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Permit TIGARD City of Tigard December 3, 2013 Bear Electric Attn: Vanessa Diosdado PO Box 389 Donald, OR 97020 Re: Permit No. ELC2013 -00569 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 7800 SW Durham Rd. #600 Project Name: Sirennet Job No.: N/A Refund Method: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $56.98. 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, 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 rp 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: Bear Electric DATE: 12/3/2013 Attn: Vanessa Diosdado PO Box 389 REQUESTED BY: Dianna Howse Donald, OR 97020 TRANSACTION INFORMATION: Receipt #: 193213 ' Case #: ' ELC2013 -00569 Date: 9/25/2013 Address /Parcel: 7800 SW Durham Rd #600 Pay Method: CreditCard • Project Name: Sirennet EXPLANATION: Per applicant's request as job was cancelled. RCA: ti't3 8V ale e "674/ /7" • REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Electrical Permit 220- 0000 -43103 $50.88 12% State Surcharge 100 - 0000 -24001 6.10 TOTAL REFUND: $56.98 APPROVALS: SIGNATURES /DATE: If under $5,000 Professional Staff If under $12,500 Division Manager $J4 taLL,„,& 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 ONLY ,�� Case Refund Processed: I Date: I /y...3 /j3 I By: j... T I: \Building \Refunds \RefundRequest.doc x 09/01/2010 SEP- 30- 2013(MON) 07:54 Bear Electric (FRX)5036781108 P. 001 /002 Ce/ 1 41 Community Development V 0 1 � Request for Permit Action ledt 1 .1. - .Ar TI GARD TO: CITY OF TIGARD SEP 3 0 2013 Building Division Services Supervisor 13125 SW Hall Blvd., Tigard, (DR 97223 CITY OFTIGARD Phone: 503.7182430 Fax: 503.598.1960 www.tigard- or.gov BUILDING DIVISION FROM ❑ Owner c1 pplicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE, TO. (Business or Individual) ' Beare l C, . Mailing Address: ' ,. City /State /Zip: ck , o. 9c:N Phone No.: f' • Lo T S • l PLEASE TAKE ACTION FOR THE ITEMS) CHECKED ( C CANCEL PERMIT APPLICATION. . REFUND PERM' 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 #: 6. -C2.0 13 — O C5 ("9 Site Address or Parcel #: — 1 Sob SW Dvr hey m gcl L.Q.c:10 Project Name 51 1 f . Subdivision Name: �. `�, V.7( fer..Q. ' Lot #: D • EXPLANATION: C�> mec -- Q S e l l Q ~ 1 cc a • Signature: i Date: C 91 D) i - Print Name: Van Pts S& t) l l7 Y� QCl D t 63. (0 2 6.3 := - 6 , / o 12 S6 •9,'4 -, $rfimd Pnliry .---------- 1. The Director or Building Official may authorize thc refund of /c '. 7° 7, 3 - / Y. a S 2 a) any fee which was nxoncously paid or collected. b) not more than IW% of the land we application fre 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 permitot d) not more than 80% of the building plan review fee when an application is canceled before nay plan review effort has been expended. c) not more than 80% of the building permit fee for issued permits poor to any inspection requests. 2. Refunds will be returned to thc original Payer in thc tame method in which payment was received Please allow 1 - weeks for processing refunds. FOR OFFICE USE ONLY Rte to S.: Admire: Date RINIIMETFi Rte to Bid: Admin: Date / Refund Processed: Date AXI� �-21111 Invoice Processed: Date B • Permit Canceled: Date /,2 ' /3 By t- Parcel TngAdded: Date By Receipt tt Date Method Amount $ 1 :\Building\I ocma \RegPermitAetion.dru Rev 02/23/2011 SEP- 30- 2013(MON) 07:55 Bear Electric (FRX)5036781108 P 002/002 Fr CITY OF TIGARD ELECTRICAL PE COMMUNITY DEVELOPMENT Permit 1: ELC2013 -00569 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Data Issued: 09/25/2013 Parcel: 251136A00200 Jurisdiction: Tigard Site address: 7800 SW DURHAM RD G00 • Project: Sirennet ubdivision: ROSEWOOD ACRE TRACTS Lot: D Project Description: (2) branch circuits for mini - split and service outlet Contractor. BEAR ELECTRIC Owner. METZGER VENTURES. LLC PO BOX 389 , P0. 