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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 3 • • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00176 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/13/2012 Parcel: 2S113AC00103 Jurisdiction: TIGARD Site address: 7236 SW DURHAM RD, STE# 100 Project: Pacific Realty Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 25 -27,2: Project Description: Low voltage for Comcast coax cable. Contractor: CAPITOL DATA & COMMUNICATIONS Owner: PACIFIC REALTY ASSOCIATES 11401 NE MARX ST ATTN: N PIVEN PORTLAND, OR 97220 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 - 255 -9488 PHONE: 503 - 624 -6300 FAX: 503 - 257 -7121 FEES Description Date Amount Specifics: , Restricted Energy Permit 08/13/2012 $75.00 12% State Surcharge - Electrical 08/13/2012 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: Y Fire Alarm: N HVAC: N Instrumentation: N Intercom/Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Total $84.00 Other Desc: 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 acco ' . n - • 'th 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. ATTEN •N: Orego law requires you to follow the rules adopted by the Oregon Utility Not'fiicati• • enter. Those rules are set forth in OAR 952- 001 -0010 hrough OAR 952 r • i • 0. ou may obtain a copy of the rules or direct questions to OUNC by call'. '-s 232.1987 or 1.800.532.23` 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. FOR OE RICE USE ONLY Electrical Permit A lication Received Date /By: S 16 Permit no.: 1 ^a2 / - City of Tigard Plan Review IN '� 13125 SW Hall Blvd., Tigard, OR 97223 Date/By: Other Permit: Phone: 503.639.4171 Fax: 503.598:19601( 0 9 20 Date Ready/By: Juris: ■ Page z for T I G A It D Inspection Line: 503.639.4175 Internet: www.tigard - or.gov on. 7 OF ! ARD Notified /Method: Supplemental Information TYPE OF WORK BUILNNEr1 T`IVISION PLAN REVIEW ❑ New construction 0 Addition /alteration /replacement Please check all that apply: ❑ Demolition ❑ Other: ❑ Service over 225 amps, comm'I ❑ Hazardous location CATEGORY OF CONSTRUCTION ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft. U 1- and 2- family dwelling El Commercial /industrial ❑ Accessory building of 1- and 2- family dwellings 4 or more new residential ❑ Multi- family ❑ Master Builder ❑ Other ❑ System over 600 volts nominal units in one structure JOB SITE INFORMATION AND LOCATION ❑ Building over three stories ❑ Feeders, 400 amps or more Job no.: C12297 Job site address: 7236 SW Durham Rd ❑ Occupant load over 99 persons ❑ Manufactured structures or ❑ Egress/lighting plan RV park City /State /ZIP: Tigard, OR., 97226 ❑ Health -care facility ❑ Other: Submit 2 sets of plans with any of the above. P4el t QI?tI u The above are not applicable to temporary construction service. Suite /bldg. /apt. no.: 100 Project name: Fhb SCHEDULE Cross Street /Directions to job site: Description I Qty. I Fee. I Total I " New residential - single or multi - family dwelling unit. Subdivision: Lot no.: Includes attached garage. 1000 sq. ft. or less $ 168.54 4 Tax map /parcel no.: Ea. Add? 500 sq. ft or portion $ 33.92 1 DESCRIPTION OF WORK Limited energy residential $ 75.00 2 Install Comcast Coax Cable Limited energy, non - residential $ 75.00 2 _ Each manufactured home or modular U PROPERTY OWNER I U TENANT dwelling, Service and /or feeder $ 67.84 _ 2 Name: Service or feeders installation, alteration, and /or relocation 200 amps or less $ 100.70 2 Address: 201 amps to 400 amps $ 133.56 2 401 amps to 600 amps $ 200.34 2 City /State /ZIP: 601 amps to 1000 amps $ 301.04 2 Over 1000 amps or volts $ 552.26 2 Phone: Fax: Reconnect only $ 67.84 2 503- 295 -5555 Temporary services or feeders installation, alteration, and /or Owner installation: This installation is being made on property that I own which is not relocation intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or less $ 59.36 1 Owner signature: Date: 201 amps to 400 amps $ 125.08 2 401 amps to 599 amps $ 168.54 _ _ 2 U APPLICANT I U CONTACT PERSON Branch circuits - new, alteration, or extension, per panel Business Name: A. Fee for branch circuits with service or feeder fee, each Contact name: branch circuit $ 7.42 2 B. Fee for branch circuits Address: without service or feeder fee, each branch circuit $ 56.18 2 City /State /ZIP: Each additional branch circuit: $ 7.42 2 