Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENTPermit#: ELC2015-00481
Z/ �W
. e 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/19/2015
Parcel: 2S101A603000
Jurisdiction: TIGARD
Site address: 7150 SW DARTMOUTH ST
Project: Pediatrics Group Subdivision: 2012-009 PARTITION PLAT Lot: 2
Project Description: Tenant Electrical for(2)temporary service only. All other work performed under ELC2015-00464.
Contractor: CHERRY CITY ELECTRIC Owner. DF DEVELOPMENT LLC
1596 22ND ST SE 23077 SW NEWLAND RD
SALEM, OR 97302 WILSONVILLE, OR 97070
PHONE: 503-566-5600 PHONE:
FAX: 503-571-4410
FEES
Quantity Description Date Amount
2 ea Temp Services or Feeders- 06/19/2015 $118.72
Specifics: 200 amps or less
2 ea 12%State Surcharge- 06/19/2015 $14.25
Type of Use: COM Electrical
Class of Work: ALT 45 Misc Administration Fee 06/19/2015 $45.00
Type of Const:
Occupancy Grp:
Total $177.97
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 OA 52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.D /
Issued By: - Permittee Signature: r✓ �G/Ct9i'7o'N /
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 603.639.4176 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.
NOV-11-2015(WED) 06: 53 P 001/001
RECEIVED
City of Tigard • COI-AMUNITY DEVELOPMENT DEPARTMENT NOV 12 2015
Request for Permit Action BUILDING 1-1(,-ARD
ION
13125 SW Hall Blvd. •Tigard,Oregon 97223- 503-718-2439 •www d,;t rc d-or.e, civ
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone. 503-718-2439 Car 503-598-1960 TigudBuildingPcrtnitsCtigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑Q Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (business orladividu4 Cherry City Electric
Mailing Address: 1596 22nd ST SE
Ciry/State/Gip: Salem, OR 97302
Phone No: 503-566-5600
PLEASE TARE ACTION FOR THE ITEM(S) CHECKED (V):
OID PERMIT APPLICATION.
g:5510E
IkMIT 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#: ELC2015-00481
Site Address or Parcel#: 7150 SW Dartmouth ST,
Project Name! Pediatrics Group
Subdivision Name: 2012-009 Partition Plat Lot#: 2
EXPLANATION: This permit is a duplicate of ELC2015-00464
v F c' E7'T2
/2 Ge S, 1A1 jri0n/S,
Signature: Date: 11-10-15 —
Print Namc: tri Muga /-7, ,J X03 Slv6 -SS P
ne-F_+^�i Policy
1. The city's Community Development Director,Building Official or City Engineer may autharize the refund of:
• Any fee which was errommusly paid or collcmd.
• Not more than 8TIa of the application or plan review fee when an application is withdrawn or=celed 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 resumed to the original payer in the form of a check via US postal service.
3. Please allow 3.4 weeks for processing refund requests.
4Z44- 6 90 ,Iry - /r.r-, 2�2 = 52.2,jY YS. rra - s�P •y
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FOR OFFICE USE ONLY
Route to S s Admin: Aare B Route to Records: Date j B
Refund Processed: Date i 2/ B Invoice Processed: Acte B
Permit Canceled: Date By PucclTagAddech I Date B
T:\Building\Forma\RegPennitAction_W 14.dm
11
City of Tigard
January 21, 2016
Cherry City Ci Electric
Atm: Sherri Murray
159622 nd St., SE
Salem, OR 97302
Re: Permit No. ELC2015-00481
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: 7150 SW Dartmouth St
Project Name: Pediatrics Group
Job No.: N/A
Refund: ® Check#219857 in the amount of$595.79.
❑ Credit card"return" receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Refund due to reduction in scope of work to (2) temporary service for this permit,
less $45.00 administration fee for permit revisions. All other work performed under
ELC2015-00464.
If you have any questions please contact me at 503.718.2430.
Sincerely,
6775e—
Dianna Howse
Building Division Services Coordinator
Enc.
1:\Bwlding\RefuJs�,,k7a5.SW nfj�j�jjv�!,J�ibArA,/0fifgon 97223 • 503.639.4171
TTY Relay: 503.684.2772 0 www.tigard-or.gov
City of Tigard
Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentanon and the RequestforPemit.,lrtion forth (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
Parable will route refund checks to Accela Sestem Administrator for distribution to applicant.
PAYABLE TO: Cherry Citv Electric DATE: 1/14/2016
Attn: Sherri Murray
1596 22°d St, SE REQUESTED BY: Dianna Howse
Salem, OR 97302
TRANSACTION INFORNIATION:
Receipt#: 201345 Case #: ELC2015-00431
Date: 6/19/2013 Address/Parcel: 7150 SW Dartmouth St.
Pay Mediod: CreditCard Project Name: Pediatrics Group
EXPLANATION: Refund portion of work completed under another permit,ELC2015-00464 and charge
$45.00 administration fee for revising permit.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Electrical Permit 220-0000-=43103
12°'o State Surcharge 100-0000-24001 63.65
TOTAL REFUND: $595.79
APPROVALS: SIGNATU DATE:
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 SYSTEN ADMINISTRATION USE ONLY
Case Refund Processed: Date: By:
1:ABuilding\Refunds\RefundRequestdoc�09/01/2010
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
7150 SW DARTMOUTH ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00481
Jeff Grove
Violation Summary:
Inspector Contractor