Permit z : n
,
IFIGWROI
City of Tigard
October 15, 2013
Parking Electric
Attn: Amanda Donaldson
14001 Fir Street
Oregon City, OR 97045
Re: Permit No. ELC2013-00343
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 10865 SW Walnut St
Project Name: Fowler Middle School
Job No.:
Refund Method: I I Check # in the amount of S .
Credit card "return" receipt in the amount of$33.25.
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
n Trust account "deposit" receipt ii-i the amount of$ .
Comment(s): Per applicant's request as applicant is not doing the work for the (5)
additional branch circuits. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincere�
r if 'Y
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
` j .. J
71
= 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 Reg/testfor Permit 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: Parkin Electric DATE: 10/15/2013
14001 Fir Street
Oregon City, OR 97045 REQUESTED BY: Dianna Howse
Attn: Amanda Donaldson
TRANSACTION INFORMATION:
Receipt #: 192759 Case #: ELC2013-00343
Date: 8/21/2013 Address/Parcel: 10865 SW Walnut St.
Pay Method: CreditCard Project Name: Fowler Middle School
EXPLANATION: Per applicant's request as they are not doing the work for the additional (5) branch
circuits. Refund 800/0 of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Electrical permit 220-0000-43103 $29.68
12°/o State Surcharge 100-0000-24001 3.57
TOTAL REFUND: $33.25
APPROVALS: SIGN•TU r S DATE:
If under$5,000 Professional Staff 41� _ -
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over S50,000 Local Contract Review Board
FOR TIDEMARK SYSTEMAMINISTRATION USE
Case Refund Processed: Date: /d//S /3 B ••
I:\RuIIdin,g\Refunds\RcfundRcyuest.d.,c x n9/01/2()10
From: 08/22/2013 15:31 •:. 4 1
. LIES
AUG 2 2 2013
Y'';:'7,0flgt City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT cI-ryo*TIGARD
Request Permit Action BUILDINGDivISIOP'
Ti;c�nFtD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • 4r\vw•.tieard-or.gov
TO: CITY OF TIGARD
Building Division Services Supervisor - -
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
(check one)
REFUND OR Name: Parkin Electric
INVOICE TO: (Business or Individual)
Mailing Address: 14001 Fir Street
City/State/Zip: Oregon City, OR 97045
Phone No.: 503-657-4958
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
VOID PERMIT APPLICATION.
® "REFUND ERMIT FEES (attach copy of original receipt and provide explanation below).
N • CE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: ELC2013-00343
Site Address or Parcel#: 10865 S.W.Walnut Street
Project Name: Fowler Middle School
Subdivision Name: Lot#:
EXPLANATION: I only need the 5 ckts we added onto the permit yesterday.We arc not
doing that portion of the work. Thankyou
Signature: Date: 8/22/13
Amanda Donaldson
Print Name:
Refund Policy
I. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 811"o of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
e) not more than SW n of the land use application fcc for issued permits.
d) not more than 81)°°of the building plan review fee when an application is canceled before arty plan review effort has been expended.
c) not more than Alt°o 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.
_FOFt(�FFIC)✓ USL U1�1I.�__. ,..., ;,
Rre to S's Admin: Date B Rte to Bid:Admin: Date "AgjrAMMET.111
Refund Processed: Date r %%�
i��� B �� Invoice Processed: Date By
Permit Canceled: Date 0 MAN B' ;�„ 'arcel Ta• Added: Date By
Recei.t# Date Method Amount$
is\Building\forms\RcsPermit:\etion.doc Rev 115/25/2012
37. /0
- 3.3,E 2g�u No. FD%
r0 •e9 I,3/ PO 9ci
CITY OF TIGARD ELECTRICAL PERMIT
' . COMMUNITY DEVELOPMENT Permit#: ELC2013-00343
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2013
Parcel: 2S103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: Fowler Middle School Subdivision:)O SUPPLEMENTAL PLAT NO.1:ANNE Lot: 7-6
Project Description: (6)branch circuits for new cooler/freezer.
8/21/13:Reprinted permit to include(5)additional circuits for kitchen equipment.
Contractor: PARKIN ELECTRIC INC Owner: TIGARD-TUALATIN SCHOOL DISTRICT
14001 FIR STREET ATTN: BONITA MAPLETHORPE
OREGON CITY,OR 97045 6960 SW SANDBURG ST
TIGARD,OR 97223
PHONE: 503-657-4958 PHONE: 503-431-4000
FAX: 503-557-1059
FEES
Quantity Description Date Amount
11 crt Branch Circuits wo/Purchase 08/21/2013 $130.38
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/21/2013 $15.65
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $146.03
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 952-001-0090. You may obtain a copy of th= or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
i
Issued By: . �i �—— Permittee Signature: _ _ 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.
