Permit Ers
TI GARD
City of Tigard
March 28, 2013
Capitol Data & Communications
11401 NE Marx St.
Portland, OR 97220
Re: Permit No. ELR2013 -00063
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 17003 SW 72n Ave.
Project Name: Twig's Bistro & Martini Bar
Job No.: N/A
Refund Method: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $67.20.
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 canceled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
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
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request forPermit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Capitol Data & Communications DATE: 3/28/2013
11401 NE Marx St.
Portland, OR 97220 REQUESTED BY: Dianna Howse
Attn: Terry Brasch
TRANSACTION INFORMATION:
Receipt #: 190652 Case #: ELR2013 -00063
Date: 3/19/2013 Address /Parcel: 17003 SW 72nd Ave.
Pay Method: CreditCard Project Name: Twig's Bistro & Martini Bar
EXPLANATION: Per applicant's request as work 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
Electrical permit fee 220- 0000 -43103 $60.00
12% State Surcharge 100- 0000 -24001 7.20
TOTAL REFUND: $67.20
APPROVALS: SIGNATURES DATE:
If under $5,000 Professional Staff 1 ar -
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 AD INISTRATION USE ONLY
Case Refund Processed: I Date: I _3/22,'3 I By:
I: \Building \Refunds \RefundRequest.doc x 09/01/2010
03/22/2013 09:42 5032551966 CAPITOL ELECTRIC PAGE 01
li
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENE�D
w j�j��Ll . +-'
Request Permit Action MAR 2 5 2013
T l c; n 1.1, 13125 SW Hall Blvd. • Tigard, Oregon 97223 •503.71.8.2439 • www.ti and or up
TO: CITY OF TIGARD UI ING WIS N
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223 3 2 � �3
Phone: 503.718.2430 Fax: 503398.1960 www.tigard-or.gov
FROM: ❑ Owner Z 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):
• CANCEL/VOID PERMIT APPLICATION.
® REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
n INVOICE FOR FEES DUE (attach cast fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel. permit).
Permit #: ELR2013 -00063
Site Address or Parcel #: 17003 SW 72' Ave
Project Name: Twig's Bistro & Martini liar
Subdivision Name: Council View Acres Lot #: 18
EXPLANATION: Job Cancelled
Signature: L/ - Date: 3/22/13
1 erry Brasch
Print Name:
Refund Polieg
1, The Director or Building Official may authorize the refund on
a) any Fee which was erroneously paid or collected.
b) not more than 80% of the land use application foe when an application is withdrawn or canceled before any review effort has been expended,
c) not more than 80% of the land use applies: inn fee for issued permi
d) not more than 80% of the building plan review fee when an application it canceler' before, any plan review effort hes been upended.
c) not more than 80% of the building permit fee for issued permits prier to nny inspection request..
2. Refund. will be returned to the original Payer in the .amc method in which payment was received. Plum allow 2-4 weds for procataing refunds.
FOR OFFiCE I1SL ONLY
Rte to Sys Admire: Date _ MM. 33 " Rte to Bid_ Aclmin: Date 2P. B
Refund Processed: Date Q, r B 42511 Invoice Processed: Date B
Permit Canceled: Date wr Parcel Ta_ Added: Date B
Rccei • t # Date Method Amount $
I: Building \ptmnARcgPctmitA.ction.doc Rev 05/25/21112 / r fi� ex, �F �s0t/ 1
eO , OD = 7. vZ o
jd /'pia /TEA 7r �0
q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
III
II ' -, COMMUNITY DEVELOPMENT Permit #: ELR2013 -00063
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/19/2013
Parcel: 2S113AC01201
Jurisdiction: Tigard
Site address: 17003 SW 72ND AVE
Project: Twig's Bistro & Martini Bar Subdivision: COUNCIL VIEW ACRES (LOTS 1 -20) Lot: 18
Project Description: (1) low voltage for Data Telecommunications
Contractor: CAPITOL DATA & COMMUNICATIONS Owner: BV CENTERCAL LLC
11401 NE MARX ST ATTN: FRED BRUNING
PORTLAND, OR 97220 7455 SW BRIDGEPORT RD
TIGARD, OR 97224
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 03/19/2013 $75.00
12% State Surcharge - Electrical 03/19/2013 $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. 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 9 2-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � /V �+ Permittee Signature: (0lu- 417"nPe cA-O I
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.