90X 400 ' DONALD. OR 97020 •SHERWOOD. OR 97140 PHONE. 503 -678 -1355 PHONE: . FAX: 503. 678 -1108 . . . • , FEES . • . . •Ouant)ty , .Description,. ' ., .. Date Amount ' . 2 crt Branch Circuits wolPurchase 0912512013 563.80 - Specliics:, Service ar Feeder, 1 ea 12% State Surcharge - 09/2512013 57.63 TYPe of Uso: COM Elet.tncal Class of Work: ALT ' ' . Type of Const: . Occupancy Cr: p ' ' Total '. -571.23 ' Required Items and Reports (CondltionS) This permit is issued subject io the regulolions contained In the Tigard Municipal lode. State of OR. Specialty Codes and on other applicable law. All work well be dcne in accordance with approved pions. This permit will expire if work is not started authln 180 days- of issuance, cr It work is =permed tor. mare Ina 180 ,days ATTENTION.-Oregon taw requires you to .follow the rules adcptod by the Oregon Utility Notification Center. Those rules are set kWh in OAR 952.D01.0010 rough OAR 9'2.0 000 You may obtain o copy ,, of thiamin ar direct questiorsto OUNC by alai 5��12,17..1957 or 1 800.3 ,. lsaued B ' 1 -- �"^��� ` �-- j `. Pormittotr'Signeture q A ( .! ~l-0 OWNER INSTALLATION ONLY ' . The instalianon is being made on property I own which is not intendod.fcr saw, lease or rant.- • • 'OWNER'S SIGNATURE Date: CONTRA•CTOR'INSTALLATION ONLY ' SIGNATURE OF SUPR. ELEC bate: LICENSE NO. ' - , - Call Se3.W9E4175'by 7:0p,a:m. far ,tho'noxtevailabtpanttpoetkin date: - Th1s p a mit card shstl be kept In-a conspicuous piece on thirloe slto'unul eompietlon:ot the protest. Approved plops ore required on the Job stuff 3t the ern/ of o56tr tiispnctdon. CITY OF TIGARD ELECTRICAL PERMIT 111111- COMMUNITY DEVELOPMENT Permit#: ELC2013 00569 • TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/25/2013 Parcel: 2S 113BA00200 Jurisdiction: Tigard Site address: 7800 SW DURHAM RD 600 Project: Sirennet Subdivision: ROSEWOOD ACRE TRACTS Lot: D Project Description: (2)branch circuits for mini-split and service outlet Contractor: BEAR ELECTRIC Owner: METZGER VENTURES, LLC PO BOX 389 PO BOX 400 DONALD, OR 97020 SHERWOOD, OR 97140 PHONE: 503-678-1355 PHONE: FAX: 503-678-1108 FEES Quantity Description Date Amount 2 crt Branch Circuits wo/Purchase 09/25/2013 $63.60 Specifics: Service or Feeder 1 ea 12%State Surcharge- 09/25/2013 $7.63 Type of Use: COM Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $71.23 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 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 the 180 days. ATTENTIO,: -•on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 rough OAR•.2-0. -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5a 2a7.1987.1987 or 1.800.332,234, Issued B r �� Permittee Signature. r / ( \ 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' Date: 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. SEP-20-2013(FRI) 06: 21 •- r' (FRX)5036781108a a P. 001/002 City of Tigard ltrerrAe.l �• 3 S . 1;1?•'sl111311111+.1. 11c:u.l 'll(�rt . I1,rIt. — -----._... Jtt I'I.nl R,.,.... I'11..n; 1)l 111 2l:b I:r� l' 'r I'�.i3 2013 I idle.I'o-!Pill if, El SerIbge7for - till.. 1101 ..nn Il'at(l-,lt edl \,n,1)•.1 shIIn..! > ti�yC��ITV°r i//GARD _ �� .� ^�--T SuDOlrmrnrolInformrtion -- ' 'LYIUt Jt�1 •----- I PLAN REVIEW 0 New �nnst uct ion ,. AJtlitutn.':111 cr;iI inn/ft:plal'CI ant I'bane ihiiA all dal app !suborn 2 x1s n1 pluis u nom ell i lCd lido.I 1 k1),...v wedC,.11)11 amps,v nu+re 1 ❑. { []Ilnrhlu,gn•:Idun•.nnre. 1 ❑ 1)illlllllllr111 ❑Other: ...-- ,.here the a.a,hble rani!a mnl u• ❑Manua.amt',Am hl. . CATEC a RY OF CONSTRUCTION .%cced.10.11181 amp+.of 1511 soil.ill ❑Fhmiim:hml,lml:. • -- _ IC's.U.aims pt.M e.