Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 11- COMMUNITY DEVELOPMENT Permit #: ELR2009-00088
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/17/2009
Parcel: 1 S 135AB03400
Jurisdiction:
Site address: 1.926,0 SW GREENBUR.G_RD 375
Subdivision: Lot: 0
Project: MASTERCARE
Project Description: TI -low voltage for HVAC.
FEES
Owner:
SHORENSTEIN REALTY SERVICES Description Date Amount
ONE SW COLUMBIA ST #300 Restricted Energy Permit 03/17/2009 $75.00
PORTLAND, OR 97258 12% State Surcharge - Restricted Energy 03/17/2009 $9.00
PHONE: 503 - 412 -4800
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST
PORTLAND, OR 97202
PHONE: 503 - 239 -4600
FAX: 503 - 239 -7038
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm:
HVAC: Y Instrumentation: Total $84.00
Intercom /Paging: Landscape /Irrigation:
Required Items and Reports (Conditions)
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other:
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work
will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
the 180 days TENTION` Oregon -w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 0 through OAR 95 •: -010k. :u may obtain a copy of the rules or direct questions to OUNC by calling 503 •6.6699 or 1 800.332.23 4.
Issued y: _ 11 0 �j L .1d l Permittee Signature: ��°."' - !✓ • rn�e
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
6= .
r
Electrical Permit Applicatioq i • FOR OFFICE USE ONLY
City of Tigard RDaced /MO
Permit No.: ��� .... 001):1# 13125 SW Hall Blvd., Tigard, 0ilpsi 2-3 n Plan Review
Phone: 503.639.4171 Fax: 503 59$`119, Q� . . - - . - t 'k "" � a '' ` s\ Date/B Other Permit:
Inspection Line: 503.639.4175 l� _ -J _ ; ell i Date Ready/By: l 0 See Page 2 for
Internet: www.ci.tigard.or.us P ® - .Notified/Method: Supplemental Information
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i + j aa' e �k A pp. a 1 '...P.,--' ... :4-'4774Z-VA , - . _'' '"m ate'': d lik :six ,,'.1.J
W - _ - k,. i ` $ o'-', s�;asa. � .e ,- x. - � .... ,, 7 fit; :. - .1& ^ ='
_N �� =�' _ ;s> n s , � .. , �
❑ New construction a Ad)iign/'alt a tion/replacement Please check all that apply:
�1`\ - "'. ['Service over 225 amps, comm'l ['Hazardous location • ❑ Demolition ❑ Otti r:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
z-
� w 3 4 ., x , _ ,, ,m „ ., of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2 family dwelling C Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other: , ['Occupant load over 99 persons ID Manufactured structures or
c 4%;'4'' a R rt ;. =
J 31 ` , III' ' �D q fl _ t �o� ❑E RV park
Egress/lighting
no.: Job site address:
/02 &'O SW 6r eenbu, RcJ ❑Health -care facility ❑Other: .
Submit 2 sets of plans with any of the above.
City /State/ZIP: Ti G r J log The above are not applicable to temporary construction service.
• Suite/bldg. /apt. no.: 375 i Project name: / 105ferCofr I Q I I "
D eser l p tf on ty. Fee. Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: [Lot no.: Ea. add'! 500 sq. ft. or portion 33.40 1
Limited energy, residential - 75.00 2
Tax map /parcel no.: _ Limited energy, non - residential 75.00 2
S 4 1 s ` s v ° n ' „ r 4 6 . Each manufactured or modular
i L.itt`oS� t+H. -„_ l _ vS�Y<c.W h2' y'-� r i -t i l n..
0 w V 0 1 q5 e wit-7. y -t G IT dwelling, service and /or feeder 90.90 2
J Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
, - i 201 amps to 400 amps 106.85 2
�0x� _.'- .;. 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
Address: • ' Reconnect only 66.85 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 600 amps 133.75 2
Owner signature: . Date: • Branch circuits - new, alteration, or extension, per panel
r - 3T d E fa r t°' a y . m 1 A. Fee for branch circuits with
�- � " F - -- ' ' '. 4. '' service or feeder fee, each
6.65 2
Business name: t
hl ✓ - lC4h. RPq .//, branch circuit '
B. Fee for branch circuits
Contact name: i:70k fgmme 71. without service or feeder fee,
46.85 2,
-I ^� each branch circuit
Address: 133 SE 6, U e S / �7 Each add'l brarich circuit 6.65 2
City /State/ZIP: 0 r - f /Gj/1 d OR 972o 2. Miscellaneous (service or feeder not included)
�/ / Pump or irrigation circle 53.40 2
Phone: (503 ) .231 l tP oo I Fax: : (5o3) 2 3 9 -703 $ Sign or outline lighting 53.40 2
E - mail • Signal circuit(s) or limited -
- O R x 7 1 �' ., - � � `� energy panel, alteration, or
1 " extension. Describe: Page 2 2
Business name: if
met i CG'7 (4 l i �
Address: /337 se ,,,, n SS-/- Each additional inspection over allowable in any of the above
2 �7 Per inspection 62.50
City /State/ZIP: K---f i(J' 0 / ` 9 / 2a 2 Investigation per hour (1 hr rein) 62.50
6
(5 3) 2 - y6, Fax: �.