03/18/2013 15:59 5032551966 CAPITOL ELECTRIC PAGE 01
ECEI�TED Fiat OFFICE USE ONLY
Electrical Permit ApnHea i Received
City of't'i and Dete/By; Permit no.nt e a01 3 _ o()O(a3
IN Plan Review fa q o
13125 SW Nall Blvd,. Tigard, OR 9722 h 18 2013 Date/By: Other Permit: p Y71 J ' DO 1 1
2 ' • Phone: 503.639.4171 Fax: $03.598.1tJ pate Ready/By: luri r. PI
A6 Line: 503.639.4175 C OFTIGARD n lr�r
e
T1 G �1A17 JrltCrrlOt: tVW�V.tI$ard- Or.$OV Notified/Method! ( 1O SupplementalInrermntion
j New construction 1►a Addition/alteration /replacement Please cheek all that apply:
■ Demolition ■ Other: ❑ Service over 225 amps, comm'i ❑ Hazardous location
-�: ,. i re �, Uf a rJj,7 ',•It's `''u ... 1 ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
❑ 1 and 2-family dwelling ' Commercial /Industrial • Accessory building of 1- and 2- family dwellings 4 or more new residential
El Multi family ❑ Master Builder 0 Othcr ❑ System over 600 volts nominal units in one structure
fah no , l _ i'Tit.'i:a:,1l iioacir�:ontOT,�,�, 7 11.6;, , ❑ Building over three stories ❑ Feeders, 400 amps or more
C13211 Job site address 17003 SW 72nd Ave ❑ Occupant load over 99 persons ❑ Manufactured structures or
❑ Egress/lighting plan RV park
City/State/LW: Tigard, Or. 97223 ❑ F3ealth -care facility El Other:
Submit 2 sets of plans with any of the above,
Suite/bldg. /apt. no.: Project name: Twigs Bistro Cable The above are not applicable to tem ovary construction service_
Cross Street/Directions to job site: Description thy. pee, Total "
New residential - single or multi- family dwelling limit.
Subdivision: I Includes attached garage.
T.,ot no.: 1000 sq, ft. or less S 168,54 4
r
Tait map /parcel ho.: Ea. Add'I 500 sq. R or portion a 32,92 I
,:;E.50"fin ^ ?',i AailLS:..:.... Limited energy residential 5 75.00
Installation of Comcast coax to N's and Dmarc. Limited energy, non - residential 5 75.00 2
Each manufactured home or modular
,:y,..1 i;;hliatTt1P,ERrTYstO,.'.a -7 .... ,�,...t ..,.._� ����C� ..
• .-� �„ .. �._._ dwellin Scrvicc a nd/or fZ:eder S 67 . _ 2
Name: Service or feeders Installation, alteration, tend /or relocation
200 amps or less 5 150.70 2
Address; 201 amps to 400 amps $ 133.56 2
401 amps to 600 amps 5 200,34 2
Cily /Slatc/ZIP: 601 amps to 1000 amps - $ 301.04 2
Over 1000 amps or volts $ 532.26 2
Phone: Fax; Reconnect only S 67.84 _ 2
503 - 295 -5555 Temporary services nr feeders installation, alteration. and /or
Owner installation: This installation is being made on property that T own which is not relocation
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or Ices S 5936 1
Owner signature: Date: 201 amps to 400 amps 5 125.08 2
401 amps to 599 amps 5 168.54 2
L_I +1,1 r', . (r7 Branch circuits • new, alternii0n, or extension, perpanel
Business Name: A. Fcc for hranch circuits with
service or feeder fee, each
Con tact name branch circuit $ 7.42 2
B. Fcc 1 branch circuits
Address: without service or feeder fee,
each branch circuit 5 56.18 2
City/State/ZIP: Each additional branch circuit: _ 5 7.42 _ 2
Miscellaneous (service or feeder not included) _
Phone: Fax; Pump or irrigation circle s 67.84 • 2
Sign or outline lighting S 67.34 2
E-mail: Signal circuits(s) or limited.
__ _ _ 43�TYI t energy panel, alteration, or
Business Nome: Capitol Data 8 Communications. Inc. extension. Describe: Talc /Dam 1 75 75.00 2
Page 2 ,
Contact name Each additional inspection over allowable is any of the above
I x" _ Per inspection E 66.25
Address: 11401 NE I arx Street lnventigatinn per hour (I hr min) $ 66.25
Industrial .lant .• hour S 78.18
City/State/ZIP: Portland, Oregon 97220 — ..�..._...... -... , IC `i, �im;Ii anrlrllFlct ; :.., .. "
Subtotal 75.00
Phone: 503.255.9488 Fax: 503. 253 iq b b _ Plan review (25% of permit fcc'
State surcharge ( 12% of permit fee) 9.00
CCB Lie.: 142467 lEleeuicnl Lk.: 26.1KticLE I Suprv. Lie.: 27S 7LEA TOTAL PERMIT FEE 84.00
4}A, MR permit eppLeminn n.pir,,� tea pen. is nor obtained within mil
Ctrprv. Electrician signature. rcouircd: ��. Cyr •
doyen aver it ben hen, necrpled n. ... r im.
Print Name: Terry eraser Date: 03118113 • Fee methodology set by Tri- County Building Industry Service Oserd
Authoriacd signature; � � '•Numl, r oTinzpcadone per permit allowed.
Print Name: Terry Branch
503 -718 -2439
03/18/2013 15:59 5032551966 CAPITOL ELECTRIC PAGE 02
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential s st sm ..
ne $ 75.00
Check Type of work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
I❑ Other:
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
El Data Telecommunication installation
❑ Fire Alarm Installation
❑ HVAC
❑ I nstrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
17003 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
135 Low voltage
03/28/2013
ELR2013-00063
PASS
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
17003 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
199 Electrical final
03/28/2013 AM
ELR2013-00063
FAIL
Request submitted 3/22/2013 by contractor to void this permit as job was cancelled. All
inspection results are voided and applicant must submit new ELR permit to obtain C of
O. DLH
Canceled
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
17003 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
135 Low voltage
03/28/2013
ELR2013-00063
PASS
Violation Summary:
Inspector Contractor