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Permit
CITY OF TIGARD ELECTRICAL PERMIT IS • COMMUNITY DEVELOPMENT Permit #: ELC2011 -00718 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2012 Parcel: 25101 BB00400 Jurisdiction: Tigard Site address: 11844 SW PACIFIC HWY • Project: Enterprise Rental Subdivision: TIGARD ROAD GARDENS Lot: 4 Project Description: (3) sign circuits. Contractor: RAMSAY SIGNS INC Owner: WALTON CWOR PARK BC 8 LLC • 9160 SE 74TH AVE BY CTMT - WALTON RE TAX PORTLAND, OR 97206 4678 WORLD PARKWAY CIR ST LOUIS, MO 63134 PHONE: 503 - 777 -4555 PHONE: FAX: FEES Quantity Description Date Amount 3 ea Sign or Outline Lighting 12/23/2011 $203.52 Specifics: 1 ea 12% State Surcharge - 12/23/2011 $24.42 Electrical Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: • Total $227.94 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 OAR 952- 001 -0090. You 1= obtain a copy of the q uestions to OUNC by calling 50,3.232.1987 or 1.800.332.2344. / Issued B � - ! Permitted Signature: � ' W • W NER 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. N -oo 3o O013t o(32 �, 3_ Electrical Permit Application PECEPJ 1 FOR FFICE USE OM 1. lig City of Tigard „ , Date /By: /R A3 // Permit �'�[C,gov /� 7/ y n 1 3125 SW Hall Blvd., Tigard, OR 97223 DEC 2 D c- i Plan Rev i 0 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: TI G r\ R D Inspection Line: 503.639 - CITY e F T, (-. A ft Date Ready /By: _ Juris: El See Page 2 for Internet: www.tigard- or.gov N \\ o¢'� 1 iCtd/Method: Supplemental Information - e TYPE OF WORK I I ' ` \- _+, ..... -- - PLAN REVIEW • ® New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ 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 © 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 ", 100HP or more. occupancy. Job no.: Job site address: y tv� %.‘..3. O„1LC K W�/ ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/Z17.--' \ 1 ❑ Health -care facilities. ❑ Supply voltage for more than 1 1 ylMA." �Q- Si 22.3 ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: 'EN --ec 1�R1S,e° ZeII,LTA ❑ 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 168.54 4 Ea. add'I 500 sq. 11. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family 75.00 2 S r C .LQ.tL Lr3 residential (with above sq. ft.) \ 0 1 Services or feeders installation, alteration, and/or relocation ` ) Rca r"-S : 9 /0 O kilo.. 200 amps or less 100.70 2 . ❑ PR RTY OWNER ENANT 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 volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State/ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps . 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits – new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ' ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2 each branch circuit . Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'l branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) Each manufactured or modular City/State/ZIP: dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle . e/E E - mail: 67.84 2 . �f1�_ Sign or outline lighting .CONTRACTOR Signal circuit(s) or limited -ever n' Business name: panel, alteration, or extension. Page 2 vV 3 r � 2 p %1_,.%K.3 \ C.t Each additional inspection over allowable in any of the abov Address: 'S I do % ` ... rir1 .n v C Additional inspection (1 hr min) 66.25/ hr �`L Investigation (1 hr min) 66.25/ hr City/ State/ZIP: 7d QT to4N C) f a.. e 1 20 Industrial plant (1 hr min) 78.18/ hr Phone: 6 ) _ 1 F ax 1/ii, I 6, r Inspections for which no fee is 90.00 / hr I 0 / fig specifically listed (%: hr min) CCB Lic.:1 Electrical Lic.: a e , c0,.. ( a ____■—■__________ , I 06 f r / /T+ 1 Q Suprv. Lic.: y ga(r s� ELECTRICAL PERMIT FEES _ Suprv. Elec 'cian signature, required: — o Subtotal: ... 51- e hLl.