Permit y . ,
C ITY OF TI GARD ELECTRICAL PERMIT
° PERMIT #: ELC2007 -00486
COMMUNITY DEVELOPMENT
DATE ISSUED: 7/17/2007
• TIGARD 13125 SW Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S135DD -03301
SITE ADDRESS: 11945 SW PACIFIC HWY 301 ZONING: C -G
SUBDIVISION: TIGARD PLAZA LOT : 002 JURISDICTION: TIG
. - , PROJECT: TIGARD PLAZA RECEPTACLES — S PEL sea
Project Description: install (4 branch circuits for extending and refeeding existing receptacles.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
•
1000 SF'OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER . BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION: •
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 3 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: .. CLASS AREA/SPEC OCC:
Owner: Contractor: . •
TIGARD PROPERTIES INC _ PHOENIX ELECTRIC
2106 SE OCHOCO ST • PO BOX 14037 '
MILWAUKIE, OR 97222 .PORTLAND, OR 97293
Phone: Contact #: PRI 503 - 886 -9930
•
FAX 503 - 266 -8394
. FEES
Description Date Amount Reg #: ELE C89
[ELPRMT] ELC Permit 7/17/2007 $66.80 LIC 162753
[TAX] 8% State Surcharge 7/17/2007 • $5.34 SUP 51695
Total • $72.14 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952- 001 -0010 through OAR 952-001-011 You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued ' // 71/./.: X / Permiftee Signature: , ��f
/ ral(
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'N: DATE:
LICENSE NO: - •
•
Call 503.639.4175 by 7:00 am. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project. •
Approved plans are required on job site at the time of each inspection.
•
Jul 16 07 02: 03p Terr Koch 503-266-8394 p . 1
4 ■ •
• teR r . . P
- Eleetri cal Permit ApplicatidinF' FOR OF FR E USE. ON1,1
ir.---
City of Tigard Permit No
Received -1_
ik • 13125 SW Hall Blvd., Tigard, OR 9722i UL 1 6 2007 Datell : 7 Ii
Pbn Review 0.611 ' - 4iL a A
a Phone: 503.639.4171 Fr= 503.598.1960 .. Date/By: Other Pcnoit:
TIGARD
Inspection Line: 503.639.4175 Cm: ,_::: i•••••:• Date Ready/By: ludic I a See Page 2 for
Internet: www.tigard-or.gov BUiLON(':. rl'`,V!00C.\` Notifie.d/Method: (Tk 6- Supplemental Inlbrmation
.
: ...: .-...:: ....::::. • ' '. : ' 1 . Y.PW ( WC.OW ....:.. :' :',..'•::.: :..: ' . ... . :•,'. :::: , :.:: . . •.: 1 14 0 .N . :
0 New construction la 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.
: • . : :::* : : : • : : : : : : : : '• • : . : : : : ' : f : . : 1 & A T E G O R y . O F :::::. : :: ::: :::: : :,' ::.::.:';::::::;::., exceeds 10,000 amps at 150 volts or 0 Floating buildings.
' lea U3 ground, or comeds 14.000 0 commercial-use agricultural
0 1- and 2-family dwelling Ca Connnercial/industrial El Accessory building amps for all other installations. buildings. 1
0 Multi-family 0 Master builder 0 Other. 0 Fire pump. 0 Installation of 75 KVA or DEmees lama separately derived systan_ I
! ...: :1 .; ' ..!::!: '' :::IO14 ::';'': ::1 ::".': 0 • • El "A". "E". - 1-2". - 1.3 - ,
. . . ...
Job no.: 2517 I Job site address: 11945 SW Pacific Hwy Su. 301 100HP or mare. rampancy.
0 SiX Or mare residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 0 Health-care facilities. 0 Supply voltage for mare than
0 Hazardotn locations. 600 volts nominal.
Suite/bldg./apt no.: I Project name:4igard S PEc . Service or feeder 60D amps or mem
tit SCHEDULE
Cross street/directions to job site: Sj Dessriptton I Qty. I re& I Tad j'
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: , 1,000 sq. ft. or less 145.15 4
Ea. addl 500 sq.11. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential 7500 2
titgeitiktitriq: *506 :::: ..:.:',•..: ::::::F::::;::::4:.:::::::::'.:: (with above K. lt.)
Limited energy, multi-family
Extend receptacle circuits and and refeed existing receptacles. residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
. . 200 amps or less 80.30 2
0 'IlROpERTY: OVOIE.R. :::: :1. : i - ; : ;...:-.; :.:''.: :::;:;:. ::: :.:::: 201 amps to 400 amps 106.85 2
Name: 401 amps 10 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
reloadion
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
..: i ': 1. : i !': '..•• :. . : :: 0 :01...tickirr;:::; above service or feeder fee. 665 2
each branch circuit -
Business name: B. Fee for branch circuits
without service or feeder fee, 1 46.85
Contact name: first branch circuit 46.85 2
Address: Each add'l branch circuit 3 6.65 19.95 _ 2
. . Miscellaneous (service or feeder not Included)
City/State/ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
COrfrjaCropR ::,::::.,!:.::, :: ,, ::' ' :::,: ;;, :::',::•:::.f' '. . ,;;:: ., - . ,,W:),.? Sign or outline lighting 53.40 2
Signal eircuit(s) or limited-
Business name: Phoenix Electric energy panel, alteration, or
Address: P.O. Box 14037 extension. Describe: Page 2 2
City/State/ZIP: Portland, OR 97293 Each addinonal inspection over allowable in any of the above
Per inspection 62.30
Phone: (503) 886-9930 Fax: (503) 266 Investigaticrn per hour (1 hr min) 62.50
CCB Lic.: 162753 I Electrical Lic.: C89 1 Suprv. Lie.: 5 69S Industrial plant per hour 73.75
;E::::;:; '":::4!'' VERMil:::4 . :..,.
