Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00017
TIGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/12/2012
Parcel: 2S104BB07900
Jurisdiction: Tigard
Site address: 14300 SW BARROWS RD
Project: Albertsons Subdivision: RUSSELL'S SCHOLLS FERRY Lot: 2, TRAC
Project Description: Electrical for power monitoring system.
Contractor: STONER ELECTRIC Owner: NEW ALBERTSON'S INC
1904 SE OCHOCO ATTN: 70428 - CORPORATE TAX
MILWAUKIE, OR 97222 250 PARKCENTER BLVD, PO BOX 20
BOISE, ID 83726
PHONE: 503 - 462 -6500 PHONE:
FAX: 503 - 659 -4968
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/12/2012 $56.18
Specifics: Service or Feeder
1 ea Signal circuit or Limited 01/12/2012 $75.00
Type of Use: COM Energy Panel
Class of Work: ALT 1 ea 12% State Surcharge - 01/12/2012 $15.74
Electrical
Type of Const:
Occupancy Grp:
Total $146.92
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 rules are set forth in OAR
952- 001 -0010 through OA' • - 001 -0090. You may ob ain.- .. of the r or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ �� _ 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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Jan. 12. 2012 1:12PM Stoner Electrc Group No, 1000 P. 1
Electrical Permit Appllicatiod \''''
c
FOR ()Hie!: t in: ()Nix
- AA.) `1, io Recz n ivcd , 1 na ltirMM rEMMINEWIN
ilhl ----- q C l3 i 12 tY 5S o W f H :f23 ,A,\ Ig",'). Plan Review
. Phone: 503.639.4171 Fax: 503.598.1s
"\ 0,8 Date/l3 : Other Pemdt:
RI) Inspection Lim 503.639.4175 4 46 Date Ready/By: Fl gee Page 2 for
Internet: www.tigard.orsgov (..\\ •) Notified(Method: EMII Supplemental Information
Li New constructiOn ti,1 Addition/alterationeplacement Please check all that apply (submit 2 Ms of plans wilier= checked below):
0 Service or feeder 400 amps or more 013uilding over three stories.
0 Demolition ' D Other: where the available fault current El Marinas and boatyards.
#(0)tleV (tlitle aNkikicriff)tlUaie.4053PVEkiyi exceeds 10000 amps at 150 volts or El Fleeting buildings.
- -. leas to ground, or exceeds 14,000 LI Commercial-use agricultural
0 1- and 2-family dwelling hi Commercial/induStrial 0 Accessory building amps for all other installations', buildings,
0 Multi-family n Master builder I=1 Other: El Fire pump. El Installation of 73' K.VA or
,rt
- ,,,-.!,,,,,,, ^. • . ■ : El 0ergency system. larger separately derived system.
COINMPY.O*00(4TOP : ' ' El Addition of new motor load of El "A", "E", - 1-2'' , "1-3",
100HP or more occupancy.
Job no.: 9z3 I r Job site address: /43,0 0 5 2 5 , ,,„. 4 ,,,,s, 0 £.4. / f- o 7 A ,. D
0 Six or mem residential units. D Recreational vehicle parks.
City/StatetZIP:_ e, 27Z , El Healdveare facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 voila nominal,
SUite/bIdglapt. 00.: Project name: 5 04- j-16- 0 scryi co or feeder 600 loops or MOM.
.A
Cross street/directions to job site: Desunnion f QV, I roe. I Total - I •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: - J Lot no.: 1,000 sq. 11. or less 168.54 ._ 4
. Ea, add 'I 500 sq, 0. or portion 33.92 1
Tine x inap/pareel no.: -
Limited energy, resident ial -
75.00 2
1- .!!:: t '!■*:tg:'; ' ;' ; ; : ^: : ' ! : S. :,' ,T';:::? ! i!F.5 .: ' :::::.'..: . :4:40 (with above 6 4. 11 )
Limited energy, multi-family
75.00 2
i,445, Aildee "vex) o-mr,e/.4)6 5/-5-"rg-Art residential (with above sq. ft-)
Services or feeders InstallatIonollera lion, and/or relocation
200 amps or less 100.70 I 2
n :;:"ifint*OVOR 14,,,-.:,:esiggrargoot,.,:::.:::val 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200,34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps Or VOi IS 552.26 1 2
Temporary services or feeder & installailon, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) 1Fax; ( ) 200 amps or less 59.36 1
Owner installation: This installation is being mode on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, least, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 599 amps 168.54 2
Branch circuits-new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
:-::: .:,:j ii t ... :,,, .bove service or feeder fee,
.,. 7.42 2
each branch circuit - ,..
Business natne: B. Pee for branch circuits without
service or feeder fee, first
/ 56.18 52,d /g 2
Contact name: branch circuit _
Each addl branch circuit 7.42 ' 2
Addres9: ' Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67.84 2
dwelling, service and/or feeder
•
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation citcle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
--:;',.:, '''::,ali ! . : ' eoNtilit .7(W:R F' ' • ': ; : 7. ' Signal circuit(s) or limited-energy , 75
Btkainesa nal ": STONER ELECTRIC, INC, panel, alteration, or extension. / Page 2 if• 06) 2
Each additional Inspection over allowable In any of the above
Address: 1904 SE OCHOCO Additional inspection (1 hr min) 66.25/ hr
Inves tigation (1 hr min) 66.25/ hr
Ci MILWAUKIE, OR 97222 - ,.
