Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEN
•
111 II Request Permit Action ctlon CtIVk
; l n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.ti ard-or.goC.d
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TO: CITY OF TIGARD Lf1'rU /2014
Building Division Services Supervisor D
13125 SW Hall Blvd.,Tigard,OR 97223 Ull JNGDlC`�RD
Phone: 503.718.2430 Fax 503.598.1960 www.tigard-or.gov
"SION
FROM: ❑ Owner ❑ Applicant Contractor ❑ City Staff
(check one)
REFUND OR Name: n We— 1
INVOICE TO: (Business or Individual) /�V VOW L �` -Ck
Mailing Address: '�O 3 0
City/State/Zip: TU a\U,\.v\ d 6. a\ - 0 co-
Phone No.: SO - 6 a - 1 5 6 5
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ 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#: (.70 1 a \
Site Address or Parcel#: Q V A y S j \V S 1.x n ,c
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Project Name: S o r0. -L
Subdivision Name: Lot#:
EXPLANATION: r10 law v 0\\--eyi r_ i h 5 a..s d•, w,\r-c`-e s S - n vA
Lvc?�5 VSe c�
eMveru.. io NA be✓MEZ. - hySioEZ,77o• 7 60•v6E- 7/ef
Signature: / Date:
Print Name: FoL lr A-ls.--
Refund Policy
1. The Community Development Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected
b) not more than 84W,of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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'V,of the land use application fee for issued permits.
d) not more than 84P/e 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 pea,ohs prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check. Please allow 3-4 weeks for processing refund requests.
FUR OFFICE USE ONLY
Rte to S s Admin: Date `]ILla[iff1idi Rte to Bid: Admin: Date 24 B 4 i
Refund Processed: Date 7 B r;t Invoice Processed: Date B
Permit Canceled: Date By s1'� Parcel"lag Added: Date By
Receipt# Date Method Amount$
1:\Building\Forms\Rcq PcrmitAction_062614.doc
y9 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
l'IP1111 Ir COMMUNITY DEVELOPMENT Permit#: ELR2014-00128
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/04/2014
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10144 SW WASHINGTON SQUARE RD B-2
Project: Scottrade Subdivision: OAKBURG Lot: 9
Project Description: HVAC system.
Contractor: ARROW MECHANICAL Owner: PPR SQUARE TOO LLC
10330 SW TUALATIN RD 401 S.WILSHIRE BLVD.
TUALATIN,OR 97062 SANTA MONICA, CA 90401
PHONE: 503-692-1565 PHONE: 310-899-6437
FAX: 503-691-1879
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/04/2014 $75.00
12%State Surcharge-Electrical 06/04/2014 $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: 0 Fire Alarm: 0
HVAC: 1 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 - . .... . b y the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a •• of the rules or dire. questions to OUNC by calling 503.232.1987 or 1 800.332.2344.
•
Issued - = - Permittee Signat• _ ,,0I11/11. —
f
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 ONI.I
City of Tigard Received ' Permit No.:
DateBy: f //y v i ti tc:t-t?
•III Z 13125 SW Hall Blvd.,Tigard,OR 97223,. Plan Review /_
Phone: 503.718.2439 Fax: 503.598.1SI,(� DateBey: Other Permit. aGt tp —Q`T. ('�
TI GA K D Inspection line: 503.639.4175 ' "� 1e, Date Ready/By: Atria td See Page 2 for
Internet: www.tigard-or.gov `� �O Notified/Method: �, Supplemental Information
TYPE OF WORK •, 1?■01:,,,a, PLAN REVIEW
❑New construction 0-Addition/alteration/replacement !SW)! Please check all that apply(submit 2 sets of plans wftems checked below).
❑Demolition Other: ❑Service or feeder 400 amps or more ❑Building over three stories
❑ ti where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTR ION 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 El Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 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: / / ,n ) !->'' IOOHP or more. occupancy.
/0 /t/ a,) C c./i-S I-) vlL • ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP"' ; ci rt�? c.72. e 2 3 ❑Healthcare facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:C Tr fi a C ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 1 e_ `1 5 Description I Qty. I Fee. I Total 1 •
L� 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'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
75.00 2
( i) f �.! ' T I 1k --_,72..A-I c 57-Y0- residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 I
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
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
APPLICANT above service or feeder fee,
® I ® CONTACT PERSON each branch circuit 7.42 2
Business name:Arrow Mechanical B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name:/L�f, -- , 7zt✓L+./d branch circuit
�L ` Each add'I branch circuit 7.42 2
Address: 10330 SW Tualatin Rd Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP:Tualatin OR 97062 dwelling,service and/or feeder 67.84 2
Phone:(503)692-1565 I Fax: :(503)691-1879 Reconnect only 67.84 2
_ Pump or irrigation circle 67.84 2
E-mail:' %'��y,� L-I <,,f - -Ac-t `-12 61 it 1 Sign or outline lighting 67.84 2
CONTRACTOR
Signal circuit(s)or limited-energy �'^
Business name:Arrow Mechanical panel,alteration,or extension. / Page 2 7, 2
Each additional inspection over allowable in any of the above
Address: 10330 SW Tualatin Rd Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
City/State/ZIP:Tualatin OR 97062
Industrial plant(I hr min) 78.18/hr
Phone:(503)692-1565 Fax:(503)691-1879 Inspections for which no fee is 90.00/hr
specifically listed(%I hr min)
CCB Lic.: 5193 Electrical Lie.: 34-47CLE Suprv.Lic.: 4647LEB ELECTRICAL PERMIT FEE S
a Subtotal: 7.-
-
Supt.Electrician signature,required: AV Plan review(25%of permit e _
w- r -
Print name: John Chamberlain Date: State surcharge(12%of permit fee): q ,
TOTAL PERMIT FEE 3�t vt=
Authorized signatu �� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete_
Print name:/4_,L,, ;ti ,e,,2_,_4 6?,[,es.1t e Date: 4,.3,/ • Number of inspections allowed per permit
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10144 SW WASHINGTON SQUARE RD,
TIGARD, OR, 97223
Commercial - Electricial Limited Energy
198 Low voltage final
PASS - No C of O
July 8, 2014 at 9:50:51 AM
ELR2014-00128
Jeff Grove
Violation Summary:
Inspector Contractor