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Permit
III TIGARD City of Tigard October 13,2014 Oregon Electric Construction Inc. Attn: Laurel Semprevivo 1709 SE 3`d Ave. Portland, OR 97214 Re:Permit No. ELC2014-00562 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 8200 SW Pfaff le St Project Name: WSCHS Gym Job No.: N/A Refund: ® Check#215217 in the amount of$54.62. ❑ Credit card"return"receipt in the amount of$ . ❑ Trust account"deposit" receipt in the amount of$ . Notes: Refund overpayment of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 4:12 ,w, .... Dianna Howse Building Division Services Coordinator Enc. I:\Building\Re funianiaagiaidalliCbArpTylgitrall Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov ErCity 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 fir 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: Oregon Electric Construction Inc. DATE: 10/2/2014 Attn: Laurel Semprevivo 1709 SE 3`d Ave REQUESTED BY: Dianna Howse Portland, OR 97214 BT TRANSACTION INFORMATION: LC, Receipt#: 197835 Case #: elc2014-00562 Date: 10/2/2014 Address/Parcel: 8200 SW Pfaffle St. Pay Method: CreditCard Project Name: WSCHS Gym EXPLANATION: Refund overpayment of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Cash Over 100-0000-48001 $54.62 TOTAL REFUND: $54.62 APPROVALS: SIGNAT S/ ATE: If under$5,000 Professional Staff 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 ON Case Refund Processed: Date: /r' //3/by By: .t I:\Building\Refunds\RefundRequest.doc x 09/01/2010 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT . Request Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): • ..,,.:.�.� VOID PERMIT APPLICATION. E REFUND ERMIT FEES (attach copy of original receipt and provide explanation below). '• FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: G9.0/11 lX_.) ). Site Address or Parcel #: cr.263� Project Name: 6ilec,.2...x1 �i r�S75 WV A r!i Jchctif Subdivision Name: "� Lot#: EXPLANATION: , _ / - ..71e d �-•M,` r�564 /7A h.3 /'U a.., 0(21°J-pa yillet)is of I SIT (c.the J cAA,5 a ,Pr /,h;cl dJ I;Nvc Signature: Date: /p/01//a-/ Print Name: Z dr. Refund Policy 1. The city's Community Development Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80%of application fees when application is withdrawn/canceled before review effort has been expended or for issued permits, prior to any inspection requests. 2. The city's Engineer may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 50°4 of application fees when application is withdrawn/canceled before review effort has been expended or for issued permits, prior to any inspection requests. 3. All refunds will be returned to the original payer in the form of a check. Please allow 3-4 weeks for processing refund requests. Rte to S s Admin: Date g g B 4 Rte to Records: Date /p®A, B i i Refund Processed: Date /v2///y By i , Invoice Processed: Date By Permit Canceled: Date ,,kr n- By •F- Parcel Tag Added: Date By Receipt# Date / Method Amount$ i:\Building\Forms\Req PermieAction_082114.doe ********ADDINC ON TO EXISTING PERMIT********* Electrical Permit Applicati IOU OFFICE:tsl ONLI CEIVED Received City of Tigard Daten3 •,,' 13125 SW Nall Blvd.,Tigard,OR Plan ived — — _ S Phone. 503.718,2439 Fax: 503398.1960 Date:13 : Other Permit: I l t :�ra n inspection T.tnc 501,(,19.4175 OCT 1 2014 Date Ready/14Y' ten" 0 See Page 2 for Internet. www.Tigard-or.gov Notified/Notified/Method Supplemental information TYPE OF;GWO fi U PLAN REVIEW Please check all that apply(submit ,sets of plans%Alms checked below): ❑Nett construction ®Addition/ +f��f ❑Service or feeder 400 amps m more ❑Demolition ❑Other: P ❑Mac arE twcr ohms sinner where the available fault catrrent ❑Manilas and boatyards CATEGORY OF CONSTRUCTION exceeds 10.000 snaps at L50 volts or ❑Flnatlnp 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 (]Emergency systent larger separately derived ssston. JOB SITE INFORMATION"AND LOCATION ❑.Addition of new motor load of ❑ a' E:' '1•r" 't 3' Job no.: 10 0 0 3 2 Job site address:8 2 0 0 SW Pfaffle St . 1 OOHP or more. occupancy. ❑Sia or more residential units. ❑Recreational vehicle parks. City/State/ZIP: Tigard, OR 97223 ❑Health-care fatalities. ❑Supply voltage for more than ❑Hawdwrs locations. 