+ededs I•l,inin ❑Lou,,,eri ia6,,.e agnenhinn1 11.12.3.......1 -.au • :.;, nmircialhndus!nal D ALCes■,1r■ I1111111in!? ,mylc l,1)AllMho muallm,a1. buildings ❑ MIIIii-1111111 l)' ❑Master builder ❑Other: ❑Ill•lu'itlp O ln.lallau,w 1)l 7,A VA Ca i C Lnlelgeky.sum hum ai taral.I+de •cd xrxlem JOB SiTE INFORMATION AND LOCATION /�f� \11\,) V-1^/1 ��/� ❑Adddum of no.uunur Imo ul ❑..A.."I.."I•',"I•?" ,Inh no.: Jul site addrei. 5t) / ,\ , ! 1I' �1Y 1 11)0111'm runic. OCCupancs t�•� �! I t(,J�. 1 1 �J� ❑Sec lu mitre lelyderalal mils. 0 RrclealPmnl+chicle pall. C 11\•/SLNC/!.I I': T 1 C CL , U p Cli e ❑1IC1rhh•earc faelliucs ©Supple•ollapc Im nuvr Man t�.r C7 ❑iiiimdnus kw.,Wt,. tom vow.nano: S11ile/1%10;tpl. nu.:*Q00 Project name:: 119.,..ENN i � ❑Service AI ICedCItdlnar1111A 1)r mow — ..– FEE SCHEDULE (Toss street/directions to jtlh site, _b.. 1proo _J. r. I Fee. J ToW J New residential single-or multi-family dwelling unit. includes attached garage. i Suit{1vISIOn: Lot nu,, I,OUO sq h.or Iess 168 54 I " • — " — Ea.add'1 500 sq ft,al pnrunn 33.92 I Tae map/pafccl Ito.: • limped energy,residential 75 D0 7 DESCRIPTION OF WORK ,with above sq,fl) _ M1 ` Limited energy.multi-family 75,170 2 ' (�rJ L't •_ 4 00 `1 r ) 1 (�[S , , O - residential(with above sq ft 1 Services or feeders installation,alteration,sod/or relocation _ 700 amps or less 10010 2 Q PROPERTY OWNER l © TENANT 201 amps to 400 amps 133.56 - 2 Name: — 401 snips 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: . 1 Temporary services or feeders installation,alteration,and/or _ relocation PllOnc:( ) Fax:( ) 200 amps or less 59.36 1 201 amps to 400 amps 1 25.08 2 Owner installation:This installation is being mode on properly!hat 1 own which is not --� intended for talc. lease,rent,or exchange,according to ORS 447.449.670,and 701. 401 amps 10 599 amps 168.54 2 Branch circuits-new,alteration,or extension,per panel Owner signature: . Date: A.Fee for branch circuits with ❑ APPLICANT 0 CONTACT PERSON above service or feeder fee, 7.42 2 — each branch circuit Business name: I `• . 'lu • , n - B.Fee for branch circuits wirhow i 'na- Il Id t� service or feeder fee,first LY Contact name! �►� SSA, ► • _ BEAR ELECTRIC. INC branch circuit 56.18 2 pU BOx Sag"-- finch add'/branch circuit I 7,42 L2:_.--1 ",.._.- 2 Address: 20988 BUTTEVIU.E RD NE Mlteellaneous(service or feeder not included) City/Stale/ZiP: —� 990E9 Each manufactured or modular 67.84 2 - dwelling,service and/or feeder Phone:( ) l:ax::( ' ')' Reconnect only _ 67.84 2 ' - Pump or irrigation circle 67.84 2 E-moil:i�P f I` 4 0. Sign Or uldline lighting 67.84 2 j"° CONTRACTOR -- signal circuil(s)or limited-energy Business name: r r 815 l l r 1 C 1 trio.. . panel,alteration,on extension. Pope 2 2 `► 1 lt- Each addilioaal inapcction over allowable in any or the above , ,UAddress; y t f Additional inspection(I hr min) 66.251 ht CitylStuicJZIP: 1d , 01-Z �i(��Cl • Investigation(f hr min) 66.25/hr — '^�� ax:(�-,,� Industrial plant(t In ruin) 7R,10/It. Phone:( UG Fans y 0 62-115-t iI f�(Q' Inspections far which no fee is 90.00f 111 — �� V L] specifically Baled CA hr min) _ CC13.Lic.:�())q Electrical Lic._494--!D Suprv.LicX J/it.2_5 EIICt`RICAL PF,Ri►AIT,.FEES d Suprv. Electrician signature,rcyuircd:)(� c,` �T..,...c Subtotal: I Plan review(25% permit fee•. - Printname:,) G.A/ r� Date:9 11 _ State surcharge(12"/of permit fee): 111 TOTAL PERMIT FEE: 1 2 • Authorized signttt me:'2 This permit application expires if a permit Is not obtained witbin 180 _ (/ry ,il/3�+ T /)12 ,11 days atter it hna been accepted as complain. Print name: V(�,! �GJI Du1e: `�i ,(� • N.imber of inspections avowed per permit. 1:1Duild.nOPEIM L .l.C-p.,rmilApp.doc 07101/10 444-41,15711 1/0S,COMnvi l4 •