Permit n
TIGARD
City of Tigard
December 3, 2013
Johansen Electric Inc.
Attn: Charlynn Leifsen
10948 SE Valley View Terr
Happy Valley, OR 97086
Re: Permit No. ELC2013 -00543
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 6650 SW Redwood Ln #365
Project Name: Umpqua Bank
Job No.: N/A
Refund Method: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $83.57.
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit" receipt in the amount of $
Comment(s): Per applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
E ,r-
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
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Johansen Electric Inc DATE: 12/3/2013
Attn: Charlynn Leifsen
10948 SE Valley View Terr REQUESTED BY: Dianna Howse
Happy Valley, OR 97086
TRANSACTION INFORMATION:
Receipt #: 193070 Case #: ELC2013 -00543
Date: 9/12/2013 Address /Parcel: 6650 SW Redwood Ln #365
Pay Method: CreditCard Project Name: Umpqua Bank
EXPLANATION: Per applicant's request as job was cancelled. /2gA.l"4.J cF `fie "F, /V/r G ' 'rte
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Electrical Permit 220- 0000 -43103 $74.62
12% State Surcharge 100 - 0000 -24001 8.95
TOTAL REFUND: $83.57
APPROVALS: SIGNATURES /DATE:
If under $5,000 Professional Staff I
If under $12,500 Division Manager 00 ( 0∎- i-"\/
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE O I
Case Refund Processed: Date: 1 / /3//3 By: 1
I• \ Budding \Refunds \RefundRequest.doc x 09/01/2010
RECE/Iir
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT OCT 4 2013
7 .1 CITYOFT /C
Request Permit Action BUILDING / ARD
[I A R t, Rrn 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.go VI$ /ON
TO: CITY OF TIGARD V 0 1 D
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223 2/3 //,3 ' 4
Phone: 503.718.2430 Pax: 503.598.1900 www.tigard- or.gov
FROM: ❑ Owner 111 Applicant ® Contractor ❑ City Staff
(she k one)
REFUND OR Name: Johansen Electric Inc
INVOICE TO: (Business or Individual)
Mailing Address: 10948 S1- Valley View Terr
City /State /Gip: Happy Valley, OR 97086
Phone No.: 503 -698 -3417
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
►A CANCEL /VOID PERMIT APPLICATION.
.� , LS REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON 1'ERMTT (do not cancel permit).
Permit #: ELC2013 -00543
Site Address or Parcel #: 6650 SW Redwood Ln 365
Project Name: Umpqua Bank
Subdivision Name: Lot #:
EXPLANATION: job is not happening
Signature: Date: 10/14/13
Charlynn T,cifscn 3 . �� //, /?
Print Narnc: _
Rcfilnd Polt�w 2 4 / , 5
!�°� �-- P 5 $ _ d ?.
1 'I'hr Director or Building Official may authoruc the refund of Af r ( p f , a ,2 9 ' . , , �O ?�ji�✓
a) any fee which was erroneously paid or collected.
b) not more than 80° /, of the land use application fee when an application ei withdrawn or canceled before any review effort has been expended.
c) not more than 80 of the land use application fee for tweed perrruts.
d) not more than 80" 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 tiro building permit fee for issued permits poor to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment waa received Please allow 2 -4 weeks for processing refunds
1 :0 R OI 11(.:I. [sr, oNI.,1
Rtc to S Admin: Date B Rte to Bid, Admin: OAMIM,
Refund Processed: ®�cl : mq_ Invoice Processed: Ii '
Permit Canceled: EinzFrj,fiziffi s �� - Parcel Tit: Added: Date B
Method Amount $
I: \Budding \Forms \lcgpcunitAcdon.doc Kcv 05/25/2012
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11111- v CITY OF TIGARD ELECTRICAL PERMIT
13 COMMUNITY DEVELOPMENT Permit#: ELC2013-00543
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/12/2013
Parcel: 2S112DA01400
Jurisdiction: TIGARD
Site address: 6650 SW REDWOOD LN 365
Project: Umpqua Bank Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: (6)branch circuits for TI
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
10948 SE VALLEY VIEW TERR ATTN: N PIVEN
HAPPY VALLEY, OR 97086 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-698-3417 PHONE: 503-624-6300
FAX: 503-698-2486
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo/Purchase 09/12/2013 $93.28
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/12/2013 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 a . _ ,ith 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. A TION: Orego law r••uires you to follow the rules adopted by the Oregon Utility Notificati•• Center. Those rules are set forth in OAR
952-00 0010 through OAR 952 •% -009• u may obtain a copy of the rules or direct questions to OUNC b • .,•2_,03.,,s,,_1987 or 1.800.332. •,4.
II
Iss =d By: I / / Permittee Signatu _....;.-..-:06J •r Ar f6 T 4 —
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' _� I 9' ('c.."—.—__. Date:
_ iur
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.