Industrial plant (1 hr min) 78,18/ hr
Phone: ( 50a) Fax: ( 503) 659-4968 Inspections for which no fee Is 90.00/ hr
_ specifically listed (1/2 hr min)
CCB Lic.: 44623 Electrical Lic.: 26-122C s
_ uprv. Lie,: 3496S , Itt$:44S2ffe ''..
Subtotal: 13/. / e
Suprv. Electrician signature, required: Licr-.•-,„, - ,
Plan review (25% of permit fee): •a)..
Print name: MICHAEL FALCONER Date: j //zirc. State surcharge (12% of pennit fee): j5", -
TOTAL PERMIT FEE: /.. _ j__/ r rrr " 1% ,q4.
Authorized signature:
Tbla permit application expires ifs minters no toliffrued within 180
day $ otter it has been accepted 69 complete.
Print name: f )atel * Number ofinspec lions allowed per permit.
Maiicliag\Pcsmiln2LC.Pemtiapp.dae 07/01/10 410l6121(11/0S/CONSAVER
(
Jan. 12. 2012 1:13PM Stoner Electric Group No.1000 P. 2
Electrical Permit Application ^ City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for fiII residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $75,00 •
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
E Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systcins
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other Law/ rir4
Total number of commercial systems:
*No licenses are required, Licenses are required
for all other installations
I: ttuildir Ponnils1ELC- PermitApp.doc 07/01/10
171!
TIGARD
City of Tigard
August 22, 2012
Stoner Electric Inc.
Attn: Dennis Whitcomb
1904 SE Ochoco
Milwaukie, OR 97222
Re: Permit No. ELC2012 -00017
Dear Mr. Whitcomb:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14300 SW Barrows Rd
Project Name: Albertson's
Job No.: N/A
Refund Method: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $117.53.
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit" receipt in the amount of $
Comment(s): Per applicant's request, refund 80% as job was canceled.
If you have any questions please contact me at 503.718.2430.
Sincerely,
/ 62 r -
Dianna Howse
Building Division Services Supervisor
Enc.
I:\ Buildin \Refun1s34(26nSWoHl AteTTgviqii; 04160n 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard or.gov
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building application
fees. Receipts, documentation and the Request _ for Permit Action form (if applicable) must be attached
to this request. Refund requests are due to Accela System Administrator by Wednesday at
5:00 PM for processing by the following Wednesday. Accounts Payable will route refund
checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing.
PAYABLE TO: Stoner Electric Inc. DATE: 07/26/2012
Attn: Dennis Whitcomb
1904 SE Ochoco REQUESTED BY: Dianna Howse
Milwaukie, OR 97222
TRANSACTION INFORMATION:
Receipt #: 185152 Case #: ELC2012 -00017
Date: 01/12/2012 Address /Parcel: 14300 SW Barrows Rd
Pay Method: CreditCard Project Name: Albertsons
EXPLANATION: Refund 80% of permit fee per applicant's request as job was canceled.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount if L J (7 'l
Permit Fee 220- 0000 -43103 $104.94 G4 `
12% State Surcharge 100 - 0000 -24001 12.59
TOTAL REFUND: $117.53
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager LA -
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONL ,425('
Case Refund Processed: Date: t /99 / /Z� By:
I: \Building \Refunds \RefundRequest.doc x 09/01/2010
Jul.12. 2012 8:39AM Stoner Electric Group No.3336 P. 1
(i
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
I . " Re uest Perm Act
r l (.; A K 1) 13125 SW Hall Blvd. • Tigard, Oregon 97223.503,718.2439 • www.tigard- or.gov
TO: CITY OF TIGARD
Building Division Services Supervisor RECEWED
13125 SW Hall Blvd., Tigard, OR. 97223
Phone: 503.718.2430 Fax: 503.598.1960 www. tigard- or.gov y JUL 1 2 2012
FROM: ❑ Owner ❑ Applicant ® Contractor F• IrIGARD
(check one) I ill uDIVISION
REFUND OR Name:
INVOICE TO: (Business or Individual) C- N i.EcnQ IC /6.56
Mailing Address: )0)oLf p �
City /Staate /Zip: yyl, e w4.0 DSZ % 72-2 Z.
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
E CANCEL/VOID PERMIT APPLICATION.
• REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: . LCZoI Z Dbb17
•
Site Address or Parcel #: I43o t) std 8 5 g
Project Name: LQ• D -T6
Subdivision Name: Lot #:
EXPLANATION: -Jo 13 C - ce4 € a An ow ,ni . acres' e F 4'w54.4-
Signature; Date: / / //y
Print Name: -b cNi✓ /S to ,7c v t J G
Refund Polity
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) nor more than 80% of the land use application fcc when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fcc for issued permits.
d) nor more than 80% of the building plan review fcc when an application is canceled before any plan review effort has been a pen4Cd.
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 2 -4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date 7 1 t f ¢ B IPW Rte to Bldg Admin: Date, ' Z - /Z B 41%)1
Refund Processed: Date P zzAz— By - Invoice Processed: Date By
Permit Canceled: Date 22-�,Z By i i Parcel Tag Added: Date By
Receipt # /jS /. Date ///a/////a///a//0 Met (�— Amount $
I:\ Building \Forms \RegPeermicActio doe ilter 05/25/2012