Permit CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2009 -00043
°} COMMUNITY DEVELOPMENT DATE ISSUED: 1/29/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY 120 ZONING: MUE
SUBDIVISION: TRIANGLE CORPORATE PARK LOT : 002 JURISDICTION: TIG
PROJECT: ETHICS POINT
Project Description: TI.
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:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
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: 4 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:
TIGARD TRIANGLE I LLC STONER ELECTRIC
4650 SW MACADAM AVE STE 220 1904 SE OCHOCO STREET
PORTLAND, OR 97201 MILWAUKIE, OR 97222
Phone: Contact #: FAX 503 - 659 -4968
PRI 503 - 462 -6500
FEES
Description Date Amount Reg #: ELE 26 -122C
[ELPRMT] ELC Permit 1/29/2009 $66.80 LIC 44823
[TAX] 12% State Surchar 1/29/2009 $8.02 SUP 3496S
Total $74.82 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.
-
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Issued By: c�"7 �j . Q n� Permittee Signature: 11 @q, \ OV\
LLL777 C `�'_"
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.
01/29/2009 15:53 FAX a001
-
Electrical Permit Applic EIVED FOR OFFICE USE ONLI'
Received
City of Tigard DaterB : l 2 4
:�
131 Hall lvd., Tigard, OR 40 A. 9 2009 Plan Review Other Pem,it:
Phone: 503.639.4171 Fax: 503.598.1960 Date :
Inspection Line: 503.639.4175 OF TIGARD Date Ready /By: See Page 2 for
T I G A R D P CITY OF Notified Mahod: Supplemental Information
Internet: www.tigard or. � I
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rn°• •z •.av"• :ar.�_ - ..rl.! : a ..•J:. - ;'v:.. '�.i :.,..GS� r. • +3,.r ,air .ar. fir;' $ : hr•.:oa: :,'1t,.:
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Please check all that apply (submit 2 sets of plans w / items checked below):
❑ New construction Addition /alteration/replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
g .�{;'ut:! 11 , •c"4'-' �r: tit _ - 3 •, u 3 3 41 1 ,2Val H'ua;.k, 1,4.aitX`'ijp exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
m...:i { •i riN 'liife',::_. ;r �p��. i:,. r�,...' �.',.- �' t r �r�r ,, . �; �t; ti G. a:. , lln!:';= y :j:
trf. %,. :_., >t: - ;.6;iit!:• •ttuB -'- e . ' - �' less to ground, a exceeds 14,000 ❑Commercial -use agricultural
❑ 1 - and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ builder Other. Master buer r. ❑ Fire pump. ❑ Ins
❑ Emergency s ystem. larger sepaon of 75 KVA or eri ed system.
tr,>r• lrc`c`iKL .� ern � •:;:r:. : :r� -n - i . 3 �z i �,p __ -x : • IMy: 9. � eil t ?'�i 3� 1> �%r'•I '•�'.r '.• ' 'rj �' motor lo ad of ..A.. , ,. •.
u-.a,,, a i t ,• ! I p,Olvrti 3 IEIV+1' .'. r:. .:.',0 x ;:?°�',.�ri e i ❑ Addition of aew ❑
.._,..�,d° Y sM ' .wt., .. :'lt:•`•4:- . .. r, . ;f.. ,..;... _-n � • :..:,.pal ... , , . occu arx
�QG4�Q Six o or more. e y
Job no.: 0 Job site address: �3 ZZ 1 S W J �y ❑ Six more residential units. ❑ Recreational veh parks.
❑ Health -taro facilities. ❑ Supply voltage for mon: than
City/ State/ZIP: R R ND Q � R 97223 ❑ Hazardous locations
3 600 volts nominal.
❑ Service or feeder 600 amps or more.
Suite/bldg./apt. no.: ZO Project name: ET7 c. t 6, - 1 - - L giaFOEI' ,: �i' j ;i ==', t-° :.,+ ;: `,'
Cross street/directions to job site: n°srri don ( Qty. I Fee. l Taisi 1 •
New residential single- or multi - family dwelling unit_
_ Includes attached garage. _
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: , energy, residential 75.00 2
,�, .,. . ::- ,.a:`• r - ' :� i11�:!"d� liie'i= U".-�. vtry
:rr,^�!e :Ili "i�"I. ` "0`7 N • a .-,7, r;'.t. �.. , . 9 a (with above ft. _
i �r'�'>i ,,rr i he r •� i! p�}�►p� rd:, .;£::f" 3 'ii • up : : :�:�_,.r U,, [kL ( s9� )
�?.�." �iM� r ,Fi� � ;' '!?:�- .}.•',, ., :�.,�..,..•��.'"�' a'��!,{'" ��' :I.T i7;" -ICY : :f7i,..fi'?�ue r:. G°re : :rl';,'H(t:L_. •,
'.il' ; FOIE :,- ,.- J-,i :Sl. _•OR, - r i rX',v +n --
/� Limited energy, multi -family
75.00 2
Services or feeders installation, alteration, and /or relocation
PRO V 1 !�_e- - �'/J�e�� 4..p �- - residential (with above sq. ft.) ,
+4 !/ rr��r 4t,.-.1..1-, �Q7`
/ f , : , r i „ � ?(1:G,ri� : ,- . , - ,, !;i;- G':wps lux ' - gH :.:t!� (r ' Wy y r :; "r amps or less 2
200 80 30
a r:, - a,
lF r i6 ,,s f , ;!;.[ �.•---, t ,. i ,.- . ia;i t . ! n; , T {li• igsi 201 amps to p 400 amps 106.85
a:. -. .i)ti: � i � '•• % !.. �,, e, , -., f.Wu. .Rif. ?�, jai% -, _
� ; ;� 1 ` I- I,�, � � � :•ltk� :� 3rila... .::tif•.. Ir.i.......� .....
