Permit •
ea
Community Development
kl
Request for Permit Action eV
TIGARD 1. 1 (, ���
TO: CITY OF TIGARD 0'0 m
Building Division Services Coordinator 90
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor JT City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) H }z.s �J r� L� er►'Z t
• Mailing Address: 105 t-( `L w r 2 2.
City /State /Zip: C,L 1 HA Oe- � 8(p
Phone No.: 503 _ t! pc{ S - 34 7
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
• a w ' RMIT APPLICATION.
REFUND PE IT FEES (attach receipt, if available).
• FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: O}O 7 - CO 52'
Site Address or Parcel #: ( 5350 6 (szLtat ✓fi P( (90-CD
Project Name: �o�PEC. A
Subdivision Name: 0/4 Lot #: 11/4)l4--
EXPLANATION: E-,) c.t e 5e _e114 � % tit le)44 o ( 3 )
Cr 2Cu.' -5 dt3Ly..
•
Signature: Date: g f JJ t 10$'
Print Name: A- F -ESN
Refund Policy
I. The Director or Building Official may authorise the refund of:
a) any fee which was erroneously paid or collected.
b) not more than R0% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80'; o of the building plan review fee when an application is canceled before any plan review effort has been expended.
c) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2•weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S Admin: Date firm/nom Rte to Bld• Admin: Date flgre, B
Refund Processed: Date y/y pp By 1 Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt #87-1503 Date :176.9
/p 7 Method CG Amount$ 0230 \Building \Forms \Regl emus ction. c Itcv 07 /26/07 •••••—
•
City of Tigard, Oregon • 13125 SW Rail Blvd. • Tigard, OR 97223
VV1/417 $111:
TIOAC 419
April 14, 2008
Johansen Electric Inc.
10948 SE Valley View Terr
Clackamas, OR 97086
Re: Permit No. ELC2007 -00525
Dear Sir /Ms.:
The City of Tigard has processed a refund for fees on the above referenced permit(s) for the
following:
Site Address: 15350 SW Sequoia Pkwy #220
•
Project Name: Spec Space
Job No.: N/A
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $130.40.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Reduced scope of work resulted in a refund of 80% of the difference in permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
4 4540. - " / Ire/J-e
Dianna Howse
Building Division Services Coordinator
•
Enc.
•
I:\ Building\ Refunds\ Administration \LtrRefund - RefundOnly.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
r
• III City of Tigard
T I G A R D Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request fir 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: Johansen Electric Inc. DATE: 4/14/08
10948 SE Valley View Terr
Clackamas, OR 97086 REQUESTED BY: Dianna Howse
DEB
TRANSACTION INFORMATION:
Receipt #: 2007 -3503 Case #: ELC2007 -00525
Date: 7/30/07 Address /Parcel: 15350 SW Sequoia Pkwy #220
Pay Method: CreditCard Project Name: Spec Space
EXPLANATION: Reduced scope of work; refund 80% of difference ($153.15 & $9.84).
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 $ 122.52
[TAX] 8% State Surcharge 100- 0000 - 207020 7.88
TOTAL REFUND: $130.40
APPROVALS:
If under $500 Professional Staff
•
If under $7,500 Division Manager — C
If under $22,500 Department Manager • i
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR. TIDEMARK. SYSTEM ADMINISTRATION USE ONLY . •
r! Case Refund Processed: I Date: I /yA I By: I R
I: \Building \Refunds \RefundRequest.doc 05/23/07
CITY OF TIGARD 4/14/2008 '
17
1312; SW Hall Blvd. 12:17:05PM
Tigard, OR 97223 503.639.4 171
TIGARD
Refund Receipt #: 27200800000000001216 !2 £ V .S c -
Date: 04/14/2008
Line Items:
Case No Trail Code Description Revenue Account No Amount Paid
ELC2007 -00525 Reversal - [ELPRMT] ELC Permit 220-0000-431510 (122.52)
ELC2007 -00525 Reversal - [TAX] 8% State Sure 100- 0000 - 207020 (7.88)
Line Item Total: ($130.40)
Refund:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal JOHANSEN ELECTRIC INC 461326 Fax (130.40)
Refund Total: ($130.40)
CA
c o 0 v
.a v . W .„ _ a
p4 w
V Cl
PM C4 a 0 .4 l
v. „- / 0 a o o a
r_.- q x • C y G.8 k
C . \
Cl) a o 6v W - V p W h
• i - x 4 e1 m a N 'D 5
ea +' C 4J a 4 v a. Q .p" U V. w b
Q • a rn p "" y
v I—,C)ac4 V O
a. w
N \ i
C IZ e CC ipt.rp, Page I a I
#.; ` 3/24/2008 . CITY OF TIGARD
�` .