Miscellaneous (service or feeder not included) Phone: Fax: Pump or irrigation circle $ 67.84 2 Sign or outline lighting $ 67.84 2 E -mail: Signal circuits(s) or limited - CONTRACTOR energy panel, alteration, or Business Name: Capitol Data & Communications, Inc. extension. Describe: Tele /Data 1 75 75.00 2 Page 2 Contact name: Each additional inspection over allowable in any of the above Per inspection $ 66.25 Address: 11401 NE Marx Street Investigation per hour (1 hr min) $ 66.25 Industrial plant per hour $ 78.18 City /State/ZIP: Portland, Oregon 97220 ELECTRICAL PERMIT FEES` Subtotal 75.00 Phone: 503 -255 -9488 Fax: 503 - 257 -7121 Plan review (25% of permit fee) State surcharge ( 12% of permit fee) 9.00 CCB Lic.: 142457 Electrical Lic.: 26 - CLE I Suprv. Lic.: 2757LEA TOTAL PERMIT FEE 84.00 Suprv. Electrician signature, required: This permit application expires if a permit is not obtained within 180 �� days after it has been accepted as complete Print Name: Terry Brasch Date: 08/08/12 • Fee methodology set by Tri- County Building Industry Service Board Authorized signature: 6-4_____54.,3—• •'Number of inspections per permit allowed. Print Name: Terry Brasch 503 -718 -2439 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systesm 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: COMMERCIAL WORK ONLY: Fee for each commercial sytem $ 75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Data Telecommunication installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* • ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: 1 *No licenses are required. Licenses are required for all other installations Er (( '' 0 f? TIGARD City of Tigard October 11, 2012 Capitol Data & Communications Attn: Terry Brasch 11401 NE Marx St Portland, OR 97220 Re: Permit N `` 012 -00176 177, 178, 179 and 180 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 7236 SW Durham Rd., Suites 100, 500, 600, 700 & 800 Project Name: Pacific Realty Job No.: N/A Refund Method: ® Check #208002 in the amount of $336.00. ❑ 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): Per applicant's request as job was cancelled. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, '- ,/ Dianna owse Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard or.gov 117 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: Capitol Data & Communications DATE: 10/4/2012 11401 NE Marx St Portland, OR 97220 REQUESTED BY: Dianna Howse Attn: Terry Brasch TRANSACTION INFORMATION: Receipt #: 187965 Case #: ELR2012 -00176 Date: 8/13/2012 Address /Parcel: 7236 SW Durham Rd., Ste. 100 Pay Method: Check Project Name: Pacific Realty EXPLANATION: Per applicant's request as job was cancelled. Refund 80 °, o of permit fees. REFUND INFORMATION: • Fee Description From Receipt Revenue Account No. - Refund Example: Building Permit Fee Example: 2300000 -43104 . $ Amount Restricted Energy Permit 2 20- 0000 -43103 $60.00 12 % State Surcharge 100- 0000 -24001 7.20 TOTAL REFUND: $67.20 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 ON Case Refund Processed: Date: �(�� / /J /� B • I: Building \Refunds \R cfundRc x 0'0 /iil /lulu Cit y of Tigard • COMMUNITY DEVELOPMENT DEPAR E • 2. g N E . Request Permit Action SEP 10 2012 q , TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • v�yj(. i Ttl - }. v 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 ❑ City Staff (check one) REFUND OR Name: Capitol Data & Communications INVOICE TO: (Business or Individual) • Mailing Address: 11401 NE Marx St City /State /Zip: Portland, OR 97220 Phone No.: 503- 255 -9488 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ 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 #: ELR2012 -00176 Site Address or Parcel #: 7236 SW Durham Rd, Ste 100 Project Name: Pacific Realty Subdivision Name: Council View Acres Lot #: 21 -44 EXPLANATION: Job Cancelled Signature: .,� �L�"_ Date: 9/5/12 Terry Brasch 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% 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 2 -4 weeks for processing refunds. e erJ F' FOR OFFICE USE ONLY o' /5 try Rte to Sys Admin: Date By Rte to Bldg Admin: Date /p // / Z LI. 2 '• r �, Refund Processed: Date lQ //// By 4" Invoice Processed: Date By � � Permit Canceled: Date /� j . By %sr • Parcel Tag Added: Date By 0 )` 16 Receipt # Date Method Amount $ I: \Building \Forms \RegPermitAction.doc Rev 05/25/2012 �! � y . 06