Permit r17 :rr
1 . jOlgt*At:
City of Tigard
May 13, 2013
Rainbow Electric Inc.
Attn: Jeff Blast
PO Box 4445
Spokane, WA 99220
Re: Permit No. ELC2013 -00197
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 $56.98.
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 they did not perform the work. Refund 80% of
permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerel
1111,
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
CEO
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: Rainbow Electric Inc. DATE: 5/13/2013
Attn: Jeff Blast
PO Box 4445 REQUESTED BY: Dianna Howse
Spokane, WA 99220
TRANSACTION INFORMATION:
Receipt #: 190821 Case #: ELC2013 -00197
Date: 4/1/2013 Address /Parcel: 17003 SW 72nd Ave.
Pay Method: CreditCard Project Name: Twig's Bistro & Martini Bar
EXPLANATION: Per applicant's request as they did not perform the work. 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 $50.88
12% State Surcharge 100 - 0000 -24001 6.10
TOTAL REFUND: $56.98
APPROVALS: SIGNA • ' ES DATE:
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 O
Case Refund Processed: I Date: I S,/3 ,v By: I NLY
I: \Building \Refunds \RefundRequest.doc x 09/01/2010
Apr; 29.: "2013 10:41RM rainbow electric No, 5300 P. 1 ei
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
m
Request Permit Action
T !CARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov
TO: CITY OF TIGARD RECEIVED
ED
Building Division Services Supervisor APR 2 9 ' .
13125 SW Hall Blvd, Tigard, OR 97223
Phone: 503.718.2430 Pax: 503.598.1960 www.tigard or.gov CITY OF'j'IGARD
DIVISION
FROM: ❑ Owner [iii S tn f DN
❑ Applicant El [� �tp S taff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) ia-■ t• d:} E te- v, `. , r Ac . .
Mailing Address: "PQ - P o X 1.14-1 44E
City /State /Zip: 'Slanka.,t„ e i \.nl. A C 20
Phone No.: C1�.7)‘ 34:;-,a
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
El CANCEL /VOID PERMIT APPLICATION.
g 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 #: _ C, 2.o X _
Site Address or Parcel #: r1 00 S vJ - 12.."."°A‘/6...
Project Name: l, , C '1:: S.k .ro 4 Mrx.n-4r n ,' .•
Subdivision Name: C . ,,. -, - I v A c Lot #:
.. EXPLANATION: -- ti n r 77 i .� a : z l� , ' 6 Fo2� 1 �1 _ Ac. lam
.. - r .Sc, , 5 .
Signature: ■.•- Date: • - 2o i3
Print Name: Jei - 50-4
jipfimd 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 f w hen an application is wi thdrawn or canceled before any review effort has been expended.
. c) not more than 80% of the land use application fee for issued permit
' 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 OFF1CF: USE ONLY
Rte to S's Admin: Date ytriAMIETITE Rte to Bid: Admin: Date ®ET 37
` Refund Processed: Date .573 L3 By !y Invoice Processed: Date By
Permit Canceled: Date 5/13 / 13 By if P arcel Tag Added: Date By
Receipt # Date Method Amount $
I: \Building \Forms \Rol Rev 05/25/2012 '
4/ /aZ 9/i 3 • I ✓-Q-i r,:.,i- C/ `. L . - *t o Ln -a. 7 c~`-
CITY OF TIGARD ELECTRICAL PERMIT
I II COMMUNITY DEVELOPMENT Permit #: ELC2013 00197
T [C A.R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/01 /2013
Parcel: 2S113AC01201
Jurisdiction: Tigard
Site address: 17003 SW 72ND AVE
Project: Twigs Bistro & Martini Bar Subdivision: COUNCIL VIEW ACRES (LOTS 1 -20) Lot: 18
Project Description: (2) branch circuits to replace (4) fixtures
Contractor: RAINBOW ELECTRIC INC Owner: BV CENTERCAL LLC
PO BOX 4445 ATTN: FRED BRUNING
SPOKANE, WA 99220 7455 SW BRIDGEPORT RD
TIGARD, OR 97224
PHONE: 509 - 534 -3030 PHONE:
FAX: 509 - 534 -8840
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 04/01/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/01/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling AWL/
Issued By: � .e� """ j 1 Permittee Signature: f/�l r if p L/ 641
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.
