Permit CITY OF TIGARD ELECTRICAL PERMIT
g COMMUNITY DEVELOPMENT Permit #: ELC2012 -00218
T t GA . D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/04/2012
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15660 SW PACIFIC HWY A -1
Project: Petco Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: TI - addition of 800 amp disconnect and new lighting and power.
Contractor: BUILDERS NW LLC Owner. TRC MM LLC
20420 NE SUNNY CREST 5973 AVENIDA ENCINAS STE 300
NEWBERG, OR 97132 CARLSBAD, CA 92008
PHONE: 503 - 538 -7976 PHONE:
FAX: 503 - 217 -1487
FEES
Quantity Description Date Amount
2 ea Services or Feeders - 601 to 05/04/2012 $602.08
Specifics: 1000 amps
109 at Branch Circuits w /Purchase 05/04/2012 $808.78
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea Plan Review Electricial 05/04/2012 $352.72
Type of Const: 1 ea 12% State Surcharge - 05/04/2012 $169.30
Electrical
Occupancy Grp: 93 Misc Administration Fee • 05/04/2012 $92.94
Total $2,025.82
Required Items and Reports (Conditions)
This permit i- • • - • • •=ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done • accordance with - pproved plans. This permit will expire if work is not started within 180 days of issuance, or if work is - uspended for more the 180
days. TTENTION: Oregon =w ires you to follow the rules adopted by the Oregon Utility Notification Cent: . Those ules are set forth in OAR
952 - 01- 0010 th •ugh OAR 952 -i %1- 0091. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19: or 1.800. • .2344.
I -sued By: / / /, i.L . / ' Permittee Signature: Miff //11110
•
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 � � �� 4, 4111 _ ��J Date: 0/2_
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.
�I
Electrical Permit Application : ? �t � � FOR OI. FICF I_ SE ONLY
, 3 - Received
City of Tigard �� : �/ , Permit No.: / ilaa,
III
13125 SW Hall Blvd., Tigard, OR 97223 A PR 2012.
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Dme/6 : Other Permit:
1' I G A R D Inspection Line: 503.639.4175 ,Fa• e' ; I; " @ % r Date Ready/By: Juris: 63 See Page 2 for
Internet: www.ti ar-or. d ov `mod I 1 t u ' ' ' PP
otified/Method: Supplemental Information
g g ya 1j y ��: " or'. it,'J :; ;.
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement check all that apply (submit 2 sets of plans w /items checked below):
ce 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
❑ Emergency system. a separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of r; ,
� `u
Job no.: Job site address: // t1 100HP or more. occupancy.
' 1C7 I r' � '�% t eL C, r k '- ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: -,-- • ✓� ❑ Healthcare facilities. ❑ Supply voltage for more than
l W cJ i ous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: ?L . f°t`
ce or feeder 600 amps or more.
