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Permit
CITY OF TIGARD ELECTRICAL PERMIT ~ PERMIT #: ELC2008 -00509 COMMUNITY DEVELOPMENT D ATE ISSUED: 9/4/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2 S 113A D -017 00 SITE ADDRESS: 16800 SW 72ND AVE ZONING: C -G SUBDIVISION: ROSEWOOD ACRE TRACTS LOT : 030 JURISDICTION: TIG PROJECT: BED BATH & BEYOND Project Description: (6) branch circuits. 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: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 5 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: BRIDGEPORT LAND LLC SQUIRES ELECTRIC 3939 NW ST HELENS RD PO BOX 16851 PORTLAND, OR 97210 PORTLAND, OR 97292 Phone: Contact #: PRI 503 - 252 -1609 FAX 503 - 253 -5831 FEES Description Date Amount Reg #: ELE 26 - 1101C [ELPRMT] ELC Permit 9/4/2008 $80.10 LIC 135085 [TAX] 12% State Surchar 9/4/2008 $9.61 SUP 5377S Total $89.71 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: / • ermittee 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. 09/03/2008 15:23 5032535831 SQUIRES ELECTRIC PAGE 02/02 Electrical Permit Application For OrrIC r I.St 0.N1...1' City of Tigard .. eeeived • Data)) : l ire . f� Permit No.: _ Ara - 0 13125 SW Hall Blvd, Tigard, OR 97223 Oki) A Phone: 503.639.4171 Fax: 503.598.1960 q q ‘ \ Other Permit: n p'll,VV_ o u 63 Inspection Line: 503.639.4175 1 • T i t-; A K i) a S p Date Reedy/By: Page t for Internet www,tigatd- or.gov `` z, A ed/M thod: � Supplemented lofbemstfo . ❑ New construction k' Ad dition/aleeration/repla • s ' Please check en that apply (submit 2 oats of plans wfitems checked below ❑ Demolition ❑Off: t \, ❑ Service or feeder 400 amps or more ❑ Building over three stories. or r .�;; • were the available fault current ❑ Mamas and boatyards. f:. ?'., t, ( ` . s ` OyI 1 gs o f 1 'R h „ < (` > `f ) < iC `i ao=eedx s at t3 ❑ Flosti ld ❑ 1- and 2-family dwelling 0 Commercial/industrial ❑ Accessory building less to gro 10.000 or amp in 1 150 vo1 n . ❑ Co bui - use agriculhva amps £m all other installations. buildings. ❑ Multi-family ❑ Master builder 0 Other: ❑ Fire pip. ❑ Installation of 75 KVA or e . ::)» ? !sett larger eta de separately cY Yd r ived .... a ....... ... ; . ..: .< 5�x ;ii <l *• 3(a� •'� tk ` ` r . a ::.i:i Ba �P Y sy t t < ... .... �'��: ❑ Addition of new motor load of Job no -: kb site address: I /400 0 ij) r /- , I t oe, 100HP or more. ❑ a ncy. ". "l -3 ". (yp y n ,/-� ❑ Six or more residential unite. ❑ Recreational vehicle parks. City /.5tatea rc b V ❑ Health -we facilities. ❑ Supply voltapa fbr morn t � / 1` ❑ Hazardous locations. 600 wits nominal. Suite/bldg. /apt. no.: I Project name: e,Y g._____. ❑ service or feeder 600 amps or more. Cross street/directions to job site: t .. me t/ a' —ILA Q42 Fes 7otat - New residential single- or multi -fumy dwelling unit. Includes attached garage. Subdivision: l Lot no.: 1,000 sq. ft. or less 145.15 Tax map/parcel no.: Ea. add'I 500 sq. R or portion 33.40 , . : >:::< :f:: :«:... Limited energy, residential `.., .s....:s�' 9x F 75.00 U• ,< ..)s. ;.., .).. , . ..\ , :'. ( withabovey, multi-family R) i �QA-) e. 1 I ) ° 1� 6 L energy, ii l ly 75.00 � residential (with above sq. it.) �l Services or feeders Installation, alteration, and/or relocation t. y ,yy��afa• F, 200 amps or lees 80.30 "......: (i.. ('tll i eK i t.