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Permit JAN. 26. 2015 8: 16AM 5032397038 NO. 0964 P. 2 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVE') III 1 : Request for Permit Action JiiNN0G2: T;t A R D 13125 SW Hall Blvd.•Tigard,Oregon 97223•503-718-2439•www,tjgd_oi.gQv 6 2 015 I fit'AkD TO: CITY OF TIGARD DUILBuilding Division DIVISION 13125 SW Hall Blvd.,Turd,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 Tig rdBuOdmgPermits@tigard-or.gov FROM: ❑ Owner Applicant ® Contractor ❑ City Staff /J V 0 1 D ch.., ,one v`/a //� REFUND OR Name: ■ INVOICE TO: purmeasorhidiidual) i v r1 r��lh �_ Mailing Address: scssgill. ve- City/State/Zip: Prii -1 A-vlA `--1;,Gg PhoneNo.: O3 3`1 4 Oz PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (U): 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). [J REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: lIL_1S L ici Site Addressor Parcel#: }if"` ,� c Lr� U'fn 12.0 4:74p__ Project Name: P 0 A\M e i j e r -- -_ Subdivision Name: Lot#: EXPLANATION: iaV‘'t' G47111"-(15 6vj tiaI Y3o1' lle -Call. c-•f 404 irk p hor...1►"►a 7Gfa --w- - Signature: /— Date: /c -1 _ Print Name: gee,a 4(ot^ gu?l flJi1.-- Refund Poliv 1. The city's Community Devebpmein Director,Building Official or City En fineer may authorize the refund of. - Any fee which was erroneously paid or coleced. - Not mote than 80%of the application or plan review fee when rm application is wandraven or coaled before review effort has bean expended • Not more chin 80%of the application or pe mit fee for issued permits prior to any inspection requests. f44^/6 /2-e-7-&-.e../ 2 Al refunds wine returned to the original payer in the form of ached:via US postal Pavicc. 3. Please allow 3-4 weeks for processing refund requen 7.5. to - 6, O . re . /s. 7,0-v - -, a 0 /, �'D FOR OFFICE USE ONLY �• °ZJ 1 /6 -,) Route to S Admix Date I EIN '[�i 'Route to Records: rzj3M;;;;I Refund Processed: Date-7Q,/QJ[ra g Invoice Processed: Date B Permit Canceled: Date -_ ,�/ji110/%ice Parcel T.:Added: Date B I:A a i diut\Forms RegPermitAaien_'• 11. x E rni 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: American Heating DATE: 2/19/2015 Attn: Brandon Hutchinson 5035 SE 24`h Ave. REQUESTED BY: Dianna Howse Portland, OR 97202 TRANSACTION INFORMATION: Receipt#: 198986 Case#: ELR2015-00012 Date: 1/14/2015 Address/Parce. ! !_ - . --n.urg Rd, 740 Pay Method: CreditCard Project Name: Pollmeier EXPLANATION: Per applicant's request as permit was 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 fees 220-0000-43103 $60.00 12% State surcharge 100-0000-24001 7.20 TOTAL REFUND: $67.20 APPROVALS: SIGN•T 'ES/DATE: If under$5,000 Professional Staff d If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ON Case Refund Processed: Date: B : /A/5,6—C..770/./ C®Ai, i 7VA & E L'4-OS g ETGJE�� I:\Building\Refunds\RefundRequest.doc x 09/01/2010 (%2L;� C2/" 7 Q Inspection Detail Portlet: Edit Mode Page 1 of 1 Record ID:ELR2015-00012 Menu Update Reset Cancel View Log Reports Help Case# Inspection Type • Address LR2015-00012 198 Low voltage 10200 SW GREENBURG RD,740 TIGARD,OR 97223 final Request Date/ Requestor 02/26/2015 Requestor's Phone Chip Chi Bamett Request Comment A V Scheduled Date • Scheduled Time 02/26/2015 __._. J I IA l spection Date-'� S = •- Department •Current Department Inspector •Current User 02/26/2015 PASS-No C of O v Building v Jeff Grove v •mment�Stan•: A V check spelling CAP Type • Internal use only • Inspection Time Building/Com/Electrical Limited Energy/NA 15COM-00000-00045 11 v ; 36 v AM V Submit Date Submit Time 11 v ; 35 V 02/26/2015 7 V AM«2r✓ �E/�C/�//� e-+' t-e,& TU https://ay.accela.com/portlets/inspection/inspectionDetailCapSpecific.do?mode=view&fro... 2/26/2015 JAN. 26. 2015 8: 16AM 5032397038 NO. 0964 P. 1 fS AMERICAN t � ,....�5 ,, FIILATII �, INC.� 5035 SE 24`'Avenue,Portland,Oregon 97202 ; PI 503.239.4600 F( 503.239.7038 r`y$'l�'y ^"`"'�' i• '-'-" "' �u--sr_. ORfGON CCB33135: WASHINGTON AMERII*212.1C/AMERIH1123R0 t Facsimile Transmittal CITY OF TIGARD To: Fax: (503)598-1960 Brandon Hutchinson From: Project Coordinator Date: Jan, 26, 2015 Re: Electrical Permit Refund Pages: 4 CC: 0 Urgent ❑For Review 0 Please Comment ❑ Please Reply 0 Please Recycle Notes: Attached is the Request for permit action, Copy of the permit and receipt for payment. Please Email me with status of refund request when it is processed. My Email is b.hutchinson(u�,americanheatinz.net Thank you. Brandon Hutchinson (503)239-4600 Page 1of1 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT n COMMUNITY DEVELOPMENT Permit#: ELR2015 00012 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/14/2015 T t�'AR Parcel: 1 S 135AB00900 Jurisdiction: Tigard Site address: 10200 SW GREENBURG RD 740 Project: Pollmeier Subdivision: METZGER,TOWN OF Lot: 9 Project Description: Low voltage for HVAC Contractor: AMERICAN HEATING INC Owner: LINCOLN CENTER LLC 5035 SE 24TH AVE BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97202-4765 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503-239-4600 PHONE: FAX: 503-239-7038 FEES Description Date Amount Specifics: Restricted Energy Permit 01/14/2015 $75.00 12%State Surcharge-Electrical 01/14/2015 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 0 Audio&Stereo: 0 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data&Telecommunications: 0 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 accor..