Permit CITY OF TIGARD ELECTRICAL PERMIT
• II '• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00283
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/15/2012
Parcel: 1 S134CC01700
Jurisdiction: Tigard
Site address: 12325 SW KATHERINE ST
Project: Mary Woodward Elementary Subdivision: MERESTONE Lot: 13
Project Description: 3 circuits to walk in coolers in kitchen
Contractor: PARKIN ELECTRIC INC Owner: TIGARD - TUALATIN SCHOOL
14001 FIR STREET DISTRICT 23J
OREGON CITY, OR 97045 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503 - 657 -4958 PHONE:
FAX: 503 - 557 -1059
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 05/15/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/15/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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: Ore on 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 2 -001 -0 90. You ma obtain a copy of the rules or direct questions to OUNC by calling 503..223 /M
503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: Il ` l ' ` r e L c 4- l o1.1_
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.
From: 05/15/2012 10:46 #399 P.002/002
Electrical Permit Applies rn. 00
E USE
,,. . V
y 1.5 z..0E2D Pe ONLY No reiB ived =Ram FOR OFFIC a
City of Tigard rm .ELC Jo - *" - ;1r.■
- -
; 2 ' Phone: 503.718.2439 Fax: 503.598.1
7 ‘ 13125 SW Hall Blvd., Tigard, OR 972W Plan Review
Date/B : Other Permit:134(0 4101.0/". c.'003
TIC Inspection Line: 503.639A175 Date Ready/By: Fifl See Page 2 for
i\RD
Internet: www.tigard CITY OF TIGARD Notifiedavlethod: EMI Supplemental Information
:":.:,. ; , ,,.. , , , , l ,. ---
0 New construction (' Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
..,-,j .,-_,.. in,,,„-,,t, v;-„,-,-,-A4,...1„,;:tesi,..;:.f.,-;,,,,I,I.,,Y.,-F1..,1,5*./..WV,,..I.elr*.,t4.,YR...4H,.,..4"..=',Ww•.-:.-4''.,,,flvt,..4,,,i'la,,,k4 less to ground, or exceeds 14,000 0 Commercial agricultural
0 1- and 2-family dwelling cg Commercial/industrial 0 Accessory building amps for all oilier installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fue pump. 0 Instalthtion of /5 KVA or
l . -;- 1 : - C*10 ,140 . ' ..: 1 ' ' 1 40:Vaita -- 2 t iln r P , 9,4 ' B Addition of 7es:vez tor load of ci !7 ,.., z , 7 ,... 2 t .y e i r . t ;e d s
Job no.: 26 A Job site address:Aag i lect&c„,,h6sfr 100HP or more.
0 Six or more residential units. o occupancy.
Recreational vehicle parks.
City/State/ZIP: li I etilt. 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal
Suite/bldg./apt. no.: Project name: 0 Service or feeder 600 amps or more.
t:V.:. Wait .._afllatSZ:'
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: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. WW1 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
75.00 2
:, : : :4.:` , ' ' ':; , .;; - :.Xe :: 2 : : :. j:.:' , V;t:; : :';':• . .ZAO,g4i.,00:11 1 10.*:#,KSV.O.OX:RAMgf-Idegitt,P1 (with above sq ft)
- Limited energy, multi-family
44,6u4 lz) hica IA 40 AleArS I/2.- residential (with above sq. ft.) _ 75.00 2
Services or feeders installation, alteration, and/or reloadion
lat ch6n- 200 amps or less 100.70 2
000.4#. 201 amps to 400 amps 13156 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: ( ) I 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch drains — new, alteration, or extension, e er panel
Owner signature: Date: A. Fee for branch circuits with
-1:A*K*-if:.$taM;.S1:AgA a fee 742 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
/ 56.18 air 2
Contact name: branch circuit
Each add'l branch circuit A 7.42 /ye y _ 2
Address: Miscellaneous (service or feeder not induded)
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 67.84 2
E
Sign or outline lighting 67.84 2
='=.. :: ', : tAtACIPCY-!. Signal circuit(s) or limited-energy
Business name: Parkin Electric panel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: 14001 Fir Street Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Oregon City, OR 97045 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 657-4958 I Fax: (503) 557-1059 Inspections for which no fee is
90.00/ hr
V specifically listed (1/2 hr min)
'CB Lic.: 35151 _ yectrical Lic.: 34-4C k Suprv. Lic.: 4241.S - ;1 ','!:::::t:';Zi*EIZ.CTRICAVPRRMFrIERR:'' :•.t:
iiignature, required: ,
,:;
Plan review (25% of peai 744
Suprv. Electrician signature, 4
Print name: David B Parkin Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
1 1? 7 ,0 . 8 r
. • ,
Authorized signature:
This permit application expires if a permit Is not obtained within 1
days after it has been accepted as complete.
Print name: I Date: * Number of inspections allowed per permit.
hutuaainavennitnatc-PermitApp.doc OMI/I0 440.4615T(I1/03/CONNWEB
T I GARD
City of Tigard
August 22, 2012
Parkin Electric
14001 Fir St
Oregon City, OR 97045
Re: Permit No. ELC2012 -00283 •
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 12325 SW Katherine St.
Project Name: Mary Woodward Elementary
Job No.: N/A
Refund Method: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $79.54.
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 permit fees as this was a duplicate permit.
If you have any questions please contact me at 503.718.2430.
Sincerely,
i
,
Dianna Howse
Building Division Services Supervisor
Enc.
I:\ Building \Refundsld 5isSaWnifi iGIN 1DAPT oeLOOregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
Er 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: Parkin Electric DATE: 07/26/2012
14001 Fir St
Oregon City, OR 97045 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 186744 Case #: ELC2012 -00283
Date: 05/15/2012 Address /Parcel: 12325 SW Katherine St.
Pay Method: CreditCard Project Name: Mary Woodward Elementary
EXPLANATION: Refund 100% of permit fee as this permit was a duplicate of another permit issued.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 - 43104 $ Amount
Permit Fee 220- 0000 -43103 $71.02
12% State Surcharge 100 - 0000 -24001 8.52
TOTAL REFUND: $79.54 .o
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: fi' /9�j By: . 47 �
L: \Building\ Refunds \RefundRequest.doc x 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: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff
(check one)
REFUND OR Name: Parkin Electric
INVOICE TO: (Business or individual)
Mailing Address: 14001 Fir St
City/State /Zip: Oregon City, OR 97045
Phone No.: 503 - 657 -4958
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
® CANCEL PERMIT APPLICATION.
• 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 #: ELC2012 -00283
Site Address or Parcel #: 12325 SW Katherine St, Tigard, OR 97223
Project Name: Mary Woodward Elementary
Subdivision Name: Lot #:
EXPLANATION: Permit created in error - duplicate of permit #ELC201 2- 0001 1 1
Full refund
Signature: 41.(.4 Date: 7/16/12
Shirley Treat
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' o 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 °/n of the land use application fee for issued permits.
d) not more than 80 '. of the building plan review ice 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 OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date 7P•Z® B ' �f
Refund Processed: Date F /PA /ha- By AP Invoice Processed: Date By
Permit Canceled: Date oft By •-" Parcel Tag Added: Date By
Receipt # %tt 7 Y/y Date / / Z Method C Amount $
I:A Building \l \RcgPcrmitActton.doc Rev 07 /26/07