131_; SW F lail Blvd. 8:12:27AM
Tigard. OR 97223 503.639.4171
TIGA
Receipt #: 27200700000000003503 04/6 --
Date: 07/30/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
ELC2007-00525 [ELPRMT] ELC Permit 220- 0000 - 431510 213.30
ELC2007 -00525 [TAX] 8% State Surcharge 100- 0000 - 207020 17.06 -
Line Item Total: $230.36
Payments:
Method Payer User ID Acct. /Check No. Approval No. Flow Received Amount Paid
CreditCard JOHANSEN ELECTRIC INC SLN 461326 Fax 230.36 .
, P \0)./ Total: $230.36
h
41 i- k6 �j. ..
p k �.
`/ V 4 1 vio
C P h9k
z7
.6 f 3c) L a ®. 5 1 a 6
/Pi..
cR,c,i Page I ul'
�/a t/d r f .,1rV1o4 Perm;-t- 3 ( c.;ccAA,t3 c M Y
CITY OF TIGARD ELECTRICAL PERMIT
4 COMMUNITY DEVELOPMENT
PERMIT : ELC2007-00525
DATE ISSUED: 7/30/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112DA-01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 220 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT : 002 JURISDICTION: TIG
PROJECT: SPEC SPACE
Project Description: TI - install (20) branch circuits with service. 3/21/08 revised scope of work to (3) branch circuits only.
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: 0 W /SERVICE OR FEEDER: 0 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 2 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:
PACIFIC REALTY ASSOCIATES JOHANSEN ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 10948 SE VALLEY VIEW TERR
PORTLAND, OR 97224 HAPPY VALLEY, OR 97086
Phone: Contact #: PRI 503 - 698 -3417
FAX 503 - 698 -2486
FEES
Description Date Amount Reg #: ELE 3 -243C
(ELPRMT] ELC Permit 7/30/2007 $213.30 LIC 51539
'TAX] 8% State Surcharge 7/30/2007 $17.06 SUP 2053S
Total $230.36 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 1.800.332.2344.
Issued By: Permittee Signature: (Fcr cJ.--..:,44. —.01/
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.
CITY OF TIGARD. ELECTRICAL PERMIT
° PERMIT #: E LC2007 MIT
COMMUNITY DEVELOPMENT DATE ISSUE 7 /30/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112DA-01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 220 ZONING: I - P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT : 002 JURISDICTION: TIG
PROJECT: SPEC SPACE
Project Description: TI - install (20) branch circuits with service.
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: 1 W /SERVICE OR FEEDER: 20 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:
PACIFIC REALTY ASSOCIATES JOHANSEN ELECTRIC INC
15350 SW SEQUOIA PKWY #300 -WMI 10948 SE VALLEY VIEW TERR
PORTLAND, OR 97224 CLACKAMAS, OR 97015 -000
Phone: Contact #: PRI 503 - 698 -3417
FAX 503- 698 -2486
FEES
Description Date Amount Reg #: ELE 3 -243C
[ELPRMT] ELC Permit 7/30/2007 $213.30 LIC 51539
[TAX] 8% State Surcharge 7/30/2007 $17.06 SUP 20535
Total $230.36 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 1.800.332.2344.
Issued B ,A__1. Permittee Signature: _ / ' hi ' i. I Jll
= y �/ �// /
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 Aflfl ication . • :1 .
City of Tigard 9 JUL 2 6 2007 nom° 7 7 07 t 0 tilt 0 101-0P525 -
13125 SW Hall Blvd., Tigard, OR 9 Plan Phone: 503.639.4171 Fax 503.598 ` - - ` ='D i p&g Other Permf:
Inspection Line: 503.639.4175 be 4175 S[Yo 12,', - ' • �
tr llic�l ®It !'+ Qamltee�rlay nisi. ■ Bee l'eial 64 hum= www.ei.tigaedar.ns tiatilkatmcdlcd:
_ SupplesnoeagllafbrmeBew
❑ New construction ® Addition/alteration/replacement phase credo all that apply:
❑ Demolition 0 Clther: over 225 amps, aomml ❑Hazardous location
Selvloe ova 320 amps – cadn8 ❑Buildng over 10,000 . R,
of 1- and 2 -fWoly dwellings 4 or more new residential
I. and 2 -family dwelling ® Commercial/industrial ❑ Accessory building 0System over 600 volts nominal units In one mumue
❑ Maio- family 0 Master builder ❑ Other: DRuitdlag over three storks DF *a. 400 amps or mono
['Occupant load over 99 persons ❑MMellate aced Mtwara of RV put
Job no.: Job site address: 15359 SW Sequoia Pkwy O facility Daher:
❑other:
Submit j, seta of plans with my of the abore.