•. ..roved 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. ATTE •N: Oregon law requir: you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-001,through OAR 952-001 ,r• .u ma obtain a copy of the rules or direct questions to OUNC by calling 50033.232.1987 0 .COO. 2.2344. Issued B • r — v Li� Permittee Signature: /1 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' 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 ApplicationREC,EIVEP FOR OFFICE USE ONLY City of Tigard Received Permit No.: `L O l 2 t3' g Datemy: i 1 ri /5— /L vo/S=ate 13125 SW Hall Blvd.,Tigard,OR 97223JAN 14 2015 Plan Review Hie II a . Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit: A0/5--000/3 T t G A R D Inspection Line: 503.639.4175 Date Ready/By: luris: M See Page 2 for Internet: www.tigard-or.gov CITY OFTIGAN) Notified/Method: Supplemental Information TYPE OF 5' /1)11y}r,a rvlS101�} ., ❑New construction ®Addition/alteration/replacement Please check all that apply(submit I sets of plans w/items 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: 0 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","t-2","1-3", Job no.: 115004 Job site address: 10200 SW Greenburg Road six 100HP or ueaion ❑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.:740 Project name:Pollmeier ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. 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 -- Ea.add'l 500 sq.ft.or portion 33.92 1 "lax map/parcel no.: Limited energy,residential DESCRIPTION OF WORK (with above sq.ft.) 75'00 - 2 Limited energy,multi-family 75.00 2 Low volt wiring and T-stats residential(with above sq.R.) Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation ❑ PROPERTY OWNER ❑ 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 I ® CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 2 Business name:American Heating Inc. each branch circuit B.Fee for branch circuits without Contact name:Brandon Hutchinson service or feeder fee,first 56.18 2 branch circuit Address:5035 SE 24th Ave. Each add'I branch circuit 7.42 ' 2 City/State/ZIP:Portland,OR.,97202 Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 Phone:(503)239-4600 Fax::(503)239-7038 dwelling,service and/or feeder Reconnect only 67.84 2 E-mail:b.hutchinson @americanheating.net Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name:American Heating Inc. Signal circuit(s)or limited-energy 1 See panel,alteration,or extension. Page 2 7S 2 Address: Brandon Hutchinson Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr City/State/ZIP:Portland,OR.,97202 Investigation(1 hr min) 66.25/hr Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 00/hr CCB Lie.: 33135 Electrical Lie.: 26993CRE Suprv.Lie.: 2640LEB specifically listed(%2 hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: Subtotal: 75---" ),,Ittbe/A---1°4'1- Pl an review(25%of permit fee): Print name: T Steve Young Date: / g /. `� State surcharge(12%of permit fee): !•c'd Authorized signature: -. TOTAL PERMIT FEE: 'eV //� ,/� This permit application expires if a permit is not obtained within ISO Print name: Brandon Hutchinson Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(i 1/05/COM/VEB 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 ElAlarm Wind generation systems in excess of 25 kva: _ 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 552.26 2 El Heating,Ventilation and Air Conditioning OAR 918-309-0040) System* Solar generation systems in excess of 25 kva: Each additional kva over 25 7.42 3 Fl Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: I Other: Each additional inspection is 66.25/hr charged at an hourly(1 hr min) Inspections for which no fee is 90 00/hr specifically listed(%hr min) COMMERCIAL WORK ONLY: _ ELECTRICAL PERMIT FEES Fee for each commercial system 575.00 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 ❑ Clock Systems ❑ Data Telecommunication Installation El Fire Alarm Installation t HVAC I Instrumentation I Intercom and Paging Systems n Landscape Irrigation Control* Medical Nurse Calls Outdoor Landscape Lighting* 1 Protective Signaling Other Total number of commercial systems: _ *No licenses are required. Licenses are required for all other installations I:1 Building\Permits\ELC_PermitApp_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 10200 SW GREENBURG RD 740, TIGARD, OR, 97223 Commercial - Electricial Limited Energy 198 Low voltage ﬁnal PASS - No C of O ELR2015-00012 Jeff Grove Violation Summary: Inspector Contractor