Permit r V , C IT Y OF TIGARD ELECTRICAL PERMIT
:: sx� ,° T ��( PERMIT #: ELC2008 -00131
COMMUNITY DEVELOPMENT DATE ISSUED: 3/6/2008
TIGD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1512600 -00300
SITE ADDRESS: 09645 SW WASHINGTON SQUARE RD FC08 ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
PROJECT: GYRO EXPRESS
Project Description: Installing (1) electrical sign.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON SQUARE LLC MULTI -LIGHT SIGN CO.
BY THE MACERICH COMPANY 809 NE LOMBARD ST
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97211
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 281 - 3083
FAX 503 - 280 -9624
FEES
Description Date Amount Reg #: ELE 26 -90CLS
IFILPRMI] PLC Permit 3/6/2008 $53.40 LIC 64107
[FAX] 12% State Surchar 3/6/2008 $6.41 SUP 343SIG
Total $59.81 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: /i / 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'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 s a ` ^ o , ; f; o r_ ICE US ON Y , 1
. , - S ; ' r i� it
y' ' , Received
Ci ty of Tigard DateB 7 4 , I Permit No.: _ _ A -- J
'`13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permit.
r d [ Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
I IGAkD;
Inspection Line: 503.639.4175 Date Ready /By: 3uris: Ei See Page 2 for
t •4,44 Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction r- Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEG RY 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: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
100HP or more. occupancy.
Job no.: Job site address: 9 & tis . L �C $�11 /'GA G;0 SQ ❑ Recreational vehicle parks.
( L irr ; ❑ Six or more residential units. p
❑ Health -care facilities. ❑ Supply voltage for more than
City /State /ZIP: -- 1 - 7 � , c, e� �:� i <:___
r ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: �1 L (() F X t 7 Ire ��s ❑Service or feeder 600 amps or more.
; ` FEE SCHEDULE
Cross street/directions to job site: W � . -� / 2� C Description 1 Qty. 1 Fee. 1 Total 1 *
4! New residential single- or multi - family dwelling unit.
1._ -I- 1./1J L 2- & Includes attached garage.
Subdivision: l Lot no.: 1,000 sq. ft. or les 145.15 4
Tax map /parcel no.: Ea. add] 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
C _.C- 7--1-:-._1 / [ e- e:77 / 1/4,-2....._6 c . -1- -- 6 ..G,. - residential (with above sq. ft.)
1 Services or feeders installation, alteration, and /or relocation
-,/,i 200 amps or less 80.30 2
2 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: wC.:i c4-1.--0 i1 c L -�.G
`� s ( 1 601 amps to 1,000 amps 240.60 2
Address: p , . p,fu -q C G Over 1,000 amps or volts 454.65 2
City/State/ZIP: /State /ZIP: f� --D Temporary services or feeders installation, alteration, and /or
y !. L- 7� -S C1 t- / 4- s, c 2 6, relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
I`I' APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: 7 B. Fee for branch circuits
G�/1�Y1 -7a q - �/1i1�
Contact ( f without service or feeder fee,
ontact name:
."' e. - G4 r7 G4 Gam , .A._-- first branch circuit 46.85 2
Address: eg 16 • L7 �1.L / � Each add] branch circuit 6.65 2
/ '� Miscellaneous (service or feeder not included)
City /State /ZIP: dh9 - 1 , -- /fX �� Each manu modular
dwelling, service and /or or feeder
90.90 2
Phone: ( 73) 77-7 - �/ S-'--' : ( ) Reconnect only 66.85 2
E -mail: 7 Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 1 53.40 S 3 L/ G) 2
Signal circuit(s) or limited -
Business name:
Mt, / f / 1 / , h.-1- < , r C O energy panel, alteration, or
Address: C ) extension. Describe: Page 2 2
City /State /ZIP: 1 ��. 7 - y) J 0 Each additional inspection over allowable in any of the above
J 4 a _ Per inspection 62.50
Phone: (503) . -7 7,- 473 s Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: / 7 S Z J 7 Electrical Lic.: L - 1 b , , Suprv. Lic.:° Ind ustrial plant per hour 73.75 • 3� l 3 5 L cn ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: P g q Subtotal: S3 . -to
7-,-- Plan review (25% of permit fee):
Print name: ir 1,1' t. j J '� L %' - h Date: 3/e--.16 ,c (12% 1
State surcharge (12 /a of permit fe t e , H;
Authorized signature: =tZ TOTAL PERMIT FEE: t-.55 1
This permit application expires if a permit is not obtained within 180
Print name: - f -- e v W c \Kfir. Date: j/ 1 t days after it has been accepted as complete.
( * Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05 /COM/WEB
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
•
T I GARD
April 21, 2008
Ramsay Signs, Inc.
9160 SE 74 Ave.
Portland, OR 97206
Re: Permit No. ELC2008 -00131
Dear Sir /Ms.:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 9645 SW Washington Sq Rd
Project Name: Gyro Express
Job No.: N/A
Refund: ® Check #56996 in the amount of $47.85.
❑ Credit card "return" receipt in the amount of $ .
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as the work is being done by another contractor. Refund
80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
'CO,r
Dianna Howse
Building Division Services Coordinator
Enc.
I:\ Building\ Refunds \Administ ration \LtrRefund- CancelPenmtdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
City of Tigard
T I G A R D Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Ramsay Signs, Inc. DATE: 4/14/08
9160 SE 74 Ave.
Portland, OR 97206 REQUESTED BY: Dianna Howse
DEB
TRANSACTION INFORMATION:
Receipt #: 2008 -735 Case #: ELC2008 -00131
Date: 3/6/08 Address /Parcel: 9645 SW Washington Sq Rd
Pay Method: Check Project Name: Gyro Express
EXPLANATION: Per applicant's request as the work is being done by another contractor. Refund 80% of
permit fees.
REFUND;INEORMATIQNc " ":''' �; ?:.. _ r•.;�.. ;•:
F ee' Descri° tion F rom`Recei 't•` — Revenue_ Account No::
`',- �,�� ".;- � Refund• -: •:..:
°Exam UILD `Permit F`ee " �, ;:Exam l'e:.: 245'- 0000 =43200 '
[ELPRMr] ELC Permit 220 - 0000 - 431510 $42.72
[TAX] 12% State Surcharge 100- 0000 - 207020 5.13
TOTAL REFUND: $47.85
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager ✓ 4 / " l 9 .09
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
SYSTEM'ADMINISTRATION
,/ Case Refund Processed: I Date: I .1/y�Q,f I By: I
I: \Building \Refunds \RefundRequest.doc 05/23/07
CITY OF TIGARD 3/26/2008
13125 SW Hall Blvd. 1 0:34: 17A M
•
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200800000000000735
Date: 03/06/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
ELC2008 -00131 [ELPRMT] ELC Permit 220 - 0000 - 431510 53.40
ELC2008 -00131 [TAX] 12% State Surcharge 100- 0000 - 207020 6.41
Line Item Total: $59.81
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Check RAMSAY SIGNS, INC. BTT 2289 In Person 59.81
Payment Total: $59.81
cIterripI.rpI I'ame I of I
I
•
, q Communi De velo ment REur- 1,, = Li
t 3' P
TIGARD
Request for Permit Action M 2. 6
CITY OF i!CiPASO
tSUILOINOtI ISIOR:
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor cSrCity Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) 6. /1 (/ ") ff
V e D • Mailing Address: C) 1 .E_ ? 4 Al..) `C,
9f Atig4f. City /State /Zip: P o (2_ n) b O2 9 7 o 6
Phone No.: S C 3- 777- 4 ( - 1 h J L L o a
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below). -
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). .
Permit #: E LC Aoo $ - DO / of /
Site Address or Parcel #: q i-P q 5 c51.0 L J f o ff /,JCo TUA-.) , e .
Project Name: (v Ex Pe_g S '
Subdivision Name: fJ /fj Lot #: N.)//t
EXPLANATION: L,0012,1, 14 fi. t - 6gi. J N..f Jlous L y P/2..1 7Th
ll OD f.2 Er t_A 0 — 0004
Signature: L .l! _LL 1...x , Date: 5- ge
Print Name: _ThE6g-( 4Tj f} i -{5(.
Refund Policy
1. The Director or Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date Ate OR 13 • /0 Rte to Bldg Admin: Date By
Refund Processed: Date y//y /p,F By 444 Invoice Processed: Date By
Permit Canceled: Date / 50,p- By Parcel Tag Added: Date By
Receipt 14,0e-9/5 Date ,3 /b /per Method ` Amount $
I:\ Building \Forms \RegPermitAction.doc R6v 07/26/07