rie? :,,, . ......,.•.,.. ._.._a, .�. L.:;: 401 amps to 600 amps 160.60 2
Name:
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and /or
City / State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or Tess 66.85 _ 1
201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not 133.75 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps
Branch circuits - new, alteration, or extension, per panel _
Owner signature: Date: - A. Fee for branch circuits with
4} s "r'! t y °a ' ��p I r " °' above service or feeder fee,
..g1:1164 rl : )trj •yyg+7' 'N``!'"''Ii }' ; 1pii:�.I4 ; t r .id`Eli ''ausJIY^%'rt!'I; ,. 2
za:;__ g4ic_�_. e�rta =t� .P .-.••. m ' i d;�{ r? nc N9!h ± R '.t ,., . ..,._ Oht. 4;.., •: " "il 6.65
each branch circuit _ .
Business name: B. Fee for branch circuits
without service or feeder fee, i 46.85 /1/ 2
Contact name: first branch circuit Vo
Address: Each add'I branch circuit 1 6.65 I9.9 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
90.90 2
_ dwelling, service and/or feeder
Phone: ( ) I Fax :: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
p r• nr,:,..,: : a °F : "t r ... ,.�.., s • `: : ,.� ,, .� -- a r ; r .. • err S,w °� lo- f (�l' ; �ieh si outline lighting 53.40 2
G , ! ' "•� ,'" u18• n .fillitt4= 'Y =4>00. tj •�,! 1 iiri {t e '
.° -di;� ... ,.nrs'}t..�iY'd.i�erl��fif'il :: ��'1 :; "'u"�S�IG.i y11L, q'� : ::tt.. 'rd'Li!ua,. =. � :lrn"IL!:.- . �;i g _
Signal circuit(s) or limited -
Business name: STONER ELECTRIC energy panel, alteration, or
P „to..n :......nroanrill Paget 2
Address: 1904 SE OCHOCO
City / State/ZIP: MILWAUKIE, OR 97222 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 4624500 Fax: (503) 659 - 4968 Investigation per hour (1 hr min) 62.50
CCB Lic.: 44823 Electrical Lic.: 26 - 122C I Suprv. Lic.: 3496S Industrial plant per hour 73.75
:,a�.tt,:r t;ua :r :�klxi'- .•...., .. ..,, �
: ;r.ac= �.li :r�T
.0- i �iPi: Npt4ii l`' a °ril9!�'.!P.!MOa9°•11t!sw: :�;.. , i;��'1'�'..1�_.+'.c+k�. :. :-t c:i,'i
Suprv. Electrician signature, requ m . 4 rM .... Subtotal: 41 et,
' Z� D Plan review (25% of permit fee): 75, Print name: MICHAEL FALCONER Date: 9 State surcharge (12% of permit fee): �. Dpi
Authorized signature: TOTAL PERMIT FEE: 74.52..
This permit application expires if a permit is not obtained within 180
Print name: , Date: days after it has been accepted as complete.
• Number of inspections allowed per penmt.
1:\ Building \PemtiB\ELC- PermitApp.doc 05/23/06 440- 46157 {11 /05 /COM/WEB
INSPECTOR'S SIGNATURES ARE NOT „
Inspections Required for: eicz ' o 3 REQUIRED ON GREEN INSPECTION CARD.
:Code Inspection Description :`PASS Date I` ✓ i.Code . `3nspecfion Descnptwn =:• PASS Date I $y :, ;
BUP - Building Permit . ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG - Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
• 215 Footing drain 135 Low voltage
220 Slab • 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post /beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors ) 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing • ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 •Tilt -up panel 195 Misc. inspection:
265 Masonry _ 199 Electrical final.
270 Reinforcing steel (rebar) •
275 Framing
810 MFG - Structure set -up MEC - Mechanical Permit
280 Insulation 605 Post /beam mechanical
285 Drywall nailing 610 Gas line •
•
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final • 630 Fire damper
i 299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab
910 Sprinkler rough -in PLM - Plumbing Permit
305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test • 315 Post /beam plumbing
995 Misc. inspection: •
320 Plumbing rough -in
998 Alarm final 322 Shower pan
999 Sprinkler final 330 Water service
• 335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert /catch basin
410 Fill 350 Septic tank •
415 Grading 395 Misc. inspection:
205 Footing • 399 -Plumbing final •
210 Foundation walls •
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection • 599 Final inspection
I:\ Building \Forms \InspCard- AOP- Blank.doc 02/02/07
•
•
• City of Tigard, Oregon 0 13125 SW Hall Blvd. a Tigard, OR 97223
11111
•
• - :.
