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Permit r 08/26/2009 10:40 FAX 503 462 6555 HVAC INC Z001/001 ~ IC2od4.o6 aa3 Community Development Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.dprd-or.gov FROM: ❑ Owner E Applicant ® Contractor ❑ City Staff (check one) REFUND OR Name: HVAC, Inc. INVOICE TO: (Business or individual) Mailing Address: 5188 SE International Way City/State/Zip: Milwaukie, OR 97222 Phone No.: 503-462-4822 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ® 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 ELC2009-00223 Site Address or Parcel 7501 SW Dartmouth St Project Name: PetSmart Subdivision Name: Lot EXPLANATION: Not doing any low voltage wiring for this job Signature: Date: 8/26/09 Pew Print Name: dy D Refuted p_ wiu 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 b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended, c) not more than 80% of the land use application fee for issued permits.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"/o of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be ret=ied to the original payer in the same method in which payment wan received. Please allow 1-2 weeks for processing refunds. MICRO Rte to Sys Admin: Date /.A (v to 9 B Rte to WTg Admin: Date B f Refund Processed: Date B Invoice Processed: Date B Permit Canceled: Date B Parcel T Added: Date B Receipt # Date Method Amount $ I:\Building\Forms\RcgPermitAction.doc Rev07/26/07 S' Blvd. Tiger d, R 97223 October 2, 2009 k*~ HVAC, Inc. 5188 SE International Way Milwaukie, OR 97222 Attn: Jody DePew Re: Permit No. ELC2009-00223 Dear 1\,1s. DePew: The City of Tigard has canceled the above referenced pernut(s) and enclose a refund for the following: Site Address: 7501 SW Dartmouth St. Project Name: Petsmart Job No.: Refund: ® Check #100998 in the amount of $67.20. ❑ Credit card "return" receipt in the amount of $ ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as contractor is not doing this work. Refund 80',o of permit fees. If you have any questions please contact me at 503.7182430. Sincerely, Dianna Howse Building Division Services Supervisor 01/16/(17 Phone: 503.639.4171 o Fax: 503.684.7297 a www.tigard-or.gov o TTY Relay: 503.684.2772 I ~zoo9 - woa3 FA City of Tigard Accela Refund Request M - This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for PermitAction 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: HVAC, Inc. DATE: 9/22/09 5188 SE International Way Milwaukie, OR 97222 REQUESTED BY: Dianna Howse Attn: Jody DePew TRANSACTION INFORMATION: Receipt 173719 Case ELC2009-00223 Date: 5/29/09 Address/Parcel: 7501 SW Dartmouth St. Pay Method: Check Project Name: Petsmart EXPLANATION: Per applicant's request as not doing any low voltage for this job. Refund 80'.'0 of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: [BUILD] Permit Fee Example: 245-0000-432000 $ Amount Limited Energy Permit Fee 220-0000-431510 $60.00 12`,'o State Surchar e 100-0000-207020 7.20 TOTAL REFUND: $67.20 APPROVALS: If under $500 Professional Staff _ If under $7,500 Division Manager 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: $ 7Case Refund Processed: Date: / By: I:ABuilding\Re'fun~is\KefundAc,qucst.doc 04/13/07 , „ity of Tigard, Oregon ° 13125 SW Hall Blvd. o Tigard, OR 97223 g; � .; :,', - = N ; e. ph October 2, 2009 . - • .. - _ HVAC, Inc. 5188 SE International Way Milwaukie, OR 97222 • " Attn: Jody DePew Re: Permit No. ELC2009 -00223 Dear Ms. DePew: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 7501 SW Dartmouth St. Project Name: Petsmart Job No.: Refund: ® Check #100998 in the amount of $67.20. ❑ Credit card "return" receipt in the amount of $ . ❑ Trust account "deposit" receipt in the amount of $ . Notes: Per applicant's request as contractor is not doing this work. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. . • Sincerely, ,' : f J 7 Dianna Howse Building Division Services Supervisor . Enc. l: \ Building \ Refunds \ Administration \LtrRefund- Cancell'crmit.doc 01/16/07 Phone: 503.639.4171 o Fax: 503.684.7297 e www.tigard- or.gov o TTY Relay: 503.684.2772 - ° 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: HVAC, Inc. DATE: 9/22/09 5188 SE International Way Milwaukie, OR 97222 REQUESTED BY: Dianna Howse Attn: Jody DePew TRANSACTION INFORMATION: Receipt #: 173719 Case #: ELC2009 -00223 Date: 5/29/09 Address /Parcel: 7501 SW Dartmouth St. Pay Method: Check Project Name: Petsmart EXPLANATION: Per applicant's request as not doing any low voltage for this job. Refund 80% of permit fees. _REF.,:UND INFORMATION:. : :F.,ee =Desch non:: From Recei ' t ' P. .,.. ..P., . ,;: Reve �Accouii.t•: No: 'Refund s' �� �� •3i`Il 'le'; � .:IJ'ILD Perinif Fee �'� `' - - . - ....... P .... �.. . .] .... Limited Energy Permit Fcc 220- 0000 - 431510 $60.00 12% State Surcharge 100- 0000 - 207020 7.20 TOTAL REFUND: $67.20 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager idt tti If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board i FOR ACCELA ADMINI,ST.RATI Refund Request Reviewed: Date: ' ' 2 , / - p, By: t' ; .:':- Case Refund Processed: Date: ) l By: I: \Building \Refunds \RefundRequest.doc 04/13/09 CITY OF TIGARD RECEIPT a . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 175425 - 10/02/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2009 - 00223 $ - 67.20 Total: $ 47.20 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 100998 DHOWSE 10/02/2009 $ -67.20 Payor: HVAC, Inc. Total Payments: $ - 67.20 Balance Due: $67.20 Page 1 of 1 - ,� CITY OF TIGARD RECEIPT _ : a 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 - 1 - [CARD Receipt Number: 173719 - 05/29/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2009 -00223 12% State Surcharge - Electrical 100- 0000 - 207020 $9.00 ELC2009 -00223 Signal circuit or Limited Energy Panel 220 - 0000 - 431510 $75.00 Total: $84.00 .PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID .RECEIPT DATE RECEIPT AMT Check 5872 LSELLERS 05/29/2009 $84.00 ' • Paybr: HVAC INC • Total Payments: $84.00 Balance Due: $0.00 • Page 1 of 1 04/26/2009 10:40 FAX 503 462 6555 HVAC INC • Ij001 /001 I Community Development . e Request for Permit Action TIGr \R 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 ❑ City Staff (check one) REFUND OR Name: HVAC, Inc. INVOICE TO: (Bucmcss or Individual) Mailing Address: 5188 SE International Way City/State /Zip: Milwaukie, OR 97222 Phone No.: 503- 462 -4822 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 -00223 Site Address or Parcel #: 7501 SW Dartmouth St Project Name: PetSmart Subdivision Name: Lot #: EXPLANATION: Not doing any low voltage wiring for this job . . Signature: I I AP' Date: 8/26/09 r.. y D Pew Print Name: Refund Policy I. The Director or Building Official may authorise 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. c) 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 to! I'I( ;C•; I . SI - : ()NIA . Rte to S s Admin: Date $ E r r o • E Y .Rte to a ,. Admin: Date / AggrAgi B % , Refund Processed: Date By Invoice Processed: Date • By Permit Canceled: Date By Parcel Tag Added: Date By • . Receipt # Date Method Amount $ I: \Building \Forms \RegPetmitAction.doc Rev 07/26/07 ., CITY OF TIGARD ELECTRICAL PERMIT 2 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00223 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/29/2009 Parcel: 1S136DCO2503 Jurisdiction: Tigard Site address: 7.501- SWDART: :MOUTH=ST 200 Subdivision: Lot: 0 Project: Petsmart Project Description: Install restricted energy for thermostat wiring. Owner: FEES LURIA, MARK T AND Quantity Description Date Amount WHEELES, DOYLE E, BY PETSMART INC /PROP MGMT, 19601 N 27TH AVE 4TH FL 1 ea Signal circuit or Limited 05/29/2009 $75.00 Energy Panel PHONE: 1 ea 12% State Surcharge - 05/29/2009 $9.00 Electrical Contractor: HVAC INC 5188 SE INTERNATIONAL WAY MILWAUKIE, OR 97222 PHONE: 503 - 462 -4822 FAX: 503- 462 -6555 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $84.00 