Permit VOID
���� <00 RECEIVED
City of Tigard • COMMUNITY DEVELO ME T DEPARTMEN al JUN 16 2020
1 Request for Permit Action CITY OF TIGARD
TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 . 503-718-2439 . wwuNii
aQe .ibSION
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(/)one
REFUND OR Name:
INVOICE TO: (Business or Individual It
61/\fj .- T U/►., A— 0 e r 11C..,L p l s-rei LT
Mailing Address: 'I(DO SW SANtii:/021 ST
City/State/Zip: 1 6AlQb , O R q 7 2.23
Phone No.:
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).
Permit #: G t-C 2013 - CO242I
Site Address or Parcel #: 1(IA12� l-}t *1 SGM ICXj�— �1R( ol p 224
Project Name: Si LIB) L i&MT 1 NEi Fo 2 ( ) ivPrt l S left.)
Subdivision Name: O14c PA12T1"110 N pL$ T Lot #: 2-
EXPLANATION: ji- Si(aN Hf-S SI i JC f EN Petfl WG
T EQ P Fnee `1 HF: Peom\T C► 1J I.107 1 ►.3SPE C_TEb A
1W WOeL. IS ND LONL4F12 l4 :
Signature: Date: G/ E.0
Print Name: N —"Mei&TMS diikitatht
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to S s Admin: Date .nrfffm B 41:101 Route to Records: Dar, /A 4 B�/ -
Refund Processed: Date N/f— By 4 Invoice Processed: Date By
P...m:•f'....�elaA. il_,.. n... n m „ , .. _
Branden Taggart
From: #Building Permit Technicians
Sent: Tuesday, June 16, 2020 5:51 PM
To: 'Ifarr@ttsd.k12.or.us'
Cc: Dianna Ornelas
Subject: RE: Request for permit action attached
Attachments: 20200612_City cTigard •COMMUNITY DEVELOPMENT DEPARTMENT Request.pdf;
Branden Taggart2.vcf
Hello Lindsay,
I will forward this Request for Permit Action form to my supervisor, Dianna Ornelas. We will get back to you once we
have completed our review.
Thank you,
Branden Taggart
City of Tigard
_ Senior Permit Technician
TIGARDD Community Development
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or,gov
From: Lindsay Farr<Ifarr@ttsd.k12.or.us>
Sent: Friday,June 12, 2020 4:06 PM
To: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Request for permit action attached
Caution!This message was sent from outside your organization.
Hello,
I hope this email finds you well.
I have attached a request for permit action. Please note that the permit in
question is from 2013 and the work that was done is no longer in the building
therefore there is nothing to inspect. We are not looking for a refund, we just need
to have the permit voided or cancelled.
I look forward to hearing from you soon.
1
- Best Regards,
Lindsay Farr
Operations Administrative Assistant
Tigard Tualatin School District
6960 SW Sandburg St.
Tigard, OR 97223
Phone: 503-431-4192
i (t
OPERATIONS
For more information on facility use
please visit our website at:
https://www.ttsdschools.ord/domain/32
2
iREC i': D
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JUN 1 7 2020
111 le CITY OF'FICA O
■ Request for Permit Action BuiLDING DivIslor4
t I c:i It 11 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD V
Building Division 0 I D
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits@tigard-or.gov
r
FROM: Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) 'C,.'t1(it) ,- --NA /V. k) 6 iiri L b l c Tit c.T
Mailing Address: 1OUoO SiaJ SAt-ril'i3oeei CT
City/State/Zip: 1 t!i<�j b . OR 4112.Z3
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
nil CANCEL/VOID PERMIT APPLICATION.
III REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: CIS(... 201'3 - Oo2to j
Site Address or Parcel #: j(-JOt2. 14t t� �-1 cc L, �1 b lW i`a t f-( 1 1J
�1 "ClLldrcuaiN t ce, q'a-2...-zil.
Project Name: SI 640 L ttlWr i NSet I o 2 C1.) to-Lc C tea-1
Subdivision Name: 1 - O I i2TITl 0 J PLAT Lot#: 2.
EXPLANATION: —ale. St64Q 1-ttA'S Sl N(...E ge.EnS PekbWei)
Tiel2 s "r i 1 Pee-m 1T Cry.1,3 tU t T RC: t N S P C_'t&D -4 5
11-1e. wOatz tS Nb Lot 402,. -Ti-4& /�lrsfiic-c j J/ fotrPG67��
&v/ZS/roi3 — a i N Q e 4,, .
Signature: Date: V/;Z? ,49
Print Name:
Refund Policy WO
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Nor more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
1111111.111111111111111111M111
Route to Sys Admin: Date By Route to Records: Date /,F/zd By
Refund Processed: Date /t/ By C Invoice Processed: Date By
Permit Canceled: Date //�f 2e) By.I Parcel Tag Added: Date By
1:\Building\Forms\RegPermitAction_i 0518, oc
III CITY OF TIGARD
n 13125 SW4 Hall71 Blvd.,Tigard OR 97223 6/18/2020
9:20:48AM
503.639.41
TIGARD Activity Listing
Case #: ELC2013-00261
Project Name: Tigard High School
Site Address: 9000 SW DURHAM RD
DATE DONE
CODE DESCRIPTION DISP DONE BY NOTES
(Descending Order) i.