August 27, 2009 i . _ _ .
Stoner Electric Inc.
1904 SE Ochoco
Milwaukie, OR 97222
. Attn: Dennis Whitcomb
Re: Permit No. ELC2009 -00043
Dear Mr. Whitcomb:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 13221 SW 68 Pkwy, Ste. 120
Project Name: Ethics Point
Job No.:
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $59.86.
El Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as job site address was incorrect. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
I: \Building \Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 . • www.tigard - or.gov e TTY Relay: 503.684.2772
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
T1GARD
Receipt Number: 175005 - 08/27/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2009 -00043
$ -59.86
Total: $ -59.86
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 067672 DHOWSE 08/27/2009 $ -59.86
Payor: Stoner Electric Inc.
Total Payments: $ -59.86
Balance Due: $59.86
Page 1 of 1
n CITY OF TIGARD 1/29/2009
,
M ill
13125 SW Hall Bh d, 4: 1 6:41 PM
Tigard, OR 9722] 503.639.4171
TIGARD
N .
O
O
gl Receipt #: 27200900000000000224 .t)/ I "= .!_
Date: 01/29/2009
Line Items:
Case No Tran Code Description Revenue recount No Amount Paid
ELC2009 -00043 [ELPRMT] ELC Permit 220 - 0000 - 431510 66.80
ELC2009 -00043 [TAN] 12% State Surcharge 100- 0000 - 207020 8.02
. Line Item Total: $74.82
Payments:
Method Payer Uscr ID Acct. /Check No. Approval No. Hone Received Amount Paid
CreditCard STONER ELECTRIC INC LS 067672 Fax 74.82
Payment Total: $74.82
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cReceiI,r.rpi Page I of 1
City of Tigard
TIGARD Accela 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 Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Stoner Electric Inc. DATE: 8/20/09
1904 SE Ochoco
Milwaukie, OR 97222 REQUESTED BY: Dianna Howse
Attn: Dennis Whitcomb
TRANSACTION INFORMATION:
Receipt #: 2009 -224 Case #: ELC2009 -00043
Date: 1/29/09 Address /Parcel: 13221 SW 68th Pkwy, Ste. 120
Pay Method: CreditCard Project Name: Ethics Point
•
EXPLANATION: Per applicant's request as address was incorrect. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245- 0000 - 432000.. $ Amount
[ELPRMT] ELC Permit 220- 0000 - 431510 $53.44
[TAX] 12% State Surcharge 100- 0000 - 207020 6.42
TOTAL REFUND: $59.86
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager 4 ,.
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Refund Request Reviewed: Date: - t= f /'., ^r '.; By:*� --
Case Refund Processed: Date: of /LA d c By: f�
I: \Building \Refunds \RefundRequest.doc 04/13/09
02/03/2009 10:44 FAX Z001
I II ■ Community Development _ _ ; -, . ;�-��
TIGARD
I ' ' �
;.
Request for Permit Action ,
t 6
r:t r� )
T CITY OF TIGARD r �.,.,c'tL,l� =° 1
Building Division Services Coordinator 1�µt1i
13125 SW Hall Blvd., Tigard, OR 97223 C13
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
(check one)
REFUND OR Name: STONER ELECTRIC, INC.
INVOICE TO: (Business or Individual)
Mailing Address: 1904 SE OCHOCO •
City/State /Zip: MILWAUKIE, OR 97222
Phone No.: 503 - 462 -6500
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 #: ELC2009 -00043
Site Address or Parcel #: / ' `� . � &- 6 -1 : Yee:, / f =_ `�
Project Name: ETHICS POINT
Subdivision Name: Lot #:
EXPLANATION: PROJECT MANAGER FURNISHED INCORRECT SITE ADDRESS,
ACTUAL SITE WAS IN THE CITY OF BEAVERTON (B2009 -0288)
Signature: /r ..� ' ( 3- 4,2- -�7is) Date: 2/3/09
DENNIS WHITCOMB
Print Name:
Refund Poli
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 emended
c) not more than 80% of the land use application fee forissued 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 snore 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 O t ONLY
Rte to S , Admin: Date , gel u ra Rte to Bid! Admin: Date GAW® B , r y
Refund Processed: Date f= p c� By , /1 Invoice Processed: Date By
Permit Canceled: Date /;,2 7 By i Parcel Tag Added: Date By
Receipt # Date Method Amount S