� S Plan review (25% of permit fee • i Print name: �eL2 Date: State surcharge (12% of permit fee): .1C1.. l2/22d20// TOTAL PERMIT FEE: • , Authorized signature: This permit application expires If a permit Is not o. alned within 18 Print name: , Date: days after It has been accepted as complete. N um b er of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 4404615T(11/05/COMIWEB 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 Jor 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: Ramsay Sign Co. DATE: 2 /17/2012 9160 SE 74` Ave. Portland, OR 97204, REQUESTED BY: Dianna Howse KJP TRANSACTION INFORNL' TION: Receipt #: 183002, 184998 Case #: SGN2011 -00133 and ELC2011 -00718 Date: 12/23/2011 Address /Parcel: 11844 SW Pacific Hwy Pay Method: Check Project Name: Enterprise Rental EXPLANATION: Refund 100% of fees collected in error for a sign permit that was voided. In conjunction, refund fees collected for (1) sign lighting. • REFUND INFORMATION: - - Fee Description From Receipt . • Revenue Account No. -. • - • . Refund • Example: 'Building Permit Fee .'• • • - E - 2300 - 43104 - • - _ . $ Am'oiunt • Sign Permit 100- 0000 -43113 $140.00 Sign Permit - LRP 100- 0000 -43117 21.00 Electrical Permit 220 - 0000 -43103 67.84 12% State Surcharge 100- 0000 - 24001 8.14 TOTAL REFUND: $236.98 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager 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 ONLY - Case Refund Processed: Date: I o 2/ V ///, By: I -W I:\ Building \Refunds\ Rcfundltetvcst.dnc s 09/01/2010 • Community Development TIGARD 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.tigard or.gov FROM: n Owner n Applicant n Contractor F City Staff (check onc) S/GivS /AiC REFUND OR Name: Ramsay-gip-1-C-0. INVOICE TO: (Business or Individual) Mailing Address: 9160 S.E. 74t Ave City /State /Zip: Portland, OR 972040 Phone No.: 503- 777 -4555 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V): F CANCEL PERMIT APPLICATION. V REFUND PERMIT FEES (attach receipt, if available). n INVOICE FOR FEES DUE (attach case fee schedule and explain below). REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: SGN2011- 00133 & ELC2011 -00718 Site Address or Parcel #: 11844 S.W. Pacific Hwy Project Name: Enterprise Rental Subdivision Name: Lot #: EXPLANATION: Due to Director's Interpretation; please void sign permit and refund $161.00 fee - created in error. Also, please refund 1 sign lighting and adjust ELC permit to read 3 sign lightings. Signature: Date: 1/24/12 Knstie Peerman Print Name: Refund Policy 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'Y, 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 % 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 OFFICE USE ONLY - Rte to Sys Admin: Date By Rte to Rd* Admin: Date, j .2' APAI B _ Refund Processed: Date.2 /2 y/ a- By - / Invoice Processed: Date By Permit Canceled: Date p 2 / i / jam Bye Parcel Tag ridded: Date By Receipt # /F500 2- Date 2d,7/1 g /j/ Method Amount $ a3(p , ga L\ Building \P9 _ 11Re tAction.doe Rev Or 2f,/07 Ph n • .' Ail GAR- City of Tigard February 23, 2012 Ramsay Signs, Inc. 9160 SE 74 Ave. Portland, OR 97206 Re: Permit No. SGN2011- 00133 & E1C2011 -00718 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11844 SW Pacific Hwy Project Name: Enterprise Rental Job No.: N/A Refund Method: ® Check #205667 in the amount of 5236.98. ❑ Credit card "return" receipt in the amount of $ . 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): Refund 100% of sign permit fees collected in error and refund electrical permit fees associated with the sign permit. If you have any questions please contact me at 503.718.2430. Sincerely, ww j'- Dianna Howse Building Division Services Supervisor Enc. f:\ Building \Refunds2 Mintr1 kghginctiIr aUl0 Qino 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard- or.gov