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Permit (14) 06/01/2016 07:31 5036911879 ARROW PAGE 01/01 City of Tigard * COMMUNITY DEVELOPMENT DEPARTMENT ft ; i ,y a Request for Permit Action ut,/ 20/6 [ 'GA�?p 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • ictrr TO: CITY OF TIGARD V 0 I ' Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 1(2/ ('C Phone: 503-718-2439 Fax: 503-598-1960 TigarelB "dingPetsnits@ttgard-O g0v FROM: 0 Owner ]C Applicant ® Contractor ❑ City Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) /1.4 Ex i-J r L ,4 -- Mailing Address: l v.3,3ca 413 ' A 1.--A-T)ald , City/State/Zip: A Phone No.: 2 PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (1): CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide ewplanation below). INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit 4: 6:74-A2 2.-c--) -- 0 ccx2 1 Site Address or Parcel#: ✓E I 2‘‘. / /2. r Project Name: � #a i Subdivision Name: - MN Lot#: EXPLANATION: zdj, ,,/� c Signature: (l L Date: - !- 14, Print Name: 2.6 _ ,,a s z‘c.0.5 r 1. The �Community Development Director,Builrlirg 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was erroneously paid or collected, • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 applicationor 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. /,�� az) lTZ� 7J `J (Tv �O rw - . o uz) 7, /6 ,4� FOR OFFICE ['SE ONI.\ Route to S's.A.daun: Date ,,/fifflillirate,, Route to Records: Date P' 1%% Refund Processed: Date / //k By r%!'' Invoice Processed: Date By Permit Canceled: _ Date '/ J1'fp By Air Parcel Tag Added: Date Bp" S:\$wilding\Farms\Reg1'wmitActio�UA4. oc 111111 TIGARD`. City of Tigard July 29, 2016 Arrow Mechanical Construction Inc. Attn: Kevin 10330 SW Tualatin Rd Tualatin, OR 97062 Re: Permit No. ELR2016-00021 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11131 SW Greenburg Rd Project Name: Jump Sky High Job No.: N/A Refund Method: ® Check#221813 in the amount of$67.20. ❑ Credit card"return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit"receipt in the amount of$ . Comment(s): Per applicant's request as work was completed by another contractor. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 41054471--C_____ Dianna Howse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov 11114 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: Arrow Mechanical Construction Inc DATE: 7/21/2016 Attn: Kevin 10330 SW Tualatin Rd REQUESTED BY: Dianna Howse Tualatin, OR 97062 TRANSACTION INFORMATION: Receipt#: 402334 Case#: ELR2016-00021 Date: 3/3/2016 Address/Parcel: 11131 SW Greenburg Rd Pay Method: CreditCard Project Name: Jump Sky High EXPLANATION: Per applicant's request as work was completed by another contractor. Refund 80%of permit fees. REFUND INFORMATION: Fee Description From Receipt Revetriiie Accoumt No. Itef d Example: Building Permit Fee Eiample: 2300000-43104 $1 c>unt Restricted Energy Permit Fee 220-0000-43103 $60.00 12%State Surcharge 100-0000-24001 7.20 TOTAL REFUND: $67.20 APPROVALS: SITU 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 ONLY Case Refund Processed: Date: 77/a2gA6 By: 42174 I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT IIIII II ' COMMUNITY DEVELOPMENT Permit#: ELR2016-00021 T EGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/03/2016 Parcel: 1 S135BC01100 Jurisdiction: Tigard Site address: 11131 SW GREENBURG RD Project: Jump Sky High Subdivision: OAKBURG Lot: 27 Project Description: Low voltage for HVAC Contractor: ARROW MECHANICAL Owner: GREENBURG SPACE CENTER LLC 10330 SW TUALATIN RD PO BOX 91305 TUALATIN, OR 97062 PORTLAND, OR 97291 PHONE: 503-692-1565 PHONE: FAX: 503-691-1879 FEES Description Date Amount Specifics: Restricted Energy Permit 03/03/2016 $75.00 12%State Surcharge-Electrical 03/03/2016 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 0 Audio&Stereo: 0 Boiler Controls: 0 CCN: 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 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 t gh OA' 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued - •• �� Y: ��/ _ Permittee Signature: — 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 City of Tigard Received gIIIIIIIIIPIIIIIIM # 5, <„ Date/By: /� ��O Permit No.:G/�O��Cv���p� ■ 13125 SW Hall Blvd.,Tigard,OR 922,3 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: : IIl G },1 Inspection Line: 503.639.4175 Date Ready/By: kris. ® See Page 2 for F :: Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF-WORK PLAN REVIEW ❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below): ❑Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. ❑Addition of new motor load of1 ❑"A","E","1-2","1-3", Job no.: Job site address:n/3/ ,e 1.1 iju R.G gc,,,tyor more. occupancy. 0 Six x oorr more residential units. 0 Recreational vehicle parks. City/State/ZIP' ❑Health-care facilities. 0 Supply voltage for more than 1/4P*�D/ / Z Z 3 0 Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: ❑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 Tax map/parcel no.: Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) Limited energy,multi-family 75.00 2 NIE .4 G-5--5 residential(with above sq.ft.) Services or feeders installation,alteration,and/or relocation 200 amps or less 100.70 2 0 PROPERTY OWNER 0 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 1 201 amps to 400 amps 125.08 2 Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Owner signature: Date: Branch. Fee or bran h circuits with alteration,or extension,per panel ® APPLICANT ® CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name:Arrow Mechanical B.Fee for branch circuits without service or feeder fee,first Contact name: /�gif� KR�5 aEA)50 branch circuit 56.18 2 ` Each add'!branch circuit 7.42 2 Address:10330 SW Tualatin Rd Miscellaneous(service or feeder not included) City/State/ZIP:Tualatin OR 97062 Each manufactured or modular 67.84 2 dwelling,service and/or feeder Phone:(503)692-1565 Fax: :(503)691-1879 Reconnect only 67.84 2 E-mail: A- .3yt,tit e r EA-, 60 l'''` Pump oroirrigation lightingcie 67.84 2 Sign outline 67.84 2 CONTRACTOR Signal circuit(s)or limited-energy °tJ Business name:Arrow Mechanical panel,alteration,or extension. / ��Page 2 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(1 hr min) 78.18/hr Phone:(503)692-1565 Fax:(503)691-1879 Inspections for which no fee is 90.00/hr specifically listed(%S hr min) CCB Lic.: 5193 Electrical Lic.: 34-47CLE� Suprv.Lic.: 4647LEB ELECTRICAL PERMIT FEES '7 5• Subtotal: oeP Suprv.Electrician signature,required: Plan review(25%of permit fee) Print name: John Chamberlain Date: fes— n /, State surcharge(12%of permit fee): 9.G 0 Authorized s',.14a e: TOTAL PERMIT FEE g 7. Ov Thispermit applicationexpires � f�-' \ if a permit is not obtained within 180 Print name:// vi �L C S 2 JL4 5,6( Date: - 4r 7t • days aftes it has been acceptedrmi. as complete. 2 Number of inspections allowed per permit.