�� � � / ..� - FEE SCHEDULE
Cross street/directions to job site: Description I Qtv. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
1- -� Limited energy, multi- family 75.00 2
t✓ 0J }- Ad d r `., • L s � ex, l4-„+ d t sc c ;.•t 1- residential (with above sq. ft.) -
ff S �,/ ` L h
G s— .i-v
T Services or feeders installation, alteration, and/or relocation
A Ai a� f . (ifh.T Cl (,.4t! 200 amps or less 100.70 2
❑ PROPERTY OWNE ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
_ 601 amps to 1,000 amps Z 301.04 ( / trt 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
n 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 I ❑ CONTACT PERSON above service or feeder fee, ��/ 7.42 ()( F� y 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'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: B ‘ a.' ,1S A J. panel, alteration, or extension. Page 2 2
lW Each additional inspection over allowable in any of the above
Address: "Zott i J 1`.1. ( SL.t_ wt. c . {ti's i I— Additional inspection (I hr min) 66.25/ hr
/State/ZIP: t f �a — 7 2 Investigation (1 hr min) 66.25/ hr
Ci
ty t U 13 1 Z Industrial plant (I hr min) 78.18 / hr
�Y f1...„,7 , �� 1 7 •
Phone: ( 7A � ` ! / Fax: ( 7 Inspections for which no fee is
specifically listed (h hr min) 90.00 / hr
CCB Lic.: 1.3(6 lc( 4,, Electrical Lic.: `j 0 Suprv. Lic.: (+ - _ ELECTRICAL PERMIT FEES
Suprv. Electrician signature ret 7/t (iK , �p/��3 _ o Subtotal: � � r
Plan review (25% of permit fee): (
Print name: A...t. S Li y L7 ■ D / State s urcharge (12% of permit fee): ( 1 L{
L TOTAL PERMIT FEE: Su Z . /11
Authorized signature:
This permit application expires if a permit is not obtained within 180
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 /10 440- 4615T(II /05 /COM/WEB
: 4
TIGARD
City of Tigard
July 26, 2012
Builders NW LLC
20420 NE Sunny Crest
Newberg, OR 97132
Re: Permit No. ELC2012 -00218
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 15660 SW Pacific Hwy, A -1
Project Name: Petco
Job No.: N/A
Refund: ® Check #207151 in the amount of $92.94.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Refund overpayment of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
, qihr
Dianna Howse
Building Division Services Coordinator
Enc.
I:\ Building \2efund3 &SW ElatieBkayLepTilgapa,ltaregon 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: Builders NW LLC DATE: 07/18/2012
20420 NE Sunny Crest
Newberg, OR 97132 REQUESTED BY: Dianna Howse
DEB
TRANSACTION INFORMATION:
Receipt #: 156596 Case #: ELC2012 -00215
Date: 05/04/2012 Address /Parcel: 13660 SW Pacific Hwy, A -1
Pay Method: Check Project Name: Petco
EXPLANATION: Refund for overpayment on check amount.
REFUND INFORMATION:
Fee Description From Receipt . . . Revenue Account No. • Refund
Example: Building Permit Fee • Example: 2300000- 43104 $ Amount
Misc. Administration Fee 230- 0000 -431 95 gig $92.94
TOTAL REFUND: $92.94
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager
IE under $25,500 Department Manager
If under $50,000 City Manager
If over $30,000 Local Contract Review Board
. FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: 7 a6fra— By: I 4
I:\ Building \Refunds \RefundRcquest.due x 09/O1/201O
IN o . Community Development
TIGARD Request for Permit Action
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor g City Staff
(check one)
REFUND OR Name:
E TO: (Business or Individual) �u‘ 4....17tE5 1, 1
Mailing Address: D�C4' b A) .3.3.(...t_1313•1 w
/1 eQ1 %
City /State /Zip: 9.ti e..3 6t.Q(' t CQ.. 4 - 7 / 3
Phone No.: 5 - 538 - q 7 4
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
❑ CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: C.. t_Cr ab[ 3.- coa.i
Site Address or Parcel #: 1 5 (o UJ d a P.H-C, 1 ,_ N-w4 rf
Project Name: Co Pl✓T
Subdivision Name: Lot #:
EXPLANATION: 63 e_Q P.ei iJ OIL (}k s e.J.- . f.12.. Hpr-k kl 1
654y - ra TA ke_ ,,J 4- ruti -
Signature: Date: _ _ i 7—
Print Name: - 7) ,t k 19)jf)N k.1
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% 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 2 -4 weeks for processing refunds.
FO OFFICE USE ONLY
Rte to S s Admin: Date sLifirmusem Rte to Bld: Admin: Date 70/� B n"
Refund Processed: Date 2/� /� By .I".4 Invoice Processed: Date By
Permit Canceled: Date At By Parcel Tag Added: Date By
Receipt # Date Method _ Amount $
I: \Building \Forms \RegPemtitAction.doc Rev 04/26/2011