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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT s COMMUNITY DEVELOPMENT Permit #: ELR2013 -00171 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/18/2013 Parcel: 25101 BD00100 Jurisdiction: Tigard Site address: 7650 SW BEVELAND RD 110 Project: Certus NW Subdivision: 1994 - 025 PARTITION PLAT Lot: 2 Project Description: Low voltage for data Contractor: PROCOM TECHNOLOGIES LLC Owner: pNWP LLC#2 PO BOX 22288 PO BOX 2206 PORTLAND, OR 97269 BEAVERTON, OR 97075 PHONE: 503 - 797 -0000 PHONE: FAX: 503 - 233 -8052 FEES Description Date Amount Specifics: Restricted Energy Permit 07/18/2013 $75.00 12% State Surcharge - Electrical 07/18/2013 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 • Audio & Stereo: 0 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data & Telecommunications: 1 Fire Alarm: 0 HVAC: 0 Instrumentation: 0 Intercom/Paging: 0 Landscape /Irrigation: 0 Landscape Lighting: 0 Medical: 0 Nurse Calls: 0 Protective Signal: 0 Security Alarm: 0 Other: 0 Total $84.00 Other Desc: 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. ATT ION: Oregon aw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 010 through OAR 952 -0 1- You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19987 or 1.800.332.2344. Issu d By: Permittee Signature: -'i / ' r 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 Received 1 / ? City of Tigard Date /By: 7 J Permit No.: f�Q co/ - ! 7/ v 13125 SW Hall Blvd. Tigard, OR 97223 Plan Review 7111 ®. Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit f I CrA K D Inspection Line: 503.639.4175 Date Ready/By' Jens: 0 See Page 2 for Internet: www.tigard or.gov Notified/Method, Supplemental Information TYPE OF WORK PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): El New construction ® Addition/alteration/replacement ❑ 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 ® Cominercial/undustrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ['Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", 'E "I -2 ", "1 -3 ". Job no.: Job site address: 7650 SW Beveland Ste.110 I00HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: Tigard/OR/97223 ❑ Health -care facilities ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal, Suite/bldg. /apt. no.: 110 Project name: Certus NW ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: � Description I Qty. I Fee. I Total New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1.000 sq. R. or less 168.54 4 Ea. add 500 sq. ft. or portion 33.92 1 Tax map/parcel no.: Limited energy, residential (with above sq. 75.00 2 DESCRIPTION OF WORK ( q- R. ) Limited energy, multi - family 75.00 2 voice and data cabling residential (with above sq. ft.) Renewable Energy ❑ See Page 2 Services or feeders installation, alteration, and /or relocation ❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 2 City /State/ZIP: Temporary services or feeders installation, alteration, and /or Phone: ( ) Fax: ( ) relocation 200 amps or less 59.36 l 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: Date: Branch circuits — new, alteration, or extension, per panel ❑ APPLICANT ® CONTACT PERSON A Fee for branch circuits with above service or feeder fee. 7.42 2 Business name: ProCom each branch circuit B. Fee for branch circuits without Contact name: Shawn Giles service or feeder fee, first 56.18 2 branch circuit Address: PO Box 22288 Each add'i branch circuit 7.42 2 City /State/ZIP: Portland/OR/97269 Miscellaneous (service or feeder not included) Each manufactured or modular Phone: (503) 519 - 9447 Fax: : (503) 727 - 3397 dwelling, service and/or feeder 67.84 2 Reconnect only 67.84 2 E - mail: shawn@procomnw.com Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: ProCom Signal circuit(s) or limited- energy I See 75.00 alteration, or extension. Page 2 2 Address: PO Box 22288 Each additional inspection over allowable in any of the above City /State/ZIP: Portland/OR/97269 Additional inspection (1 hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr Phone: (503) 519 - 9447 Fax: (503) 727 - 3397 Industrial plant (1 hr min) 78.18/ hr Inspections