Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00180
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/13/2012
Parcel: 2S 113AC00103
Jurisdiction: TIGARD
Site address: 7236 SW DURHAM RD, STE# 800
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 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. ATTEN • • • Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-01 • through O • ' 9 3;1-0090. You may obtain a copy of the rules or direct questions to OUNC by callin . .1987 or 1.800.332.2344.
Issue. =y: Permittee Signal � e
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.
•
Electrical Permit A. r lica • i a - --� �� Received ry FOR OFFICE USE ()Nix
- V d Date/By: a Permit no.: Q41 czao
: im
141 City of Tigard Plan Review
13125 SW Hall Blvd., Tigard, OR 9213 Date/Ry: Other Permit:
Phone: 503.639.4171 Fax: 503.59 811960 ?
Inspection Line: 503.639.4175 Date Ready/By: Juris: ■ e Page 2 for
G A I D 1 CM/07720D Notified /Method: Supplemental Information
Internet: www.tigard- or.gov
mi L m ITti "�`
TYPE OF WORK ��1" ° "�Iz, PLAN REVIEW
❑ New construction 0 Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: ❑ Service over 225 amps, comm'l ❑ 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 U 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:
,te..I lc L I A £q Lry S ubmit 2 sets of plans with any of the above.
Suite/bldg./apt. no.: 800 Project name: `- The above are not applicable to temporary construction service.
FEE SCHEDULE
Cross Street /Directions to job site: Description I Qty. I Fee. I Total
New residential - single or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1000 sq. ft. or less $ 168.54 4
Tax map /parcel no.: Ea. Add? 500 sq. ft or portion 5 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 5 200.34 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.: 2 54CLE 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
- ' – ' f _ (J 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: ji..---""-- / "Number of inspections per permit allowed.
Print Name: Terry Brasch VVV ����
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:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
El 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
El Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
--) Li 1
: .
. .
TIGARD
City of Tigard
October 11, 2012
Capitol Data & Communications
Attn: Terry Brasch
11401 NE Marx St
Portland, OR 97220
Re: Permit No. ELR2012- 00176, 177, 178, 179 an. 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
City of Tigard
. :1
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 %or 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 #: 187969 Case #: ELR2012 -00180
Date: 8/13/2012 Address /Parcel: 7236 SW Durham Rd., Ste. 800
Pav Method: Check Project Name: Pacific Realty
EXPLANATION: Per applicant's request as job was cancelled. Refund 80% 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 -0000 -43103 $60.00
12% State Surcharge 100- 0000 -24001 7.20
•
TOTAL REFUND: $67.20
APPROVALS:
If under $3,000 Professional Staff
If under $12,500 Division Manager �_.
If under $25,500 Department Manager �/"27j V / >L%
If under $50,000 City Manager
If over $30,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: `Q /j / / /Z. B
I:\ Building \Refunds \RefundIt ucst.Jnc x 11 9 /0 I / II)
RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTWEN4 O 2012
Request Permit Action CITY ARo
TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
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 (1):
El 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).
El REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: ELR2012 -00180
Site Address or Parcel #: 7236 SW Durham Rd, Ste 800
Project Name: Pacific Realty
Subdivision Name: Council View Acres Lot #: 21 -44
EXPLANATION: Job Cancelled
Signature: � �-- 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.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date /p 4 / .- By M
Refund Processed: Date /e / Z 13 Invoice Processed: Date By
Permit Canceled: Date /p p� //L By 4 / Parcel Tag Added: Date By
Receipt # Date Method Amount $
1: \ Building \ Forms \ReyPeriitAction.doc Rev 05/25/2012