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Permit CITY OF TIGARD ELECTRICAL PERMIT 311 • 1:-:r1, COMMUNITY DEVELOPMENT Permit#: ELC2015-00894 Date Issued: 11/04/2015 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S14/2015 100 Jurisdiction: TIGARD Site address: 6650 SW BONITA RD Project: Sleep Train Subdivision: 2000-020 PARTITION PLAT Lot: 1 Project Description: Power and lighting circuits for Sleep Train. 11/12/2015: Corrected address from 6600 to 6650.Plans received(34) branch circuits and(1)600 amp feeder. Contractor: ERTELL ELECTRIC LLC Owner: PACA PROPERTIES LLC PO BOX 279 6600 SW BONITA RD FOREST GROVE, OR 97116 TIGARD, OR 97224 PHONE: PHONE: 503-841-4511 FAX: FEES Quantity Description Date Amount 34 crt Branch Circuits wo/Purchase 11/04/2015 $301.04 Specifics: Service or Feeder 1 ea 12%State Surcharge- 11/04/2015 $36.12 Type of Use: COM Electrical Class of Work: ALT 75 Plan Review-Electrical 11/04/2015 $75.26 95 Cash Over 11/04/2015 $94.51 Type of Const: Occupancy Grp: Total $506.93 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 :•plicable law. All work ill be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if wor is suspended for more the 80 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. T ose rules are set for n OAR 952-001-0010 through 0 952- 1-0090. You may obtain a copy of the rules or direct questions to OUNC by call's, • .232.1987 or 1.:00.332.2344. Issued By: Permittee Signature: L() 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 ApplicatiaW FOR OFFICE USE ONLY City of Ti and Received • 1111 ° 13125 SW Hall Blvd., nIOV 1 2 2015 DateB : li / is(All , , ! /t�• lvd.,Tigard,OR 97225[ Plan Review I G .. I�, Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 Date/B : 411.!t-.14111 1 GAKU Inspection Line: 503.639.4175 CITY OFIGARD Date Ready/By: , ' g auris: El See Page 2 for Internet: www.tigard-or.gov ;,� Notified/Method: / I `/'4 Supplemental information ! 11 I i it i1Illkl •-,... .,• --- - ,,:� ,.it •.. r.- ._ f ����� `��� - � ,.•- 4r'I•PLAN.'REVIIEW*'' ;�'ts :.'S,: . �s' %�Tl'PE OF` � �.: t,raCc"�M:... �•�'' .•.:... . :,. .. .. , �;�,i::fi-...:-�," .... , 0 New construction J 0 Addition/alteration/replacement Please check all*that apply(submit 2 sets of plans w/items checked below): 0 Service or feeder 400 amps or more 0 Building over three stories. ❑ Demolition 0 Other: where the available fault current 0 Marinas and boatyards. • exceeds 10,000 amps at 150 volts or 0 Floating buildings. ':, ` CATEGURY OF CONSTRUCTION ` '`'r : _ • - less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑ I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for ail other installations. buildings. - 0 Multi-family 0 Master builder 0 Other: 0 Fire pump. Installation of 150 KVA or y .''JO -. z,.,. •. . . - ,.,, ❑Emergency system larger separately derived system. .,. B •SITE INFORMATION:AND::00s ION' `.:.,,,,.':----,::.-. 4-:4-:,:'.' 'i ' ::` ❑Addition of new motor load of ❑"A","E","1-2","1-3", Job no.: Job site address: ,� C) 1 I00HP or more. occupancy. ��-•— ig©K 1 7� PA ❑Six or more residential units. 0 Recreational vehicle parks. Cit /State/Z1P: 9 7 Z ❑Health-care facilities. 0 Supply voltage for more than y �j L��r ©✓,d CI O�1 600 volts nominal. v t J ❑Hazardous locations. Suite/bldg./apt.no.: Project name: ) '� Service or feeder 600 amps or more. I �!G"�� �V Gl i v\ ;• f`a •FEE''.4400th[%='' f.. -,- • _ ::1_. 7�,,, /4,,, : :.. Fee :=:..I:; :, •.. Cross street/directions to job site: n«eripNoa� I Qty. I Fre- 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'(500 sq.ft.or portion 33.92 I Tax map/parcel no.: Limited energy,residential 75.00 2 . ': _.:.DESCRIPTION.`.OF WORK - ,:7-,``, - :----. (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy ' . 0 See Page 2- • is o feeders installation,alteration,and/or relocation 2 Services or n 1 ❑'�PROPERTY,OWNER''''',-4•; >_i'l'".. "_:❑ TENANT` •'-. ,t( 200 amps r less 1- J r I 201 amps to 400 amps 133.56 2 Name: 1114,5%;) N a� 401 amps to 600 amps 1 200.34 2 (dress: _/, , fit' Q(,tt,"f 01 Lei ` 601 amps to 1,000 amps 301.04 2 50it/i/ ,0r .1"- (Lv' , id�,tt Over 1,000 amps or volts 552.26 2 City/State/ZIP: f f D� ' „i( r f- Temporary services or feeders installation,alteration,and/or Phone:( ) Fax:( ) v.*" t l Icor' id i`I• relocation 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 Owner signature: Date: Branch circuits-new,alteration,or extension,per panel . a . .. A.Fee for branch circuits with ❑'APPL`ICANT:. :,:;' '.,... ❑;CONTACT;PERSON•' above service or feeder fee Q �f�� 7 42 2 Business name: k"fie// �`iee/V 1'� each branch circuit jJ�,s�r „2*•°c 2 !