Permit ' .q
.T.IGARU
City of Tigard
August 1, 2013
Bare LLC
Attn: Jeff Luedloff
22275 SW Scholls Sherwood Rd
Sherwood, OR 97140
Re: Permit No. ELC2013 -00281
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15960 SW Alderbrook Cir
Project Name: Bare LLC
Job No.: N/A
Refund Method: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $75.98.
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): Refund 100% of permit fees as Building Official determined that
reconnect permit was not required due to type of service panel.
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: Bare LLC DATE: 8/1/2013
Attn: Jeff Luedloff
22275 SW Scholls Sherwood Rd REQUESTED BY: Dianna Howse
Shenvood, OR 97140
TRANSACTION INFORMATION:
Receipt #: 191433 Case #: ELC2013 -00281
Date: 5/20/2013 Address /Parcel: 15960 SW Alderbrook Cir
Pay Method: CreditCard Project Name: Bare LLC
EXPLANATION: Due to the type of service panel, building official determined that a reconnect permit
was not required and authorized a refund of 100% of permit fees paid.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Electrical permit 220- 0000 -43103 $67.84
12% State Surcharge 100 - 0000 -24001 8.14
TOTAL REFUND: $75.98
APPROVALS: SIGN T S 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 ONL
Case Refund Processed: I Date: I 1-7////3 I By: I �J�
I: \Building \Refunds \RefundRequest.doc x 09/01/2010
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
N, 2(...
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Request Permit Action
JUN ,,,
T I Gn R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • wwwei 1- r g bi' 1 3
is r ' ilNa
TO: CITY OF TIGARD
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Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223 V I t 1 0
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov 4,/,/ ,j
FROM: ❑ Owner Applicant ❑Contractor 111 City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) C- L-C-
Mailing Address: (-24h2:6 cc-(r\-c. t 5 -- cLi-LcxD 4
City/State /Zip: S 2s -<->oa0 (.- - 9/y,60
y,60
Phone No.: 5 0 - c-( 9 - c4 3 2J
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL /VOID PERMIT APPLICATION.
R.,.
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 #: 66-C-- aZ O /3 00 Z a
Site Address or Parcel #: 75 v -) 4 dGr--ex7i
Project Name: ,4 & /L-+C
Subdivision Name: v/L/yt.�iC-• / Lot #: •
EXPLANATION: -- ?,9.." ‘ 0 I O O % � ,M ' ' ' '
ALLQ___I A
{®-- °�''`.e�C
Signature: ,6;2 ��4.....c.- Date: ( (/ - 7//_ / 7
Print Name: . Z....e.e.0;e2o
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 (p 11 13 • ■ Rte to Bldg Admin: Date 6 P / /3 By ..'!'..--
Refund Processed: Date e f i /3 By .427Y Invoice Processed: Date By
Permit Canceled: Date ,3///,C3 By ,fr. .Parcel Tag Added: Date By
Receipt # Date J Method Amount $
I: \Building \Forms \RegPermitAction.doc Rev 05/25/2012 ,
` y �� CITY OF TIGARD ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2013 -00281
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/20/2013
Parcel: 25111 DC01600
Jurisdiction: Tigard
Site address: 15960 SW ALDERBROOK CIR
Project: Bare LLC Subdivision: SUMMERFIELD NO.8 Lot: A
Project Description: Reconnect only
Contractor: Owner: BARE LLC
22275 SW SCHOLLS - SHERWOOD RD
SHERWOOD, OR 97140
PHONE: PHONE: 503 - 349 -4326
FAX:
FEES
Quantity . Description Date Amount
1 ea Reconnect Only 05/20/2013 $67.84
Specifics:
1 ea 12% State Surcharge - 05/20/2013 $8.14
Electrical
Type of Use: SF
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 _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. 1 l ENTION: O er gon law re wires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 01- 0010 th ugh OAR 95200 09 . Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I ued By: . , Permittee Signature:
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 Application FOR OFFICE USE ONLY
City of Tigard Date/By: ^�'
q Y �J r, /
13125 SW Hall Blvd., Tigard,OR 97223 Plan Review v v Received
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: ,,, Permit No.: /3 — 00 � v: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
I' I G r1 h D Notified/Method: Supplemental www.tigard-or.gov PP lemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please 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 A 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 ❑ Commercial/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
13 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
/J/ Li 100HP or more. occupancy.
Job no.: Job site address: /$'9� Sri .l p 0tj4 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: -.4 C ❑ Health -care facilities. 0 Supply voltage for more than
l 5 t �� C.� -' ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: / Project name: "/ 2E LLB ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 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
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
/ �7� £ ' _ _ 7 residential (with above sq. ft.)
\ \l ! Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
A PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
�7 201 amps to 400 amps 133.56 2
/l
Name: �-Q� ( �c� / 401 amps to 600 amps 200.34 2
Address: 2-2_2-7 S �� ((s 12 -t��y; � T' .01 amps to 1,000 amps 301.04 2
e er 1,000 amps or volts 552.26 2
City/State /ZIP: p p - y 4/
���J '?0 , ! � /�>`S�'E, Temporary services or feeders installation, alteration, and /or
Phone: ( - 14 (5;3 )3 - caZ6, relocation
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
Owner signature: / "e.c ate: i224,/� Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:
each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first
branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
67.84 2
Phone: ( ) I Fax: : ( ) dwelling, service and/or feeder
Reconnect only / 67.84 6)778x( 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Signal circuit(s) or limited- energy
A panel, alteration, or extension. Page 2 2 )/ Address: Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP:
Investigation (1 hr min) 66.25/ hr
Phone: ( ) I Fax: ( ) Industrial plant (1 hr min) 78.18/ hr
Inspections for which no fee is
CCB Lic.: I Electrical Lic.: I Suprv. Lic.: specifically listed (%: hr min) 90.00/ hr
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: & 7. e
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): . /4{
Authorized signature: �� �� TOTAL PERMIT FEE: 75. 98
r-'- This permit application expires if a permit is not obtained within 180
J
Print name: / ( f Date: .5.,,./2 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building\ Permi ts\ELC_PermitApp_040913.doc 440 -0615T(I I /05 /COM/WEB
Electrical Permit Application — City of Tigard
•
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK (ONLY: ' `.. W',i' FEE ;SCHEDULE ; n ir` a„ t
•
Fee for all residential systems combined $75.00 Description I Qty. I Fee I Total I
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
El Garage Door Opener* 50.01 to kva 552.26 2
>100 kva (fee in accordance with 552.26 2
OAR 918- 309 -0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over25 7.42 3
❑ Vacuum Systems* >100 kva —no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is 66.25/ hr 1
charged at an hourly (I hr min)
Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
'COMMERCIAL WORK ONLY: T . _ ,ELECTRICAL 'PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
El Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Bu ilding\Permi ts\ELC_Permi tApp_040913. doc