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 rul s are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.24 .669 or 1.80 t2.234. / I Issued By: A • _ .1 _ � ,, L. ♦ ft 466 Permittee Signature: ■117••••J 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 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 RECEIVED FOR OFFICE USE ONLY CI of TI and !' Permit No.: III - 'J g R eceived Date/By:` / � � - &c'Ze0 9 —opt)? s ° 13125 SW Hall Blvd., Tigard, OR 97223 M 19 2009 Plan Revi r Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit. TIGARD Inspection Line: 503.639 Date Ready/By: 1uris: RI See Page 2 for Internet: www.tigard- or.gov CITY OF TIGARD Notified/Me � /�� l�j Supplemental Information TYPE OF DING DIVISION � � a -LAN REVIEW ❑ New construction ,J. Addition/alteration /replacement Please check anal apply i bmit 2 sets of plans w /items checked below): ❑ Service or fe - r er 400 amps or more El Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. • CATEGORY 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 45:1 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 ", "1 -2 ", "1 -3 ", Job no.: 1,4 6 1 Job site address: — n1)1 SW QC V.110V S+ J 100HP or more. occupancy. ❑ J 0 Six or more residential units. Recreational vehicle parks. City/State /ZIP: �� ( I t , M� a�� �/I ❑ Health -care facilities. ❑ Supply voltage for more than vvv�w��_ �w ttt <� ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: 'a'A I Project name: kr,SLAAft.,4 ❑ 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 145.15 4 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 ' u• DESCRIPTION OF WORK , • (with above sq. ft.) Limited energy, multi - family AIM) V D I 414 " v_ i V io J tak 10\V residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ■ .PROPERTY : OWNER . ❑ TENANT . 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps , 240:60 . 2 Address: Over 1,000 amps or volts 454:65 2 City/State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) I 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 ., ' APPLICANT' I CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: \) A V\ B. Fcc for branch circuits Contact name: Y without service or feeder fee, 46.85 2 first branch circuit Address: C l R /. / yV) d w Each add'I branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/State /ZIP: ' I r `\ IWRA K C -) Each manufactured or modular tt Die, � ' -. dwelling, service and/or feeder 90.90 2 Phone: S T O � j ) ti g � � / Fax: : b 3 ) 4 2S S Reconnect only 66.85 „ 2 E -mail: ' t)Cky VW �(�,11/� t CD Pump or irrigation circle 53.40 ; I 2 / Co NTRA C'I OR Sign or outline lighting 53.40 _ 2 Business name: ?a /( Signal circuit(s) or limited - V (AL., energy panel, alteration, or / Address: extension. Describe: / Page 2 2 City/State /ZIP: � )n f �S �tj'\ additional inspection over allowable in any of the above Phone: ( ) N V I Fax: ( ) Per inspection 62.50 Investigation per hour (1 hr min) 62.50 CCB Lic.: ''..ti t" 1) J Electrical Lic. - 9 S1 I (✓ Suprv. Lic :: , V 0 Industrial plant per hour 73.75 p1s 1 J " 1 . ELECTRICAL PERMIT FEES • Suprv. Electrician signature, required: Subtotal: Print name: M OVA)' I Date: sytq! 6 Plan review (25% of permit fee): r ((( State surcharge (12% of permit fee): Authorized signature: It f . , l l TOTAL PERMIT FEE: U � ,� This permit application expires if a permit is not obtained within 180 Print name: Q ck NIWO Date: Siff days after it has been accepted as complete. ' Number of inspections allowed per permit. 1: \Building\Permits - PermitApp.doc 05/23/06 440- 4615T(I 1/05 /COM/WEB Electrical Permit Application - City of Tigard • Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: 'RESIDENTIAU WORK ONLY: . Fee for all residential systems combined .. $75.00 Check Type of Work Involved: n Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical n Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations l \Building\Permits\ELC- PermitApp doc 03/23/06