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Permit
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED 11 -2- w Request Permit Action MAY 27 2C .. . -ffUAHL T I to.'�r. 13125 SW Hall Blvd. • Tigard, Oregon 97223 - 503.718.2439 • www.tigarci-bl=g ,i tn141141l) TO: CITY OF TIGARD VOID Building Division Services Supervisor 13125 SW Hall Blvd,Tigard,OR 97223 �V I/�2//4//21/1/ 4 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov � FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff (check one) REFUND OR Name: Safe Technology Group Inc INVOICE TO: (Business or Individua) Mailing Address: 6400 NE HWY 99 Suite G375 City/State/Zip: Vancouver,WA 98665 Phone No.: 360-699-2130 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ® CANCEL/VOID PERMIT APPLICATION. ® 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 PERMIT (do not cancel permit). Permit#: ELR2013-00245 Site Address or Parcel#: 9771 SW WASHINGTON SQUARE RD D08 Project Name: HARRY&DAVIDS Subdivision Name: Lot#: EXPLANATION: Customer did not know existin_ cables existed. Used existin• cablin:. No new cables were moved or installed. Signature: J3(A)O Date: 05/27/2014 JASON D SWEET A-row/ Print Name: l s= 25',re 4o , as �o 1, Thor or Building Official may authorize the refund of: 9.� 7��a) any fee which was erroneously paid or collected. L/ (,, 7. 0�0 /6 .f() b) not more than 80%of the land use application fee when an application is withdrawn or canceled be oxE any icy/effort las been expended. c) not more than 80%of tote land use application fee for issued permits. d) not more than R0%of the building plan review fee when an application is canceled before any plan review effort has been expended. e) 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 2-4 weeks for processing refunds. FOR OFFTCF. USE ONLY Rte to Sys Admin: Date Rte to Bldg Date ( j Byt4„L Refund Processed: Date 6 (? / Invoice Processed: Date _ By Permit Canceled: Date / - / B' I r• Parcel T.;Added: Date By Recei•t# Date Method Amount$ I:\Building\Forms\RegPeutritAcaon.doc Rev 05/25/2012 TIGARD City of Tigard June 19, 2014 Safe Technology Group Inc. Attn: Jeff Fallows 6400 NE Hwy 99, Suite G375 Vancouver,WA 98665 Re: Permit No. ELR2013-00245 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 9771 SW Washington Square Rd. Project Name: Harry&Davids Job No.: N/A Refund Method: ® Check#214066 in the amount of$67.20. ❑ Credit card"return" receipt in the amount of$ 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 customer is using existing cabling and permit is not required. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, z.,(- 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: Safe Technology Group Inc. DATE: 6/12/2014 Attn: Jeff Fallows 6400 NE Hwy 99, Suite G375 REQUESTED BY: Dianna Howse Vancouver,WA 98665 TRANSACTION INFORMATION: Receipt#: 193444 Case#: ELR2013-00245 Date: 10/10/2013 Address/Parcel: 9771 SW Washington Square Pay Method: Cash Project Name: Harry&Davids EXPLANATION: Per applicant's request as using existing cabling/permit not required;refund 80%of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Restricted Energy Permit 220-0000-43103 $60.00 12°/o State surcharge 100-0000-24001 7.20 TOTAL REFUND: $67.20 APPROVALS: SIGN U T S/DATE: If under$5,000 Professional Staff .7(1 '«/ If under$12,500 Division Manager 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: Date: 4;49//r By: ,..c y/ I:\Building\Refunds\RefundRequest.doc x 09/01/2010 v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 1111- a ° COMMUNITY DEVELOPMENT Permit#: ELR2013 00245 T E CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2013 Parcel: 151260000300 Jurisdiction: Tigard Site address: 9771 SW WASHINGTON SQUARE RD D08 Project: Harry&David Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S Project Description: Data telecommunications system. Contractor: SAFE TECHNOLOGY GROUP INC Owner: PPR WASHINGTON SQUARE LLC 6400 NE HWY 99 STE G375 PO BOX 847 VANCOUVER,WA 98665 CARLSBAD,CA 92018 PHONE: 360-699-2130 PHONE: FAX: 360-719-1527 FEES Description Date Amount Specifics: Restricted Energy Permit 10/10/2013 $75.00 12%State Surcharge-Electrical 10/10/2013 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio&Stereo: 0 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data&Telecommunications: 1 Fire Alarm: 0 HVAC: 0 Instrumentation: 0 Intercom/Paging: 0 Landscape/Irrigation: 0 Landscape Lighting: 0 Medical: 0 Nurse Calls: 0 Protective Signal: 0 Security Alarm: 0 Other: 0 Total $84.00 Other Desc: 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued B • - — Perm ittee Signature: 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. Electrical Permit Application FOR OFFICE USE ONLY Cl of Ti and ]� Received p `� g C� Date/By: I b/ (�/r3 1, jr- Permit No.: FLIP-?._1 3---00 IA 5— ,11111 ■ • 13125 SW Hall Blvd.,Tigard,OR Plan Review OYJ Phone: 503.718.2439 Fax: 503.5 8.1960 © rt�13 Other Permit: 661.0940(3`—VOA I T Date/By: T I G A R D Inspection Line: 503.639.4175 R(- 1 Date Ready/By: _tuns: El See Page 2 for Internet: www.tigard-or.gov Q f! ^^� Notified/Method: ,� - Supplemental Information TYPE OF W �®ail.