` �EIVED
Electrical Permit AnolicaI I i Ft Iii 01•1:11.1. I:,l.t)\I.,
Received •
City of Tigard S 1 1 ?013 Date/13 : /� pdnnitNa.:�,��ao/3—ooSy,3
illh
• 13125 SW Hall Blvd.,Tigard,OR 97223 plan Review
therPermit ai,4 pao/3-ooa "7 g Phone: 503.639.4171 Fax; 5 8b 9vF TIGAUJ UateB :
i 1,,,II t Inspection Line: 503.639.4175k, Hale Ready/Ely: Jults• ® See Page 2 for
Internet: www•Ilgard-or•gav3UILDING DIVISION NMlfled/Method: Supplemental Information
.'-lirPt OF WORN: PLAN RFN8EW
[]New construction ®Addition/altetation/replacement Please check all that apply(submit a sets of plans whtents checked below):
❑Servitx or ceder 400 amps or more ❑Building over three storks.
❑Demolition ❑Other: when the available fault current ❑Marines and boatyards.
CATEGORY OR CONSTRUCTION neeerdv 1(1,000 amps at ISO volts or ❑Floating belldings.
less to ground,or exo od,14,000 ❑Commereiat•uxe agricultural
❑
I.and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings,
El Multi-family Q Master builder 0 Other: ❑Fire pump, 0 Installmion of 75 KVA or
: '
Emergency system. [urger sepura Inl derive d system.
` ',..•. JOB SITE INFORMATION•AND LOCATION ' `
QA44itloi ,i'ncw motor load of ❑"A- "E" "1.2" °1-3"
Job no.; Job site address: 6650 SW Redwood, 365 roansormrrs. Pccreattcy.
[�$ix or more residential units. ❑Rettcetiontd vehicle parks.
City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than
p�
In Hazardous locations. 400 volts nominal.
"Suite/bldg./apt.no.: 365 "Project name: Umpqua (eip J 1,, ❑service or lbcder 600 amps or more.
NBE SCREDV`LS`:
Cross street/directions to job site: tx,en uloe I OW. I rm. 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
—Tax map/parcel no.: Ea.add'I 500 sq.R.or portion 33.92 1
73 0 2
Limited energy,residential 0
1D
SSORIP1Tt)N Ot WQRK (with above sq.0.)
limited energy,multi-family 75.00 2
Tenant Improvement residential(with above sq,ft.)
—° Services or feeders Installation,alteration,and/or relocation
200 amps or less 100.70 2
. ❑ PitOPERTY.OWNER I'. ❑ TENANT. ' . ' • 201 amps m 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301,04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 t
201 amps to 400 rumps 125.08 2
Owner installation:This installation is being made on property that l own which is not _401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670.and 701.
Branch circuits—new,alteration,or extension,per panel
Owner signature: _ Date; A.Fee for branch circuits with
. •"` feeder lee.
' .'' ">®..APPLICANT I : ':Q tter'AC3$PBR9bN:` . above service or feed 7.42 2
each branch circuit
Business name: tohansen Electric B.Fee for branch circuits without
service or feeder fee,first
Contact name: Charlynn Leifsen branch circuit ` 56.18 2
Each add'I branch circuit �j 7.423-7.1.6 2
Address: 10948 SE Valley View Terr Miscellaneous(servlreor feeder not Included)
Psch manufactured or modular 67.84
City/State/ZIP: Happy Valley, OR 97086 dwellarlq,service and/or teeder
Phone:(503) 698-3417 [Fax;:(503) 698-2486 Reoortnectonly 67.84 2
E-mail: Sign or irrigation circle 67.84 - 2
Signor outline lighting 67.84 2_
• ' , - CONTRACTOR' Signal eireuit(s)or limited-energy
Busincssnnme: Johansen Electric panel,alteratlgn•orextension. 1'age2 2
Each additional Inspection over allowable In any of the above
Address: 10948 SE Valley View Terr Additional inspection(1 hr min) 66.25/hr
Investigation(I hr min) 66.25/hr
City/State/ZIP; Happy Valley, OR 97086 Industrial phut(l hr thin) 78.18/hr
Phone:(503) 698-3417 1 Fax: 5 0 3 698-2486 lrnpectians for which no fee is 90.00/lir
specifically listed('h hr min)
CCB Lie.: 51539 Electrical Licc.;3-243C/� � Suprv.Lic.: 20535_ ‘r . '.. .. .. . .:'ELECTRICAL'.PERMIT FEES• . ; ' '
Suprv.Electrician signature,required: a� 4 /� Subtotal: �7�,�$
t✓ Plan review(25%of_rermil fee):
Print name: Carl J hansen Date: 9/11/13 State surcharge(12%of permit fee): /A,/'J
TOTAL PERMIT PEE: /Q Z 97
Authorized signature. 'ibis permit application expires if a permit is not obtained within 180
Print name: Charlynn Leifsen Date: 9/11 13 tape Pion Ithasbeen permit.
as Complete.
/ • Number o f inspections ahgwed per pctmtlL
15,\Iii
I:Wiiiidln9V'nmita\kLC-rermirApp,dsc 07/01/10 44n_46107(l1/05/COWWEB
Z /T '3DVd 98VZ869EO9 98VZ869E05 ZD3rIa NaSNVHOf Wd 9V:V0 ETOZ'TT-deS
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
6650 SW REDWOOD LN 365, TIGARD, OR,
97224
Commercial - Electrical
199 Electrical final
2013-11-19 00:00:00
ELC2013-00543
PASS - No C of O
Violation Summary:
Inspector Contractor