CITY OF TIGARD ELECTRICAL PERMIT
•'
III °. . CO MMUNITY DEVELOPMENT Permit #: ELC2013 00343
T (G r1 R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/20/2013
Parcel: 2S103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: Fowler Middle School Subdivision:)O SUPPLEMENTAL PLAT NO.1: ANNE Lot: 7 -6
Project Description: (6) branch circuits for new cooler /freezer.
Contractor: PARKIN ELECTRIC INC Owner: TIGARD - TUALATIN SCHOOL DISTRICT
14001 FIR STREET ATTN: BONITA MAPLETHORPE
OREGON CITY, OR 97045 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503 - 657 -4958 PHONE: 503 -431 -4000
FAX: 503 - 557 -1059
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 06/20/2013 $93.28
Specifics: • Service or Feeder
1 ea 12% State Surcharge - 06/20/2013 $11.19
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 952 -00 - 90. 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: /1/
/
Perm 1 .1 /// C�77O//
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.
From: 06/19/2013 14:28 #038 P.002/002
A ECEn/ ED
, . , .
Electrical Permit Application JUN 19 2013 FOR OFFICE USE oNLI'
City of Tigard R eceived l � /I ,
• 13125 SW Hall Blvd-, Tigard, OR 97 :/�r g
OF �����® Date/B ` -.Li IM/411
� � G
Plan Review
Phone: 503.718.2439 Fax: 503.5 1 , Other Perry ,/3 --446142.40 --446142.40 1'IGA inspection Line. 503.639.4175 r� � LJIVI NUIN" Da teReady /B y: ® See Page 2for ?la Internet: www.tigard- or.gov Norified/Method: Supplemental Information
TYPE ;OF° WORE` _.. .. ;, - -,PLM ,..to 'W ,
❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition Other: Service or feeder 400 amps or more ❑ Building over three stories.
. ...: , >,.� .. ... ......:.�.�0 where available boatyards.
` • ere the availabl fault current Marinas and boa y
•,,,, T X F �i&TitpN Y +, , : 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 ommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
�� ; , :;SOB Si t !'E • It�1�A 'TI!D�!1 :' y6�..tI1TIbN:':;'; �`
t- ,,:.,,, ❑ Emergency system. larger separately derived system.
• rz .. � �:'S3!?:' � a' �' .:.t. r :.;.;''_;:,': -. ❑Addition of new motor load of
Job no.: Job site address: ./ �,i I 100HP or more. occupancy.
Mc)..., ! + 0 �h/ u I ��� -� ['six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tgard ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Su ite/bldg. /apt. no.: I Project name: Vic MS Cobi - :r� ❑ Service or feeder 600 amps or more.
_ FEE SPOEDVLE
Cross street/directions to job site: Descrip Our -) Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I 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 W ORK (with above sq. ft.) 75.00 2
n, �/� J Limited energy, multi - family 75.00 2
l X -( C � ( residential (with above sq. ft.)
I /J lM l d Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
' • ❑ PROPERTY' OWNER -. p ,❑ `TEN 20l amps to 400 amps 133.56 2
Name: 6L�l.� M ,� i 7 , Y 401 amps to 600 amps 2 ,34 2
Mid' t �C ( , i / ((J L ( 60l amps to 1:000 amps 301.04 2
Address:
74' /6/11 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 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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
above service or feeder fee,
0,- APPl:ICAli1T : • :: :--. f.1 :01!1TACT ERSON; !,: each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first / 56.18 ✓ F 2
Contact name: branch circuit
Each add'I branch circuit 1' 7.42 , i' 2
Address: _ Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) Fax : ( ) Reconnect only 67.84 2
E -mail:
Pump or irrigation circle 67.84 _ 2
Sign or outline lighting 67.84 2
,i CONTRACTOR. •,. Signal circuit(s) or limited- energy
Business name: Parkin Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 14001 Fir Street Additional inspection (I hr min) 66.25/ hr
City /State/ZIP: Oregon City, OR 97045 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
V P hone: (503) 657-4958 Fax: (503) 557 -1059
Electrical Lic.: 34 Inspections for which no fee is 90,Op/ hr
specifically listed (Si hr min)
CCB Lic.: 3515 34-4C Suprv. Lie.: 4241 S °:?1 l /Q1.f FEES .
Suprv. Electrician signature, required: ,��� lx
Plan review (25% of rmit Su feebtotal: �
): 3 d t
Print name: David B Parkin Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE: / �f
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
1011 Print name: Date: • Number of inspections allowed per permit. ��
, O t _ / �7
/jr>�/
t: Building \Permits5ELC -Permi1 App,doc 07/01 /10 440 - 46157 11/05/COM/WEB
From: , 08/19/2013 10:25 #128 P.002/002
N44f .