(503) 2 35 - 7 038 Industrial plant per hour 73.75
Phone: r
CCB Lic.: 23/ 3 5 Electrical Lic.:24$ 3 01 Suprv. Lie.:261/0 LEE3 Subtotal 75 ; e O
Suprv. Electrician signature, required: \ ?..74._______ g Plan review (25% of permit fee) -
T S i-e Ve n youi, 3 - /6,-0 -
1 / �� St ate surcharge (8p�of permit fee) g 2
Print name: � Date:
' /;i/ ' ! / / TOTAL PERMIT FEE gt UU
Authorized signature: /� A4C . L This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete Industry Se
Print name: v d qrf L`] hl <o s b
e� Date: 3 - � � 0 � • Fee methodology set by Tri- County Building Inddustry Service Board
"' Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PcrmitApp.doc 12/03 440- 4615T(10/02/COM/WEB
City of Tigard, Oregon ® 13125 SW Hall Blvd. ® Tigard, OR 97223
1 z 4 4
August 20, 2009
American Heating, Inc.
1339 SE Gideon St.
Portland, OR 97202
Attn: Brad Manchester
Re: Permit No.: ELR2009 -00088
Site Address: 10260 SW Greenburg Rd., 375
Project Name: Mastercare
. Dear Mr. Manchester:
The City of Tigard has received your request to cancel the above referenced permit. The
status of this permit indicates that inspections have already been completed prior to your
request for cancellation and refund. Therefore, the Building Official has determined that the
permit fees will be retained to cover administrative costs.
Thank you for your notification to cancel the permit. If you have any questions you may
contact me at 503.718.2430.
Sincerely,
"di - / ) ,_ ° R:/
,/ 4 / / 70 ..... 1e:__ _
Dianna Howse
Building Division Services Supervisor
I: \ Buil d i ng\ Refunds \Administrat ion \arNoRefund- CancelPernut.do 01 /16/07
Phone: 503.639.4171 ® Fax: 503.684.7297 o www.tigard- or.gov o TTY Relay: 503.684.2772
•Inspection List Portlet Page 1 of 1
CAP ID: ELR2009 -00088
A notice was added to this record on 2002.05 -02
Condition: severity: Nonce
View notice
Cs l; Menu . 31 New }3 Delete Cancel Reschedule IttF ; Edit Flow + ■ Help
bq i i bOndit 1s (1) f Contacts (0) P Documents (0) .i Fee (2) H, GIS (1) Hearings Inspections (1) Organization Owner (1) F Parcel (1) Payment
• Inspection Type Scheduled Scheduled Inspector Inspectign Result Result Comment Request Comment
C- Date Time Date
E 199 Electrical.rwal 03/26/2009 12.00 Gary Noble 03/26/2009 PASS 000853 -01 ..
httns• / /av accela cnm /nnrtlets/ can /cansummarv/CanTabSummarv.do ?mode= tabSummary &... 8/20/2009
-- • . MAR. 27. 2009 9 :56AM 5032397038 N0, 66 P. 1
Community Development
- Request for Permit Action
TTGAR.I)
MAR 2 7 2009
TO; CITY OF TIGARD C ITY OF TI GARD
Building Division Services Coordinator BUI LDING DIVISION
13125 SW Hall Blvd., Tigard, OR 97223
' Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM; ❑ Owner ❑ Applicant O Contractor ❑ City Staff
(check one)
REFUND OR Name;
INVOICE TO; (Business or Individual) Aericv ile-/ y .f 6
Mailing Address /33 1 $ E 61 C1 eon 5
Cit /State /Zip: PO I Ian C o ( 1 ' 72 0 2
Phone No.: 503 - 23 1 ~ 6 00 Qr
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): Q
❑ CANCEL PERMIT APPLICATION. � 6 /� � P
REFUND PERMIT FEES (attach receipt, if available). ,14 CP Oci 1
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). � I �t4
El REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). P a - �
V
Permit #: EL g 200 9 0008 8 �, o "
� vr Rd 375
Site Address o>. Parcel #: / /1,/ 0 ) 2 6 0 �J v \ / �, r�e n b � �'
Project Name: / i g S — [er co re,
Subdivision Name: ll /Chili Lot ##:
EXPLANATION: V i I U i' y /5 ( ph C (Jr 74 i s Con
does had h ee d - -/ W1
Signature: ..." .� Date: 3-27-0 7
Print Name: 1K c/ /44. CS ' C e'
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid Or Collected.
b) nor more than 50% of the land use application fcc when an application is withdrawn or canceled before s y review effort has been expended.
c) not more than 80% of the land use Application fcc 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 60% of the building permit fee for issued permits prior co 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 (iFPICE USE ONLY
Rte to S a Admire: Date -- TmEg] EjE�1_! Rte to Bldg Admin: Date _ , — . r j
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
Receipt # Date Method Amount $
I.\ Building \ Forms \RegPcmmirAcrion.doe Rev 07/26/07 7/1/S fire 770^1 de) i`iett T 6..6
aoo?— 0 --
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TR. ARU
Receipt Number: 2009 -00612 - 03/17/2009
CASE NO. • FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELR2009 -00088 12% State Surcharge - Restricted Energy 100 - 0000 - 207020 $9.00
ELR2009 -00088 Restricted Energy Permit 220 - 0000 - 431510 $75.00
Total: $84.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 745543 DADAMSKI 03/17/2009 $84.00
Payor: Bradley Manchester - American Heating Inc
Total Payments: $84.00
Balance Due: $0.00