for which no fee is 90.00/ hr CCB Lie.: 194272 Electrical Lic.: CLE282 Suprv. Lie.: 1172LEA specifically listed ('/ hr min) Suprv. Electrician signature, required: y ELECTRICAL PERMIT FEES 1 Subtotal: 75.00 Print name: Shawn R. Giles Date: 7/12/2013 Plan review (25% of permit fee): n I ��r State surcharge (12% of permit fee): 9.00 Authorized signature: e � TOTAL PERMIT FEE: 84.00 Print name: Shawn R. Giles Date: 7/12/2013 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. * Number of uupections allowed per permit I:\ Building\ Permits\ELC_PemiitApp_ELR_ERE.doc Rev 05/21/2013 440- 4615T(11105 /COM/WEB t►'.G'ARD City of Tigard August 1, 2013 ProCom Technologies LLC Attn: Shawn Giles • PO Box 22288 Portland, OR 97269 Re: Permit No. ELR2013 -00171 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 7650 SW Beveland Rd., Ste. 110 Project Name: Certus NW Job No.: N/A Refund Method: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $67.20. 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 cabling was not needed. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, /(0 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 TI GARD 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: ProCom Technologies LLC DATE: 8/1/2013 Attn: Shawn Giles PO Box 22288 REQUESTED BY: Dianna Howse Portland, OR 97269 TRANSACTION INFORMATION: Receipt #: 192294 Case #: ELR2013 -00171 Date: 7/18/2013 Address /Parcel: 7650 SW Beveland Rd, Ste 110 Pay Method: CreditCard Project Name: Certus NW EXPLANATION: Per applicant's request as cabling not needed. Refund 80% of permit fees. 'REFUND 'INFORMATION: - • Fee Description From Receipt Receipil Revenue Account No Refund Example: Building Permit Fee_ : ' _ Example: 2300000- 43104 $ Amount -. Restricted Energy Permit 220- 0000 -43103 $60.00 12% State Surcharge 100-0000-4.34e5 'Vo 7.20 TOTAL REFUND: $67.20 APPROVALS: SIGNAT S /DATE: If under $5,000 Professional Staff "(2 If under $12,500 Division Manager If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board ; 'POR T .RATION- USE'ONLY, L Case Refund Processed: I Date: I / / //� By: '.�( V • 1: \Building \ Refunds \RefundRcquest.doc x 09/01/2010 - • ProCom 503- 727 -3397 p.1 �� • . . . , .. ,. . . , . . ,, . . - .. , City o Ti and COMMUNITY n g DEVELOPMENT DEPARTMENT ir • Reque Perm Act JUL 2 4 2013 . T1GA 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503,718.2439 - wwl. •.tit= 4 gGIF TIGARD fk?znIVISIOP` TO: CITY OF TIGARD C Building Division Set-vices Supervisor V I 0 13125 SW .Hall Blvd., Tigard, OR 972 Phone: 503.7'18.2430 Fax: 503.598.1960 www.tigard or.gov t // //j Air FROM: ❑ Owner licant (check one) ❑ Applicant [ Contractor 12 City Staff REFUND OR Name: INVOICE TO: (Business or Individual) ?RC) Cow, 1. -otri>Chr:S lt- . Mailing Address: 90 fox 2.12._as City/State/Zip: I�DRr 1 6,R ( c t 1Z(oq Phone No.: 5a3 - / g-1 e>000 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): © CANCEL/VOID PERMIT APPLICATION. © REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: 6 Lk zot 3 _ 6--,0 l,." Sire Address or Parcel #: ZS 1 p 03, D po l Db Project Name: CE12TuS Nev Subdivision Name: 1 q i 9 `i - OZS' PA RTC i t oE 7LAI- Lot #: 2_ EXPLANATION: u t4 Ko 1ya=e1)Et) • Signature: __,/_,„,...- e Ai-e-. Date: ' 7- gee --/ 3 Print Name: � �� GES 7. c') 9, C D — t$o -o 7, a moo 0. . Leh nd Policy ! p 1. The Director or Building OLTcal may authorize..hc refund of. /....<07) I. O d. /AE17S ai any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn cr canceled 'efore any review effort has been expended. cj not more than 809 of the land use application fee for issued permits. d) not more than 30;;, tithe building plan review rcc when an application is canceled before any plan review effort lens been expended. e) not more than 80% of the building permit ice 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 Adnrin: Date By Rte to Bld• Admin: - Date -, ��� B - ,C`. ° Refund Processed: Date / By .<4 ' invoice Processed: IZEEIMIIIIII B Permit Canceled: Date .' / rj By � 7 P- Parcel Ta Added: Date B Receipt # Date Method Amount $ 1:''\Building \ Fermis \,RcgPerrni:.Action.dee Rev 05/22 3/2012