: PAGE:
(oO
SITE ADDRESS: Ci-ife-v 6 to ikAtsCI T6 SQL.. tx CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: S% \ 0S
OWNER: PHONE #:
CONTRACTOR: PHONE #:
•
Inspection Request Scheduled For: Date: b 11J0i Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments/ Instructions:
•
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1 ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr ‘N)06 LC Date: 6 'ZZ -_O Phone #: (503) 718-1A40