- v PLAN REVIEW ®New construction ❑Addition/alte0Wcement Please check all that apply(submit 2 sets of plans w/hems 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 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. ❑Addition of new motor load of ❑"A","E","I-2","I-3", Job no.: Job site address:9771 Sw Washington Square Rd IOOHP or more. occupancy. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name:Harry&Davids ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qty. I Fee. I Total 1 • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 I Tax map/parcel no.: Limited energy,residential DESCRIPTION OF WORK (with above sq.ft.) 75.00 2 Limited energy,multi-family 47-2, 7�h /.�, 0,f s, ,.�.0 residential(with above sq.ft.) 75.00 2 l", Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation ❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation,alteration,and/or Phone:( ) Fax:( ) relocation 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125 08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits—new,alteration,or extension,per panel ® APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 2 Business name:SAFE TECHNOLOGY GROUP INC. each branch circuit B.Fee for branch circuits without Contact name:JASON SWEET service or feeder fee,first 56.18 2 branch circuit Address:6400 NE HWY 99 SUITE G375 Each add'I branch circuit 7.42 2 vl Miscellaneous(service or feeder not included) City/State/ZIP:VANCOUVER WA 98665 • Each manufactured or modular dwelling,service and/or feeder 67.84 2 r Phone:(360)699-2130 Fax: :(360)719-1527 Reconnect only 67.84 2 E-mail:SALES @SAFETECHNOLOGY.NET Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name:SAFE TECHNOLOGY GROUP INC. Signal circuit(s)or limited-energy See panel,alteration,or extension. I Page 2 75.00 2 Address:JASON SWEET Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr City/State/ZIP:VANCOUVER WA 98665 Investigation(1 hr min) 66.25/hr Phone:(360)699-2130 Fax:(360)719-1527 Industrial plant(1 hr min) 78.I 8/hr Inspections for which no fee is CCB Lic.: 173731 Electrical Lic.: CLE79 Su rv.Lic.: 4272LEA specifically listed(V2 hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: 47—e Subtotal: -75--`c}ai._ Print name: JASON SWEET Date: 10/09/2013 Plan review(25%of permit fee): . / State surcharge(12%of permit fee): ` 1.c.14 Authorized signature: TOTAL PERMIT FEE: `��LI•This permit application expires if a permit is not obtained within 180 Print name: JASON SWEET Date: 10/09/2013 days after it has been accepted as complete. ' Number of inspections allowed per permit. :UruildingTermitAELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(1 1/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined ... $75.00 Description I Qty. I_ Fee I Total I • Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 nBurglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 n Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with 552.26 2 ❑ Heating, Ventilation and Air Conditioning OAR918-309-0040) System* Solar generation systems in excess of 25 kva: Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 ❑ Each additional inspection over allowable in any of the above: Other: Each additional inspection is 66.25/hr 1 charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specifically listed(/2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system $75.00 Subtotal: (SEE OAR 918-309-0000) Plan review,if required(25%of permit fee): State surcharge(12%of permit fee): Check Type of Work Involved: TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted as complete. • Number of inspections allowed per permit. ❑ Boiler Controls n Clock Systems ® Data Telecommunication Installation n Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\BuildingWermits ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013