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Permit (51) City of Tigard • COMMUNITY DEVELOPMENT DEP ART v` 1 ! r 11111 .. Request for Permit emit Action 16 TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.t drd-or`.g v 1,,11 ), `ix, 116046 TO: CITY OF TIGARDJIl D NG DIVISI Building Division V0 I 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov///'/4, FROM: ❑ Owner ❑ Applicant 1 Contractor ❑ City Staff Check(V)one REFUND OR Name: /' /� INVOICE TO: (Business or Individual) f`it ( 1 �k rter Jj ,e`_tr.4`e.� Mailing Address: x"11 1-5— ' v 5,,.� .,...t,' (1(-r—, f De, City/State/Zip: < <kr,r d �Z_ 9 7-Z Phone No.: S-0 .?, . 34-0, 4-2)6 ',- PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 4 CANCEL/VOID PERMIT APPLICATION. ii REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). • Permit#: L..6. 2.016 , 005-6 6 4-- Site Address or Parcel#: 1 3 6(0 5 L..5 6 e-4-=- eki,...,cti..f Project Name: TG- Subdivision Name: Lot#: EXPLANATION: em ....1.6.3-. -f--3 to d :.Ce.?-< Cov-trc...c -'f o 1 Signature: / ./rz-- ----- Date: /0/5—//6 Print Name: , `;,,_ Jc 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. ld o j, / — "o 2, go T /r c '/� /, 0 9 - 74; . F-? - may, - - l/ .30, ,.;2/ 90", f7 :1,26, or Route to Sys Admin: Date By Route to Records: Date// By By Refund Processed: Date ///7 /, By42C7 Invoice Processed: Date By Permit Canceled: Date // 7//k, By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_0 31 .doc 111 TIGARD City of Tigard November 14, 2016 Charged Electric Attn: Sean Randall 12175 SW Summer Crest Dr. Tigard, OR 97223 Re: Permit No. ELC2016-00564 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 13010 SW 68th Pkwy Project Name: Tigard Corporate Park I Job No.: N/A Refund Method: ® Check#222902 in the amount of$904.17. ❑ Credit card"return"receipt in the amount of$ . 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 customer cancelled job. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 11111 t '"-- , 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 mi III 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 PermitAction form (if applicable) must be attached to this request form. Refund requests are due tof 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: Charged Electric DATE: 11/7/2016 Attn: Sean Randall 12175 SW Summer Crest Dr. REQUESTED BY: Dianna Howse Tigard, OR 97223 TRANSACTION INFORMATION: Receipt#: 405271 Case#: ELC2016-00564 Date: 8/1/2016 Address/Parcel: 13010 SW 68th Pkwy Pay Method: CreditCard Project Name: Tigard Corporate Park I EXPLANATION: Per applicant's request as job was award to another contractor. Refund 80% of permit fees and retain plan review fees. 1. �r�r, ,Ip� ,, f ® °r. r3... r m# L 7,- ' r�i ',r X-.�„: , • - �, • 220-0000 43103 $807.30 12%State Surchar•e 100-0000-24001 96.87 TOTAL REFUND: $904.17 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 FdR TIII Ei�%1 t -SYSTEM,;ADMI iIS'.TRAT,II I?�T iJS1 ON .Y, . C +HProcessed: Date: //��fo By: L,� ase Refund I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD ELECTRICAL PERMIT 1114 COMMUNITY DEVELOPMENT Permit#: ELC2016-00564 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/01/2016 Parcel: 2S 101 DA00100 Jurisdiction: Tigard Site address: 13010 SW 68TH PKWY Project: Triangle Corporate Park I Subdivision: VARNS ACRES Lot: 9 Project Description: Building 1 -(5)15.01 to 25 kva's for roof mounted solar photovoltaic system. Contractor: CHARGED ELECTRIC LLC Owner: PACIFIC NW PROPERTIES LIMITED PA 12175 SW SUMMER CREST DR STERN FAMILY LIMITED PARTNERSHIP TIGARD, OR 97223 STERN, HELEN R REVOCABLE TRUST 6600 SW 105TH AVE#175 BEAVERTON, OR 97008 PHONE: 503-380-4364 PHONE: 503-626-3500 FAX: FEES Quantity Description Date Amount 5 ea 15.01 to 25 kva 08/01/2016 $1,001.70 Specifics: 1 ea Each additional kva over 25 08/01/2016 $7.42 Type of Use: COM 1 ea 12%State Surcharge- 08/01/2016 $121.09 Electrical Class of Work: ALT 1 ea Plan Review Electricial 08/01/2016 $252.28 Type of Const: Occupancy Grp: Total $1,382.49 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 Cen Tho ryles are set forth in OAR 952-001-0010 through OAR 912-001-0.•0. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503. 2 87 r 1.8 332`2344. � Issued By: �" ! / . Permittee Signature: f�,✓,�fi�—� 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. 