Permit t..ITY OF TIGARD ELECTRICAL PERMIT
6 : 3 2 0 PERMIT #: ELC2008 - 00098
COMMUNITY DEVELOPMENT DATE ISSUED: 2/25/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102AA 00600
SITE ADDRESS: 12045 SW HALL BLVD ZONING: CBD
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT : 012 JURISDICTION: TIG
PROJECT: 7 - ELEVEN
Project Description: Installation of (1) sign lighting.
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: 1
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: 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:
7- ELEVEN CORPORATION ES & A SIGN AND AWNING CO.
2711 N. HASKELL 89975 PRAIRIE RD.
DALLAS, TX 75206 EUGENE, OR 97402
Phone: 253 - 796 -7164 Contact #: PRI 541 - 485 -5546
FAX 541 - 485 -5813
FEES
Description Date Amount Reg #: ELE 20- 243CLS
[FI.PRMTI EI,C Permit 2/25/2008 $53.40 LIC 163470
[TAXI 12% State 2/25/2008 $6.41 SUP 514SIG
Total $59.81 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
503.246.669 or 1. 0.3 . 344.
Issued By: Permittee Signature: ��_- i L � 'e
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: ,� ��,_its +,� 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.
Electri 4. al Permit Applicat•,., ECEI'J E FOR OFFICE USE ONLY
' Received y Q �
• City of Tigard Date :13y: �/ l i / P ermit No.. jea� iv +
- a 13125 SW Hall Blvd., Tigard. OR 97223 EEB 2 0 2008 Plan Review
Phone: 503.639.4171 Fax 503.598.196 Date /Bv. Other Permit:
TI GA RD Inspection Line: 503.639.4175 ARD Date Ready /By: 0 See Page 2 for
Internet: www.tigard- or.gov k OF T Notified /Method. TEEM Supplemental Information
TYPE' `OF
• F Ir`t ���
.. , • x �., � �: ;�::....: :: PLAN : REVIEVI .• `: w;:.:. '.:.
Please check all that apply (submit 2 sets of plans wiitems checked below):
❑ New construction ❑Addition /alteration /replacemt Addition/alteration/replacement
I/ q � ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: ,jt... � eite,e -Gtie b.- y , P where the available fault current ❑ Marinas and boatyards.
CATEGORY • OF .CON87 .. exceeds 10.000 amps at 150 5olts or ❑ Floating buildings
.. less to ground. or exceeds 14.001) ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling gC'ommercial /industrial ❑ Accessory building amps thrall other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Addition system. larger separately derived system
❑ Addition ul' new motor load of
Job no.: 7101 Job site address: /2. 06/5 S co Aka 211c/1 IoO or more. occupancy.
1 ✓L ❑ Six o or r more residential units. ❑ Recreational vehicle parks.
City /State /LIP: ' I II i G /y,l1A_ 0 I 9 r �- ❑ I lealth -care facilities. ❑ Supply voltage for more than
J tr t ❑ Hazardous locations. 600 volts nominal
Suite/bldg./apt. no.: Pro name: - _ -i ❑ Service or feeder 600 amps or more.
p Project � L. �E' � z° � �L.
_ .... .. FEE..SCHEDIJLE
C
' -YC' SS .�te' ':•
Cross street/directions to job site: � S L/L) ��L.. r l 1( � L Description l I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
I1'ty . Includes attached garage.