_ - Apr, 1. 2013 8:13AM rainbow electric No. 5246 P. 2
RECEIVED -
E1ectrical Permit Application FOR OFFICE L - SE ONLti
City of Tigard APR 01 2013 'A 13 s Permit No,: ELG46E 3 -Awl
I I " 13125 SW Ha1191vd., Tigard, OR 972 Play Review
?hone: 503.718.2439 Fax: 5e S TIGARD oatrar. WILT Permit: j'a Il T, �„ft o inspection (jar:: at 9 r ILDING DIVISION NatiSecVMetbod' CO RI Set IYf orwatlop
Intettlet wpvw,tigatd- or - go B �J
"` ' ''i ,rf. • ' r ' '•
• . .it4 ,, '7n'rz'.OE. ) WOIUC: ' i. 1 ff: ' :i.;;;;;; 1, .) t ` ''.:: : : : .. PLAT!(;REVi)rWfrr,: 1 ;11i'r7• '•:.
❑ New construction ® Addition /alteration/replacemeni Please check all that apply (submit juts of plans Witham dialled beta«):
❑ Service et feeder 400 amps or more ❑ 5ellding ever three stories,
❑ Demolition ❑ Other where elm available Ash ciesenr ❑ Marims and boatyard.
t ` " 'i:+ t A EGORY F'COIiS RVCI7o1+ ' ' ' :. ••- • '� • : ".' �`1- exceeds 10,000 amps at 150 wets or Q FtMaio buWilms. gf ,`!ti: ' rrr�r" : 5 .' 1 - r tj W k '.• , 1 s p 6mrwd
or l .000 QCun ag
., • ,Q. a. es a nr Irma
❑ 1- and 2- family dwelling ® Commercial/Industrial 1:I Accessory building amps thr all other inslauauem- buildings
❑ Multi- family C] Mauer builder ❑ Other- Q Foe pump, O irEVlladerl of 75 KVA or
s ti + r i , S O Emergency system- larger eeparalely derived system.
''if' itr�ie i( i 1� 1G ;1 'JOB;$r'ZjTh'O R1vIAT10N.1N? 1 LOCATION: ; c, F.,� g , a ,, Addirioaof new mow toadaf ❑'A-, • E", •1- r', 1.3
'
Job s ite address 17003SW 72 Ave. 1 W"R a more. t u $"w
Job fro : I ❑ Six or mom resi lensial ends. ❑ [teaeatiooat vehkk ;ow
City/State/ZIP: Tigard, OR 97224 C Heettb.orc ntliitka. Q 5.Pply voltage rat more then
C Raterdoes locations. 600 voter nominal.
Suiteibldg, /apt no-: ' Project Ilsuuc Twigs Btstro&Martini Bar qf❑{��� or.feederr amoi or more- , i,10 1 0'�erP!4F. - V '�', E SC� i • ,... .' , „., - ._. 7
Cross street/directions to job site: Lower Boones Ferry Rd & 72 " Ave Turn mammon on ) 0j Taal J •
New residential single- or nnuld- family dwelling unit.
North on Bridgeport Village. includes attached garage- .
Subdivision: Council View Acres Lots 1 -20 Lot no 18 1.000 sq. Ii- oriel* 168,54 4
le- add' 1 500 se-. R. or portion 33.92 t
Tax map/parcel no.: 2S113AC01201 ' Limired energy. residential 75.00 2
�}r: �t "
o3 -tta7 , .... , rC, ,r�yr '� A (withab .ft.)