1 Electrical Permit Applicatia lr , ,, . fOR 01 1 It E 1 Si, 0y1.1 City of Tigard Date/ 717P!r i Permit#: A,1lp-J05((Q 111 • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review .W1� � i Phone: 503.718.2439 Fax: 503.598.19160! Date/B : Related Permit#: Inspection Line: 503.639.4175 •e..y sat- ® See Page 2 for 1 I CARD i�/s. Internet: www.tigard-or.gov Notified/Method: 1-,-- lki Supplemental Information > --. ItNew construction ®Addition/alteration/replacement Please check all that apply(submit./sets of plans w/items checked): 0 Service or feeder 400 amps or more 0 Building over three stories. Demolition 0 Other: where the available fault current Marinas and boatyards. . '* '0 ':' ' k ry exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or �� ...._,„. .e, *t zU � £ . 0 Emergency system. larger separately derived Job#: Job site address:13010 SW 68`h ❑Addition of new motor load of system. 100HP or more. ❑"A" "E" "1-2""1-3" City/State/ZIP:Tigard Oregon 97223 0 Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#:Bdg I Project name:Triangle Corp Bidding I 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site:68"'and 1-5 'jp tut p: ';, 7Ax i- Vit. k .... Description ..,. I Qty. ( _Each I.._ Total.. I • New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 ..�. •i ° , , � , . H < < "n ,� W ,, Limited energy,residential (with above sq.ft.) 75.00 2 Install roof mounted solar system Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy CO See Page 2 100912 ' )17 .MhT f r. ...} -' Services or feeders installation,alteration,and/or relocation Name:Pacific NW Property Managers LLC 200 amps or less 100.70 2 Address:6600 SW 105th ave 201 amps to 400 amps 133.56 2 City/State/ZIP:Beaverton1,000amps Oregon 97008 401 amps to 600 amps 200.34 2 tY601 amps to 3011.04 2 Phone:(503)626 3500 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 y Branch circuits—new,alteration,or extension,per panel .ti � �� >• - _ �- � � A.Fee for branch circuits with Business name:NW Photon Energy LLC above service or feeder fee, 7.42 2 each branch circuit Contact name:Kirk Cameron B.Fee for branch circuits without service or feeder fee,first Address:10720 SW Moapa Ave branch circuit 56.18 2 City/State/ZIP:Portland Oregon 97219 Each add'`branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)703 4046 Fax::( ) Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email:kirk@nwphotonenergy.com Reconnect only 67.84 2 __ ._sr,- r,,--<C4c .v . ;_ ;.r•" Pump or irrigation circle 67.84 2 Business name: Photon Energy - C /GI ‘67,2S 97e C77Z 1 Sign or outline lighting 67.84 2 Address: 10720 SW oa P a Signal circuit(s)or limited-energy 0 See Page 2 2 panel,alteration,or extension. City/StateIZIP:Portia Oregon 97219 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)703' i 46 Fax:( ) $03 38,0 toe, T Investigation(1 hr min) 90.00/hr Email:kirk@nwphotonenergy.com Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 1,8616 A l'7j , Electrical Lic.: (4,5 7 Suprv.Lic.:f53-5 sFecifically listed(4 hr mm) Suprv.Electrician signature,required: ,a c'�r e}vt.� Subtotal: 100912 �� u Print name: L L Date: 7-6 -(, 0 Plan Review Required(25%of permit fee): 25228 State surcharge(12%of permit fee): 12 X09 Authorized signature: ci/t-'4 TOTAL PERMIT FEE: 138249 1 This permit application expires if a permit is not obtained within 180 Print name: r A CAKeAro ij Date: 7 he up days after it has been accepted as complete. * Number of inspections allowed per permit. /3":0Z , vI:1Building\Permits\ELC PennitApp_ELR ERE.doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB O Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: Fee for all residential systems combined: $75.00ewa . 1 `n Total ' Renewable electrical energy systems: Check Type of Work Involved: s kva or less 100.70 2 5.01 to 15 kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 5 200.34 1001.7 2 Wind generation systems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 2 ❑ G• arage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance 55226 2 with OAR 918-309-0040) ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 1 7.42 7.42 3 ❑ V• acuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: Each additional inspection is 6625/hr 1 charged at an hourly(1 hr min) Inspections fich fee is specifically liorstedwh(%2 hr no mm� 90.00/ r Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): 1009.1 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ B• oiler Controls ❑ C• lock 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:\BuildinglEermits\ELC_PennitApp_ELR_ERE.doc Rev 06/17/2015