City/State/ZIP: 7be above me not applicable to temporary construction service.
Suite/bldg./apt. ao.: a Project name: o • L 121 1 C.Q
Cross street/directions to job site: New residential single- m ha s � ••
stagla dtldamlly dwelling suit.
Includes attached gene.
1,000 sq. ti. or less 145.15 4
Subdivision: Lot no.: Pm edd'I 500 sq. t;. or portion 33.40 1
Tax map✓paacel no.: Limited energy, residential 75.00 2
Limited energy, ncmrtsideatial 75.00 2
Each manuhctured or modular
Tenant Improvement
dwelling, service o<t 2
Servleaar fades installation, alteration, and/or relocation
200 amps or less 1 so30 80.3 2
:. l amps to 400 amps
106.85 2
401 amps to 600 amps 160.60 2
Names 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZlP: Temporary services or fbedes isutallad a, attcrattoa, and/or
Phone: ( ) Fax: ( ) relocation
Owner installation: This installation is being made on property that I own which is not 2 00 amps to test 00_30 t
201 amps to 400 amps 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 to 600 amps 133.73 2
Owner signature: _ Date: Branch circuits– new, alteration, or eateesloa, per panel
A. Fa for branch circuits with
service or feeder tbe, each
Business name: Johansen Electric Inc. branch circuit 20 6.65 133 2
Contact name: C6arl�e Il�lfaea B. Fee fin branch circuits
without service or feeder the, 46.83 2
Address: 10948 SE Valley View Terr. each branch circuit
Each add'l breach circuit 6.65 2
City/State/ZIP: Clackamas, OR 97015 Mbedta Doss (service or feeder not included)
Phone: (503) 69417 Fax: : (503) 698-2486 Pump or irrigation cede . 53 -40 2
Signor outline lighdag 53.40 2
E- mail: ohanaeneltctemaa.com Signal circuit(s) or limited-
. .. . - ........ . .' ., am pemd, attaatlon, or
Business name: Johansen Electric Inc. X10°' Describe Pap 2 2
Address: 10948 SE Valley View Terr. Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: Clackamas, OR 97015 invesdgadon per hour (I tr mm) 62.50 _
Phone (503) 698-3417 Fax: ( 503) 698 -2486 Industrial Inn hour 73.73
CCB Lie.: 51539 - •
dir /If ;�.- - r . Subtotal 213.30
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print mime: / state aurhmge (8%6 of permit fie). 17.06
,/ J i �` / r Date: 7/25/07 TOTAL rERneT FPS 230.36
Authorized signature ` ,. , /�� 113 permit application empires W e permit but obtained within IgG
/ days altar It bas been accepted as aeyhte •
Print name: / ' FA' D ate : 7/25/07 • Fee methodology set by 71ri -C.om y Bulking Wooly service Hoard
•• Number of ioipemonn per permit allowed
1:1Bid 1203 410.4dLiT(10002/CaMIW®
I . e4 xki3 13C213S1:11 dH WdEE : 2I LOOZ 92 1 nC
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007- 00525
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/30/2007
Phone: (503) 639 -4171 1 I
Inspection Requests (24 Hrs.): (503) 639 -4175 . I �..
INSPECTION WORKSHEET FOR DATE: 3/24/2008 TIME: 7:00AM PAGE: 23
SITE ADDRESS: 15350 SW SEQUOIA PKWY 220 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: SPEC SPACE
DESCRIPTION: TI - install (20) branch circuits with service. 3/21/08 revised scope of work to (3) branch circuits only.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: JOHANSEN ELECTRIC INC PHONE #: 503
Inspection Request Scheduled For: Date: 3/24/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 EIectiical final 067206-0 503.704 -1534 N
Corrections /Comments/ Instructions:
dV
RAI Orr Pow e^:CZ-- ?EN &u , p p ;; cj- 3 •
Az-ki bRAb P1/4 61(5r, (4
•
%,.eASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �' Nvv� Date: 31* 6 Phone #: (503) 718 - Pi%