�, I� i,..tt1 :,< d , t s < >:.t..c)...... % ..:;:<......s. ....:. .( ...:.,... <.. 201 amps to400amps 106.85 401 amps to 600 amps 160.60 601 amps to 1,000 amps 240.60 Over 1,000 amps or volts 454.65 1• Temporary service, or feeders installation, alteration, and/o relocation 200 amps or less 66.85 Owner This y : :. , s is being made on property that own t 201 amps to 400 amps 100.30 intended • exchange, .. to • • 1 and 701. 401 amps to 599 amps 133.75 • t y , : , ' a : _ Branch circidts - new, alteration, or extension, per panel A. Tree for branch circuits with :iii .'.:i:ts:F:>i:i: SaAf:> . s::t .,. : ab ove service or ee fee, 6.65 ,.. ca h br anc h ci rcu f it d Business Hattie: a Fee for branch circuits Contact name: without service or feeder fee, I 46.85 44g:5 Sret branch circuit Address; Each add'1 branch circuit a 6.65 , gS, ,,,1 MLeceilvheou, (service or feeder not included) City /State/ZIP: Each manufactured or modular 90,90 dwelling, service and/or feeder Phone: ( ) 1 Fax- : ( ) Reconnect only 66.85 E-mail: Pump or irrigation circle 53.40 : > i% . .. .... :•:> �•• ...:........i ..:... :. ,:::rz::.::.: >:.: :. , .< .. >. u ), <ia:<s:':: :: -s::,a Sign or otrtlume ligh Business name: i,•d ¥ 4 / r i' - it. @_„ m eta l p a ne l, al er t o d - 5340 e nergy panel, alteration, or Address b 14 '5 / extension. Describe: Page 2 City /State/ZIP :. / " . d - b mo D k 9'419.4- - Each additional inspection over allowable In anxof the abov _ Per inspection 62.50 Phone ( g6 -) -o9 Fax ( )- 6 3 59..3 Investigation r gation per hour (1 hr min) 62.50 . CCB Lic.: 13 j 5 be .5- Electrical Lic.: ,i J jj Suprv. Lic.: 4g), industrial pleat per botu 73.75 . Supry. Electrician signature, required. .st , sabres!, S9 , / � Print name:.0 A fc r , r E,� i D Q/ ,q 6? Plan review (25% ofpermit fee): " "� ( " �f State surcharge (12% of permit fee): q , I Authorized signature: TOTAL PERMIT FEE: 'C . 1 1 I Print name: This permit application expires if a permit is not obtained within 18 • Date: days after ft has been accepted es complete. + Number of inspections allowed per permit. I:\6udtdtover us\ELC- PetmitApp.doc oats/00 440- 4015T(i1 /05 /COMAVEB • City of Tigard, Oregon ° 13125 SW Hall Blvd. © Tigard, OR 97223 • • August 27, 2009 Squires Electric P.O. Box 16851 Portland, OR 97292 Attn: Donna Toothman Re: Permit No. ELC2008 -00509 Dear Ms. Toothman: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 16800 SW 72n Ave. Project Name: Bed, Bath & Beyond Job No.: Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $71.77. ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as job was cancelled. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, • V 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 • TTY Relay: 503.684.2772 Q CITY OF TIGARD RECEIPT i p . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD X. t ? Receipt Number: 175003 - 08/27/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2008 - 00509 $ Total: $ -71.77 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 015749 DHOWSE 08/27/2009 $ -71.77 Payor: Squires Electric Total Payments: $ - 71.77 Balance Due: $71.77 Page 1 of 1 9/4/200S 11,11 CITY OF TICARI) 7 11:37:59AM N t 3125 SW flail Blvd. -• o • 'Tigard, OR 97223 503,639.4171 • cv TIGARD _ / � / • o ��6�� f � / / ll a -.,® -. o - Receipt #: 272008000000000031 12 •' 'Date: 09/04/2008 • O . ' Line Items: . Case ND 'Fran Code Description Iteveaue account No Amot i ''aid IiLC200S -00509 [1.A.PRMTJ IELC I'crniit 220- 0000 - 431510 40.10 1.:1.C200S -00509 RAN] ] ) 2% Stale Surcharee 100 - 0000.