Electrical Permit Application $ ( 'k ■ 3' . , . . , , . . .... . . ,.., . .
. .,, ' ,,..,;. , . l'OR OFFICE USE ONLY . • . . '.:-.: . • '.::
.,. . - e\■ c)
City of Tigard cb S1/4 "t•-.ceived
4+ ' ' c\\ c3r. 1, 1 tem : • pq / . -m Permit No.: ,._ ..•
..r MI am
.11111 41 13125 SW Hall Blvd.,Tigard.0'',.,.,•:-__ :' .... ----"
; C' - Phone: 503.718.2439 Fax: 503. ''-',.Is'60 \;,...`--) (....'''NO.1/4CZ3 Plan Review
Date/B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Fa See Page 2 for
TIGARD
Internet: www.tigard-or.gov :; -k4 > Notifiedimethod: IM Supplemental Information
Iiejr$770417.V.titint.;:. -,. :,3,:'....- ,-.,i..4..:.,,;.-‘;:-:Y:',... .f-, .;.---.-,((. ..1.1;Y:'.':• :-.-:-...--- -.1i.'...UNqt-tolEvo,,,-:...;,..,aj 0 New construction 0 Addition/alteration/replaiement 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.
Tip.iOCGO::ILIJ:V_*KOKStr*:00t)),,.'., i.i.'.K:--.::-J.-..:iafg.R1;:,:it. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
E:1 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
11:**tiVII;liti—'RNiltit* eltijidittei .-g;lk.:I-:`.‘;1.--.-;.,'...;...,IVA';::14X4-:Vi.
- 0 Emergency system. larger separately derived system.
100HP or more. occupancy.
Job no.: Job site address:it e'6,3` < .t.) 1026_,e,N.c._41-
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Trgv.,-62 04 9 7g23 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: l'i I Project name: i.-fwur,in it„ s.40, 0 Service or feeder 600 amps or more.
.-':'_:%-te...&-' PPULE'
Cross street/directions to job site:
Description I Qty. 1 Fee. I Total 1 •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.addl 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:
Limited energy,residential
7500 2
--:,,._-•,' '''.. ,' ' • . . IRAPOrriQS.0,_':*014*-::: :;,-: '•:-,,:,:‘,;-::::, .:.'=:-,''' i.1-..-7':-1;.‘;' (with above set ft.)
Limited energy,multi-family
5 (f-/-c 4,L1_,) K4-60-e—_ residential(with above sq.ft.) 75.00 2
-- Services or feeders installation,alteration,and/or relocation
;(2 /1.--e..-‘../a- 200 amps or less 100.70 2
JD-PROPERTY.9W.1■1_ER-,...,...--,..:::..,':f..,.1...,,i, ...,.--?:;:::2:-:„:-.•,.:1; jic,wr.,., , .,, , , . 201 amps to 400 amps 133.56 2
Name: ro /€4. - 7)1%4(4 ,s-ded*o. 401 amps to 600 amps
601 amps to 1,000 amps 200.34
301.04 2
2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP:
relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not
to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
0.4),tivAst„,,,,,,,:::::0,:,,,:„s,,,,ri,:r;,ttir,„,. ....La.....;:..;_—,,:... ......,,,,.::,i2::'.:,-;.„,; above SerViCe or feeder fee,
742 2
-..1-3644;71-,KWYP1"... :1-".- each branch circuit
Business name: B.Fee for branch circuits without .
service or feeder fee,first
Contact name: branch circuit 56.18 2
Each add'l branch circuit _ 7.42 3 7./0 2
Address:
Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP:
dwelling,service and/or feeder 67.84 2
Phone:( ) Fax::( ) , Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
. ,_ . . Sign or outline lighting 67.84 2
: ;::::',,'.-S-',..l '-',::::L•.'':.':.::,. Signal circuit(s)or limited-energy
Business name:Parkin Electric panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address:14001 Fir Street Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Oregon City,OR 97045 Investigation(I hr min) , 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(503)657-4958 ,V7 Fax:(503)557;1059 Inspections for which no fee is
90.00/hr
specifically listed(1/2 hr min)
CCB Lic.: 35151 ,r rElectrical Lic.: 34-4C LZ Suprv.Lic.: 4241-5
Suprv.Electrician signature,required:
., . Subtotal: 37./0
Plan review(25%of permit fee): '
Print name: David B Parkin Date: State surcharge(12%of permit fee): -j,41 -
TOTAL PERMIT FEE: Lit 5( ,
Authorized signature:
- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit,
lauilding TermitsELOPermilApp.doc 07/01/10 440-4615TO 1/D5/C054/WEB