/ B.Fee for branch circuits without O Contact name: service or feeder fee,first 56.18 5"6,,id 2 /� branch circuit Address: ,a sox �l 1 Each add'l branch circuit 7.42 2 City/State/ZIP: /h./4 �1 �b Miscellaneous(service or feeder not included) y h i3O /� 2/Z Each manufactured or modular 67.84 2 dwelling,service and/or feeder Phone:(5 ' ) 'y/.�5-// 1 Fax: :( ) Reconnect only 67.84 2 E-mail: A /6t v14) tai✓1' l/ /�5L (7v iL. Co wwl Pump or irrigation circle 67.84 2 . ' _ , _ , . -'CONTRACTOR :: : , ._ ._. , .,_ .. Sign or outline lighting 67.84 2 Business name: 1 t. k�)�o`.✓, � - Signal circuit(s)or limited energy See Fr ti.,/ panel,alteration,or extension. Page 2 2 Address: O s 0, 21 ! Each additional inspection over allowable in any of the above / Additional inspection(1 hr min) 66.25/hr City/State/ZIP: j.h.116 ort, /Gj 7/J/ Investigation(l hr min) 66.25/hr Phone:(503 ) 51)9-1.757/ Fax:( ) ..t'- Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.:l SCSya Electrical Lic.: Suprv.Lic.: specifically listed(%:hr min) V,T.-,.': 'ELECTRIC[1LsPERMITi,'FEES;-.: :-.:,•.;:•`,!:c.a;; --Ruprv. Electrician signature,required: Subtotal: 30/, DI print name: Date: Plan review(25%of permit fee): 75 r24 /�,�vl/v ' f1 _itff___ — State surchazge % f fee): 34; f2 Authorized signature: Y �� �}'/ TOTAL PERMIT FEE: y/ .y - This permit application expires if a permit is not obtained within 180 Print name: M.ke Sterol-A-V. -- Date:/� /Z /� days after it has been accepted as complete ' Number of inspections allowed per permit. I:IBuilding\Permits\ELC_PemutApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB 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 6650 SW BONITA RD, TIGARD, OR, 97224 Commercial - Electrical 199 Electrical final PASS - No C of O ELC2015-00894 Chip Barnett Violation Summary: Inspector Contractor City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 71Request for Permit Action on r i G A i n 13125 SW Hall Blvd. • Tigard, Oregon 97223 . 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ge Owner ❑ Applicant E Contractor ❑ City Staff Check(✓)one REFUND OR Name: �^ INVOICE TO: (Business or Individual) _F. k�^ f�J cxc — C., cC Mailing Address: PO, .t,, ill ,/ / City/State/Zip: "!% / ,ll�4,� �C �7 ( 2-..Phone No.: `mac / - C PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): U . ',._.— OID PERMIT APPLICATION. M. REFUND r RMIT FEES (attach copy of original receipt and provide explanation below). i '' • CE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CON TRACTOR ON PERMIT (do not cancel permit). Permit#: EL C 02 C 15 — e9 0 c? Site Address or Parcel#: (p 4 S0 sec) ,eiA/, 7;9 ,e-b. Project Name: -SLL L'77 77297i✓ Subdivision Name: Lot#: EXPLANATION: 7e,=/Gu'c// s e // Z/°‘• >,Iy En/i , -ES a-I- 7A/&- //t/ /e-,6 -cc e_77o.J C s -, Vi . Signature: 4 Date: � �� Print Name: 6‘ALI ,ii- Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date /2.7(4) /S By 41 Refund Processed: Date 42/#'/jS By 14. Invoice Processed: _ Date By - Permit Canceled: Date A/Mt— By . 'arcel Tag Added: Date By I:\Building\Forms\RegPcrmitAction_09 14.doc Iqu . T}IGARD City of Tigard December 10, 2015 Ertell Electric LLC Attn: Dylan Wentworth PO Box 219 Hillsboro, OR 97123 Re:Permit No. ELC2015-00894 Dear Applicant: The City of Tigard has processed a refund for overpayment of pets pit fees on the above referenced permit for the following: Site Address: 6650 SW Bonita Rd Project Name: Sleep Train Job No.: N/A Refund: ® Check#219467 in the amount of$94.551. ❑ Credit card"return" receipt in the amount of$ ❑ Trust account "deposit" receipt in the amount of$ Notes: Refund of overpayment of permit fees due to reduction in scope of work If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Coordinator Enc. 1 125.SW �a1 1vd • Tigar , f 7 gon 97223 • 503.639.4171 \Building\Refunds\Adnuru, mon\ trl nd-5verpa .r be /ITi/UT '1 _Y Reay: 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: Ertell Electric TJ C DATE: 12/3/2015 Atm: Dylan Wentworth PO Box 219 REQUESTED BY: Dianna Howse Hillsboro, OR 97123 TRANSACTION INFORMATION: Receipt#: 400461 Case#: ELC2015-00894 Date: 11/04/2015 Address/Parcel: 6650 SW Bonita Rd Pay Method: CreditCard Project Name: Sleep Train EXPLANATION: Refund overpayment of permit fees after reduction in scope of work. REFUND INEORb1ATION: 'Fee Description From'Receipt - Revenue Account No - t Ref th :EYainple Buildina.Persriit Fee_ . . �;r x-`-- Example:=2300000_,43104 . .. ;$Auio iii Cash Over 100-0000-48001 $94.51 TOTAL REFUND: $94.51 APPROVALS: SIGNATURES/DATE: If under $5,000 Professional Staff ; J If under$12,500 Division Manager If under $25,500 Department Manager If under$30,000 City Manager If over$50,000 Local Contract Review Board =:.FOR TIDEMARK SYSTEM ADMINISTRATION LTSE'_ Case Refund Processed: Date: / 2/ /L By:�< I:\Building\Refunds\RefundRecluest.doc x 09/01/2010