- 207020 9.61 Line Item Total: $89.71 Payments: 1 Method Payer t . ser ID Acet., Check No. Approval No. How Received Ammnut Paid cc w CredilCard SQUIRES IiLEC'PRIC 13TT 015749 Fax 5 w Payment Total: 589.71 w o • . J • '. F • M CO In c`) 1 N'1 N ( • 7 • 1 O • I If) . v N O I O O . N a C., cv 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: Squires Electric DATE: 8/20/09 P.O. Box 16851 Portland, OR 97292 REQUESTED BY: Dianna Howse Attn: Donna Toothman TRANSACTION INFORMATION: Receipt #: 2008 -3112 Case #: ELC2008 -00509 Date: 9/4/08 Address /Parcel: 16800 SW 72 ^d Ave. Pay Method: CreditCard Project Name: Bed, Bath & Beyond EXPLANATION: Per applicant's request as customer cancelled job. 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 $64.08 [TAX] 12% State Surcharge 100- 0000 - 207020 7.69 TOTAL REFUND: $71.77 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager INA4 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 r ' Refund Request Reviewed: Date: ;'/ ,s'y r i By: Case Refund Processed: Date: By: �1/ I:\ Building \Refunds \RefundRequest.doc 04/13/09 L „ Community Development DEC 3 0 2008 Request for Permit Action C OF TIGARD BUILDING DIVISION TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 wlvw.tigatrd or.gov • FROM: Owner ❑ Applicant Contractor ❑ City Staff (check one) REFUND OR Name: �j z � ( yJ 1GC- �Y1 INVOICE TO: Burinccc or Individual) /Z,�° re - 4 Mailing Address: n l oX I Ce 55 • • City /State /Zip: I Q�i- I Die 9 7c)'9.1 Phone No.: 563 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). I INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). • Permit #: Eke_ a c j v g” Do 5 C q • is Site Address or Parcel #: I teg v6 (,(, Ave- Project Name: ec( nn Subdivision Name: >QC�e Wc..c . CC A iL/'e rrr.� Lot #: D3 EXPLANATION: 40075 I . . 1 Signature: ,�,� nn ,n9 Date: 0- 8Z Print Name: DO hv1ot_ C 171ce : yk Y , • • Refund Polies 1. The Director or Building Official may authorize the refund of. a) any fcc which was ern meoualy paid or collected. • b) not moec than 130% of the land use application fee when an application is withdrawn or ainceled before any review effort has been expended. c) not more Chan 140% of the Land use application fcc for issued permits. d) not more than 80° /, of the building plan review fcc when an applicetiun is canceled before any plan review effort hea been expended. r) not more than 80% of the building permit fee for is :;ued permits prior to any inspection raluests. 2. Refunds Will be Ieturned to the original Payer in the Sarre ,m thud in which payment w2.< received. Please allow 1 - weeks for worming refunds. Rte to Sys Admi n: Date IMMirifi B Rtc to Bld Admire Datc ;t 7® B _a - Refund Proccsscd: Date :yA►® g r/f�� nvoice Proccsscd: Date B Permit. Canceled: Date Affyinii By L ,45,0 Parcel `1'a. Added: Date Rccei.t # Date ' Mcthod Amount $ l:\ Building \Pottru \ReeennitAction.doc Rev 07/26/07 i;00/100'd OLLOA 3I813313 S3tIIlOS LE89ESZE09 DZ :OL 800Z /0E /ZL