Subdivis n: Lot no.: 1.000 sq. R. or less 145.15 4
Ia. add'I 500 sq. ft. or portion 33.40 I
"fax map /parcel no.: Limited energy residential
DESCRIPTION OF WORK- : •• ....:::•:•• (with above sq. It.) 75.00 2
1 n Limited energy. multi - family 75.00
I/1 S -CC 1 ( .I 1 ILL li I YLGut i...) CL t ..S ( fit, - kei., residential (with above sq. ft. )
l � / / Services or feeders installation, alteration, and /or relocation
ja.14 - J 200 amps or less 80.30 2
°` 1 ROPLRTY':O %NER • ❑ TENANT .. :: 201 amps to 400 amps 106.85 2
Name: i ElP 0�i1 401 amps to 600 amps 160.60 2
I �� � 2 . ,
/ 601 amps to 1,000 amps 40.60
Address: D 1 ( ft/ /-I-' ci.s'1�.-C___ Over 1.(100 amps or volts 454.65 2 • City /State /LIP: jt 17GL l - yI � x ��d Temporary services or feeders installation, alteration, and /or
Lt S ) relocation
Phone: ( ) '1 0) (, 7(c; GI Fax: 05 - 7 C (g 200 amps or less 66.85 I
I �' --/1 6 201 amps to 400 amps 10(1.30 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 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. fee for branch circuits with
•'g :••• ❑:APPLICANT.: ❑ CONTACT PERSON: `::`:' above service or feeder fee,
:..: <.... 6.65
each branch circuit
Business name: E S e:i. {Q S C - ,. .., ei ) ,,,,,,,,,. ,,,,,,,,,. - ,._, B. Fee for branch circuits
I J� without service or feeder fee, 46.85 2
Contact name:
"nut k �.� first branch circuit
Address: (- I `l C) 7 5- P r I eJ (2._00,-.L Each add] branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /LIP: t. ;-..eu,..34:-,:eite �. - 7 7L1 L) D- Each manufactured or modular 90.911 2
dwelling, service and /or tceder
Phone: (9 - f I ) Lf9 Fax: : (5"L{l ) - tl& 13 Reconnect only 66.85 2
E -mail: - iL Iv`� Pump "'.Q�'l 7�>✓� �C ��ls 1�. � Q Pum or irrigation circle 5.14(1 2
CONTRACTOR , i't• Sign or outline lighting I 53.40 53M) 2
Business name: Signal circuit(s) (Sr limited-
S, s ( Vx `� WYU �� enemy panel, alteration, or
Address: $ C1 ei ' S Q cc , - i 7 ,�. e oo �' extension. Describe: Page 2 2
City /State /ZIP: -11 q. - Each additional inspection over allowable in any of the above
J t _ Per inspection 62.50
fl
Phone: ( 5 - L_ KS - J 5-Li (, Fax: ($q[) ( -1 . S - I.3 Investigation per hour) I hr min) 62.50
CCI3 Lie.: (1 fl 3(1 tHectrical I.ic.:gO.� (-(3CeS Suprv. I.ic. q . S Li Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Super. Electrician signature. raluirctl: o / / 7 �i �� ��l Subtotal: N 3. -0
Print name: 1 0 . f - C L S J L - Date: e. - / a , 0
Plan review (25 "/o of permit fee):
State surcharge (12% of permit fee): (P q I
Authorized signature: - f j _ G c/ I
Lt. cL, l ��;. TOTAL PERMIT h FEE: � It J
Print name: --r- r} This permit application expires if a permit is not obtained within 180
1 1 1't.c* Lti ,
�.�7� Date: ' V days after it has been accepted as complete.
* Number of inspections allowed per permit.
1.' \\ Building \ Permits \ELC- Perms.App doe 05123/06 440- 4615T1 I t'55;COM WEB
R EC. h_ ED
Community Development
TIGARD Request for Permit Action
MAR 2 5 ZUU8
t "'
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner 0 Applicant Et Contractor ❑ City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) 5 '4- n-• sip, 14 �
V 0 1 ® Mailing Address: a% 7 S Pra. e d
City/State/Zip: E..tjs—es >, U ,r C 1 7L -/DoZ.
/ /
Phone. No.: • 6 Giles 55L14v
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): •
II CANCEL PERMIT APPLICATION. .
REFUND PERMIT FEES (attach receipt, if.available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below). •
n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: E LC ao05- -
Site Address or Parcel #: (a_ U /--15. S w -1-k et-_ l j a ( ' d
Project Name: - 9 ' E I e.U-e_ I.1 .
Subdivision Name: 1 1 , n4.1 - c( }A- t W 0 — - -t c..-i 5 Lot #: U I D_
EXPLANATION: F i X-c_0( CL O-f VLa- � -• S '1l, -2 1 »i (.e s . •
n n rt. e .P t P Pa ce j o (fi(( aa, . N. d YI-n / ,-- e e . :
ca/7 r/a,1 '
Signature: s 46X (L• b Date: 3 -) // O .g
Print Name: (rt 6i w-e, (I
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
-
h) not more than /10% of the land use application fee when an application is withdrawn or canceled before any review efliirt has been expended.
c) not more •than Rtl% of the land use application fee for issued permits.
d) not more than MI % of the building plan review fee when an application is canceled bcliire any plan review effort has been expended.
e) not 'more than Rll '.■■ 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 1 -2 weeks liit processing refunds:
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date /a/ t91.--• By .'9
Refund Processed: Date j/y o By ,7 < ..Invoice Processed: Date By
Permit Canceled: Date 9 /y P- By r / :. - Parcel Tag Added: Date By
• Receipt #Q, 4,2 Date / e- Method ', Amount $ .