140 Sign installation 06/25/2013 PASS Jeff Grove
CaseActivityShortForm.rpt Page 1 of 1
CITY OF TIGARDII RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Ti ARD
Project Name: Tigard High School
Site Address: 9000 SW DURHAM RD
Receipt Number: 191284 - 05/08/2013
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELC2013-00261 Sign or Outline Lighting 220-0000-43103 $67.84
ELC2013-00261 12% State Surcharge-Electrical 100-0000-24001 $8.14
Total: $75.98
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 302866 DADAMSKI 05/08/2013 $75.98
Payor: Tim M Scott-Signcraft
Total Payments: $75.98
Balance Due: $0.00
Page 1 of 1
y ry CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00261
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2013
Parcel: 2S114AA00100
Jurisdiction: TIGARD
Site address: 9000 SW DURHAM RD
Project: Tigard High School Subdivision: 1993 -078 PARTITION PLAT Lot: 2
Project Description: Sign lighting for (1) wall sign
Contractor: SIGNCRAFT ELECTRICAL ADVERTISING LLC Owner: TIGARD - TUALATIN SCHOOL DISTRICT
8900 SW BURNHAM, E109 6960 SW SANDBURG ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 639 -4910 PHONE:
FAX: 503 - 639 -4999
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 05/08/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 05/08/2013 $8.14
Electrical
Type of Use: COM
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 actor• - pproved 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: Oregon la re•u'res you to follow the rules adopted by the Oregon Utilit •.;,. - ion enter. Those rules are set forth in OAR
952-001-001% throu.h OAR 952 -00 -r'90. Yo ay obtain a copy of the rules or direct questions to OU • • ' •k.: •87 or 1.800.332.2344.
�� r
Issued � y: .. � � t / \ Permittee Si • • . _ _! � �::� � s
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:
f i
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 Applicati 6"1 FOR OFFICE Icr:util; oNC.i
City of Tigard Received e r Permit No.: 5 /� l
® 1 Hall n Date/B : 5� G s�[_pfCJ J� 0� o /
3125 SW Hal Blvd., Tigard, OR 97223 Plan Review p _
® ; / Other Permit: p e y3
i s Phone: 503.639.4171 Fax: 503.598. )r"ir'�� Date /B •
08 2013
I' I c:i A I(f) Inspection Line: 503.639.4175 Date Ready /By: luris 611 See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE 1D I CITY G DI ( PLAN REVIEW
13-New construction ❑ Addition/alteration /replacement P lease check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ER ommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
10014P or more. occupancy.
Job no.: Job site address: 70 /- ti i
ct ,,
L.l � e.... ❑ Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: T , Sc - - Oa— _ Z L (/ ❑ Health -care facilities.
❑Hazardous locations. ❑ Supply voltage for more than
600 volts nominal.
Suite /bldg. /apt. no.: Project name: / 6,/- j id—i h A 5 I I ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: \ /
J � i� f'�,,�,�„ `Z L- Description I QtY• I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
fax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 I
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. (1.)
I� Limited energy, multi - family 67.84 2
Lno[) IC (JP 5 j P ,1 51--0 C.X i 1 S )--1)^ y Sis r ,,,/ residential (with above sq. (i.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
t -PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 7% L T ,, (U d ,,,,,, 5 � v ,) ( ( ` ( s � ,,;Ld 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with _
e- APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
P- C each branch circuit 7.42 2
Business name: S r C,,u r - �- I .c f 1'c c. ( A ,,..0-1-25 -)-.) zt c B. Fee for branch circuits
without service or feeder fee,
Contact name: ,\M 5 (4-- first branch circuit 56.18 2
Address: v Q, y QC/ 5� , O n Mr"w . / I p- S v t� Y /d 1 Each add'l branch circuit 7.42 2
/ Miscellaneous (service or feeder not included)
City/State /ZIP: T 00,x- O0- 5 7 2_ L ? Each manufactured or modular 67.84 2
dwelling, service and/or feeder -
Phone: (,50 S) b ci ,— _ c-( 9'' Fax (X ) ( > ' y (y 6 Reconnect only 67.84 2
E -mail: 3 a S / v G , .S 1� 5 .,,c; /`L f F G(CG<{-- « cc, / , c GM Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting I 67.84 Le7.' '1 2
Signal circuit(s) or limited -
Business name: . 54 ,t energy panel, alteration, or
Address: extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: ( ) Fax: ( )
Investigation per hour (I hr min) 66.25
CCB Lie.: / S 5— '(Z Electrical Lic.: y3 -( S 2.5 Suprv. Lic.: 7( Q S r Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required4,e4 /1�/' , J / Subtotal: Ca 7. "
Plan review (25% of permit fee):
Print name: I � f 6.6....0 -5 Date: S "� ^ 7 State surcharge (12% of permit fee): 8 / y
Authorized signature: i ? • ' - ' - ' .--- ..._._ z _____. --- "" TOTAL PERMIT FEE: 75'. 9 g
Thi permit application expires if a permit is not obtained within 180
Print name: / p Date: S - — 3 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Perm its\ELC- PermitApp doc 10/01/09 440- 4615T(t I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
0
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
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
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09