600 volts nominal Suite/bldgJapt.no.: I Project name:WS CHS Gymnasium ❑Seresce or feeder 600 amps or more, FEE SCHEDULE Cross street/directions to job site: Dever:it.,, rem. rata( I - New residential single-or multi-family dwelling unit, Includes attached garage. Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4 F. add'1500 sq.ft or portion 33 92 1 Tax ma(tipart el tw.. limited energy,residential 'with above Ct 75.00 DESCRIPTION OF WORK '�L J - , Limited energy,multi-family 75.0(1 Adding on to permit ELC2014-00562 residential(withabovesq.f) - Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation ® PROPERTY OWNER i ❑ TENANT 200 amps or less 1 t00.70 100.70 2 201 amps to 400 amps 133 56 2 Name: Westside Christian High School 401 amps to6(tbamps } 210334 Address: 8200 SW Pfaffle St . 601 amps to 1,000 amps i 301.04 Over 1.000 amps or volts 552.26 12 City/StuteiZ.lP:Tigard, OR 97223 Temporary servicesorf eedersinstallation,alteration,and/or I relocation Phone:( ) I Fax ( ) 21111 amps or less 1 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 509 amps 168.54 2 Owner signature: _._.____. Date: _ Branch circuits-new,alteration,or extension,per panel APPLICANT e:4 CONTACT PERSON A.Fee for branch circuits with T above service 07 feeder fix. Business name: each branch circuit 10 7.42 °•42 2 B.Fee for branch circuits wi hour Contact name: Todd Sullivan I scn ice or feeder fee,first 56.18 branch circuit Address: Each add]branch circuit 7.42 2 City/State/ZIP:/StateC/,1P: Miscellaneous(service or feeder not included) y Each manufactured or modular 0784 2 Phone:(503) 849-2240 Fax::( ) Reconnect(only and'urfcxder Reconnect only 67.84 2 E-mail: Pump or irrigation circle 67 84 2 CONTRACTOR Sign or outline lighting 67 84 2 Business name:Oregon Electric Construction, Inc. Signal ereon(s)or limited-energy Sec net,alteration.or extension 1 Page 2 75.00 2 Address: 17 0 9 SE 3rd Ave , Each additional inspection over allowable in any of the above Additional Inspection(1 hr mm) 66.25.hr City/State/ZIP: Portland, OR 97214 investigation llhrmin) 66.25'hr Phone:(5 0 3) 234-9900 I Fax:( 5 0 3) 2 3 4-10 01 industrial plant(l In min) f 78.18:hr Inspections for which no foe Is 90 00,hr CCB Lie.: 2 03 Electrical Lie.: 26 95 p '' 4818s specifically listed(%hr mini ELECTRICAL PERMIT FEES Suprv.Electrician signature.required:6�1 / ' ,/�JI Subtotal: 246.12 Print name: / Date: Platt review(25%of permit fee): Mark Weinb ndee 10/01/14 State surcharge(12%of permit fee): — 1J.Stl'sin.S3 Authorized signature: //ti 4: ( TOTAL pl:Rlym FEE • •4F �7 S.(cr // +� }n� C) �"f This permit application expires if u permit is not obtained d within 180 Print name: i , /c.4 ix Dart: tl it� days after it has been accepted as complete. i "V • xtunbcr of Inspections allowed per permit IV cikkag'P'emtas1LI.0 PermrtApp Flit ERE.doe Rev O-9../2013 440-4615'111 'OSICOMrWEI • 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 Deuriptioa I on. f Fee I Total I • Renewable electrical energy systems: Check Type of Work Involved: 5 kva orless 10070 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 00.34 Wind generation systems in excess of 25 kva: n Burglar Alarm 25.01 to 50 kva 301.04 2 ❑ Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with OAR 918-309-0040) 552.26 ❑ Heating,Ventilation and Air Conditioning - System* Solar generation systems in excess of 25 kva: Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >I00 kva-no additional charge 0.0 3 ElOther: additional inspection over allowable in any of the above: Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('h 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 ifs permit is not obtained within 180 ❑ Audio and Stereo Systems days after it has been accepted ax complete. • `umber of inspections allowed per permit El Boiler Controls ❑ Clock Systems © Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ 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■Bwad.ng\Pernms\ELC_PemalApp_ELR_ERE.doc Rev 05!21/2013 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 8200 SW PFAFFLE ST, TIGARD, OR, 97223 Commercial - Electrical 199 Electrical final PASS - No C of O ELC2014-00562 Jeff Grove Gfis in locker rooms to be installed. Will check at building final. Check clearances in service room Violation Summary: Inspector Contractor