Suprv. Electrician signature, required: ....,/t) •:
.....,/ i Subtotal: 66.80
4.,
Print name: Terry Koch 7
Authorized signature (
o 7 - 1 Plan revew (25% of permit fee):
,ot-- _ Stale surcharge (8% of penult fec): 5.34
TOTAL PERMIT FEE: 72.14
T K
P
7 I Date: '7-16-07 This permit application expires If a permit Is not obtained wIttdet 180
rint name: eny
days after it has been accepted in complete.
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
II
TIGARD
July 23, 2007
Phoenix Electric
P.O. Box 14037
Portland, OR 97293
Attn: Terry Koch
Re: Permit No. ELC2007 -00486
Dear Mr. Koch:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 11945 SW Pacific Hwy, Ste. 301
Project Name: Tigard Plaza
Job No.:
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $57.72.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as work was canceled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Permit Specialist
E nc.
I: \ Buil ding\ Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard or.gov • TTY Relay: 503.684.2772
Jul 18 07 11:21p Terry Koch 503 - 266 -8394 p.1
lk) Building Division
Request for Permit Action or Refund *,
City of Tigard 3V1 1
•
TO CITY OF TIGARD
Permit System Administrator g�a ° ° `�
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
(check one)
Name: Phoenix Electric
(Business or Individual)
V 0 f D Mailing Address: P.O. Box 14037
7/207 x pAl--_ City /State/Zip: Portland, OR 97293
Phone No.: 503- 886 -9930
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
® CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES.
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: ELC2007 -0 4, c
Site Address or Parcel #: 11945 SW Pacific Hwy Su. 301
Project Name: Tigard Plaza
Subdivision Name: Lot #:
EXPLANATION: Work has been canceled
Signature: ! Date: 7 -18 -2007
Terry Koch
Print Name:
Refund Policy
1. The Building Official may authorize the rcfimd of:
a) any fee which was erroneously paid or collected
b) not more than 80 percent of the permit fee for issued permits prior to any inspection requests.
c) not more than 80 percent of plan review fee when an application is canceled before any plan review effort has been expended
2. Refunds will be returned to the original Payer in the same method in which payment was received.
xSa77
Rte to Sys Admin: Date 9 19 01 Rte to Bldg Admin: Date 7/i2.%7 BY
Refund Processed: Date 7/214, 7 By Invoice Processed: Date By
Permit Canceled: Date 7 /21/o 7 By cel Tag Added: Date v By
.
/7�0 7 re.t..,.asCC A.,,.,,,..r a 7,2 • /'/
CITY OF TIGARD . . 7/23/2007
13125 SW Hall Blvd. 2:24:31 P M
Tigard, OR 97223 503.639.4171
• • • TIGARD
. Refund Receipt #: 2720.0700000 25��
. 000003397 /2�"v�.-
•
Date:. 07/23/2007
Line Items: .
Case No Tran Code Des Revenue Account No Amount
ELC2007 -00375 Reversal - [ELPRMT] ELC.Permit 220-0000-431510 (128.16)
ELC2007 -00375 Reversal - [TAX] 8% State Surc • - . 100 - 0000 - 207020 (10.25) .
Line Item Total: ($138.41)
Refund: - - .
Method Payer User ID . Acct. /Check No. Approval How Received Amount Paid
Credit Reversal.. THAD FIRKINS - YOUNG DLH In Person (138.41)
ELECTRIC SIGN CO '
Refund Total: ($138.41)
•
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cReceipt.rpt Page 1 of 1
. . „
CITY OT TIGARD 7/23/2007 • •
13125 SW Hall Blvd. 2:09:36PM
Tigard, OR 97223 503.639.4171
-
TIGARD
Receipt #: 27200700000000003298 Oks/C/A/V--
Date: 07/17/2007
Line Items:
Case No Tran Code Description * Revenue Account No Amount Paid'
ELC2007-00486 [ELPRMT] ELC Permit 220-0000-431510 66.80
ELC2007-00486 [TAX] 8% State Surcharge 100-0000-207020 5.34
Line Item Total: • $72.14
Payments: •
Method Payer User ID Acct./Check No. Approval No. - How Received • Amount Paid
• Credit Card PHOENIX ELECTRIC SLN 00544B Fax 72.14
Payment Total: • $72.14
cReceipt.rpt Page 1 of 1
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Ac ion or Rtfund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Phoenix Electric DATE: July 23, 2007
P.O. Box 14037
Portland, OR 97293 REQUESTED BY: Dianna Howse
Attn: Terry Koch
TRANSACTION INFORMATION:
Receipt # : 2007 -3298 Case # : ELC2007 -00486
Date: 7/17/07 Address /Parcel: 11945 SW Pacific Hwy Ste 301
Pay Method: CreditCard Project Name: Tigard Plaza
EXPLANATION: Per applicant's request as work was canceled. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245 0000 - 432000 $ Amount
[ELPRMT] ELC Permit 220 - 0000 - 431510 $53.44
[TAX] 8% State Surcharge 100 -0000- 207020 4.28
TOTAL REFUND: $57.72
APPROVALS:
If under $500 Professional Staff
If
r .
unde $7,500 Division Manager
If under $22,500 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: I Date: I 7 2 /�: - 7 � By. I A. ", r
J
I: \Building \Refunds \RefundRequest.doc 05/23/07