�Ir•11�i l is 7? iu .I �ESfvsur ,/}O1ti:.OFn : Vf�O1tJC;4 �' � 1 k -e ,. w rr •v t
Limited energy, mutli•famdy f _
Replace (4) light fixtures
rrsidanial (with above so. 0.) 75,00 J
� - Services or feeders Installation. alteration. and/urreloration
. 200 amps or less 100.70 12
., t t , y�y 201 mops to 800 amps 13356 2
401 amps to 600 am
pa 4i .jP ROPEIitn.'. ci - . El 'iti.lie r '-• "1i% tai V . v:' t ae ps 200.34 2
- t
Name Twig's Bridgeport LLC _ 601 amps to 1.000 morns 301.04 2
Address: 401 W Farwell Rd —w Over 1,000 sops or voles I 552.6) 2
Temporary sues or feeders installation, alteration, end/or
City/State/ZIP: Spokane, WA 99208 - relocation
—
504 466.7508 200 amps or lag 5936 1 I
Phone: (509)x46 9490 F ax: ( ) - 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that i own which is Dot
401 moos to 599 amps l68S4 2
intended for sale, lease, rent, or ecchange, according to ORS 447, 419, 670, and 701. Branch circuits- new, alteration. or extension. per panel
Owner signature: Date: A. fee Ibr brands circuits weak
'. i9Wk r lk " {{r Q.lCON1'*efliiE1�50Nv )Ei�1 abovescrviecarfeeder cc, 742 2
4 AP PJ�I dchlxanchdreoit
EL Fee for blanch circuits without 56.18
Business name: Rainbow Electric, Inc. service or Iambs fee. fiat 1
_ �• breach circuit. 56.18 2
Contact name: Jeff Bust
Lath mein branch detail I 7 7.42 2
Address: PO Box 4445 Miscellaneous (service or feeder net included)
Each manufactured or modular 67 Ed. 2
City/StatdZIP :Spokane, WA 99220 _ dwelline.smice and/or feeder
Reaonoect only I 67.84 2
Phone (509) 5343030 Fax: : (509) 534-0340 pump or ligation circle I 67.84 _ 2
— E -mail: jefib('raiaboweleetricnet Sign orotlinelightieg 67.84 2
age' Y IyY,� . 1 ro rya'
:if! L;'g7i 'Ara!'i!1st;. TV. corrnAC1 ?.a' Y ' A . , l w sr_ri ;a signal circeilIIIee an ited-r+agy
panel, alsee i oo. or extension. I Paget
Business name: Rainbow Electric, lac Each additional inspection over allowable In anzof the above
Address= PO Box 4445 Additional inapectioa (1 hr min) 6625/1r
1 1
_ lnveuigetipn (1 hr mitt) 66.25/ hr
City/State/ZIP: Spokane, WA 99220 Industrial plant (1 to min) 76.18/ he
Phone: (509) 534 -3030 Fax: (509) 5343030 Inspections for olden tie fee is 90 -00/ hr
dcally hated (%a l ioin't
7 , . M a l ._ •,{ �f: I r
,
CCf3 Lie.: 185603 Electrical Lie.: C900 �Suy. Lie.; 43415 ':. Sal. 4; i" 1t•FJ.BG7'ItiCAL;PBRMI�YE1ES t
•
/ � � f � Subtotal: 63.60
Suprv. Electrician signature, required: -/d(S,!,.*•f , i f.� � ' tf t4'e� , S Plan review ( %of pmnit fee):
Print name: Richard L. Willm State surcharge (t2% afpetmit fee): 7.63
ering Sr_ v pate: d•01 -2013 _ ,
' - TOTAL PERMIT rEE: 71.23
Authorized signature: This permit 'pp-Ocarina ecplres if a ps,nit Is cot obtained within 100
days after it bed been amp red a complete.
Print narnx Jeff Bast - � Date 4 -01 -3013 • Nsmbnr of inspcctioro allowed per permit.
-
INSenteinL'1'amiranFlGraetNfFSx 61.a1rd° y0 - teII - rd l,as,tOWW8B
Apr. 1. 2013 8:13AM rainbow electric No. 5246 P. 1
U MO
'
FEAPilt I1T1KR • • '•
P.O. BOX 4445 RAINBOW ELECTRIC, INC.
N. 809 NAPA _ (509) 534 -3030
SPOKANE, WA 99220 ELECTRICAL-CONTRACTOR FAx (509) 534 -8840
FAX COVER PAGE •
. DATE: "-A/ -0 1 TOTAL # OF PAGES:
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ATTN: - R-Q-- XS
FAX #: )) S - 19 RE: I S
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