I:\ Building \l orms \RegPermitAction. oc' Rev 07/26/1)7
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 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: ES & A Sign and Awning Co. DATE: 4/14/08
89975 Prairie Rd.
Eugene, OR 97402 REQUESTED BY: Dianna Howse
Attn: Tina Wetzell
TRANSACTION INFORMATION:
Receipt #: 2008 -602 Case #: ELC2008 -00098
Date: 2/25/08 Address /Parcel: 12045 SW flail Blvd
Pay Method: Check Project Name: 7- Eleven
EXPLANATION: Per applicant's request as electrical work was not required (only repaired faces of sign).
Refund 80% of permit fees.
::: ..
.... ...........
. REFUND. I '
Fee-Descri tion;=From.:Recei t....::.:..; :.:::':; •::..::Revenue�Account:No:':'3• .. ;.$: Refunda:....<:,
:Exam T . .. , ..., ',
le ..._ L.II.D, Pernvt Fee
.....
[ELPRIVfI] ELC Permit 220- 0000 - 431510 $42.72
[FAX] 12% State Surcharge 100- 0000 - 207020 5.13
TOTAL REFUND: $47.85
APPROVALS:
if under $500 Professional Staff
If under $7,500 Division Manager j "` �'
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FO TIDEMARK SYSTEM.ADMINI T
_,.:... .. S._.: RATION :` ::; .:::: : �, : ?
v� Case Refund Processed: Date: ec B : LigraY
I:\ Building \Refunds \RefundRequest.doc 05/23/07
•
City of Tigard, Orergon • 13125 SW Hall Blvd. • Tigard, OR 97223
•
U1
TIGARD
April 21, 2008
ES & A Sign and Awning Co.
89975 Prairie Rd.
Eugene, OR 97402
Attn: Tina Wetzell
Re: Permit No. ELC2008 -00098
Dear Ms. Wetzell: •
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following;`
•
Site Address: 12045 SW Hall Blvd.
Project Name: 7- Eleven
Job No.: N/A
Refund: ® Check #57001 in the amount of $47.85.
❑ Credit card "return" receipt in. the amount of $ .
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as electrical work was not required (only repaired faces of
•
sign). Refund 80% of permit fees. •
If you have any questions please contact me at 503.718.2430.
Sincerely, •
rn
Dianna Howse
Building Division Services Coordinator
Enc.
•
•
I: \ Building\ Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07
P hone: 503:639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
yx s
s _ CITY OF TIGARD 3/25/2008 . .y
134 25.5w Ilan Blvd. I I :06:22AM
' . ; : Tigard, 012 97223 503.639.4171
;T;IGA!R'D;
Receipt #: 27200800000000000602
Date: 02/25/2008
Line Items:
Case No Tran Code Description • Revenue Account No Amount Paid
ELC2008 -00098 [ELPRMT] ELC Permit 220- 0000 - 431510 53.40 - '
ELC2008 -00098 [TAX] 12`%, State. Surcharge 100- 0000 - 207020 6.41
Line Item Total: $59.81
Payments:
Method Payer User ID Acct. /Check No.. Approval No. How Received Amount Paid
. Check ES & A SIGN AND AWNING CO. DEB 46760 By Mail 59.81 '
Payment Total: $59.81
•
•
cRrrripi.rpi Page I of I
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
n
T I GARD
April 21, 2008
ES & A Sign and Awning Co.
89975 Prairie Rd.
Eugene, OR 97402
Attn: Tina Wetzell
Re: Permit No. ELC2008 -00098
Dear Ms. Wetzell:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12045 SW Hall Blvd.
Project Name: 7- Eleven
Job No.: N/A
Refund: ® Check #57001 in the amount of $47.85.
❑ Credit card "return" receipt in the amount of $ .
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as electrical work was not required (only repaired faces of
sign). Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
I: \Building\ Refunds\ Administration \LtrRefund- CancelPermicdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov . TTY Relay: 503.684.2772