Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V
= r Re uest Permit Action 1/29//Y f Isil,D
Request
TIGARI) 13125 SW Flail Blvd. • Tigard. Oregon 97223 • 503.718.2439 • www.tigard-or.gov
'1'0: 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 1°t' City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
6 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#: i-2.._ 1.,0 r 3 - o.c) r
Site Address or Parcel#: /I 50 6 w (e 7 40£-
Project Name: 4.. ,� c e ( e- dv.ts-i ,o
Subdivision Name: Lot#:
EXPLANATION: ,,___LA 41 ,,,,,� , 1f1 ,, , ,. - to
61:)o-01..1.-0 liN441}:), / e_p-AIA7---- -;-)N. i "Tki.../) ICIAO-Ace....a- (A-Doi-0
Signature: Date: L ,9-9.)i 4
Print Name: -C c ppP)l er PcI ,pr M 5 k j
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b) not more than 80°o of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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°o 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 t 9,9- /q : • ).....1 4- Rte to Bldg Admin: Date r2_9 2_9 1 y By :a?,
Refund Processed: Date A/ By 421/ Invoice Processed: Date By
Permit Canceled: Date if 29`/y By Parcel Tag Added: Date B
Receipt# • Date Method Amount$ _
I:\Building\Forms\RegPemv-tAction.doc Rev 05/25/2012
Debbie Adamski
From: Debbie Adamski
Sent: Thursday, April 17, 2014 10:44 AM
To: 'phipps @fpsnw.com'
Subject: Triangle Commons, 11850 SW 67th Ave, ELR2013-00212
David,
We are checking on the permits we have in our ready to issue file and the above mentioned permit has been ready to
issue since 8/26/13. Please let me know if this project has been cancelled. It appears that we were waiting for the fire
alarm permit to be submitted. I do not see that one was ever applied for. If you still want to pull the permit, the fees
due are $84.00.
If you want an extension, you will need to let us know the reason for the extension and an approximate timeframe when
the permit might be picked up. Thank-you and let me know you have any questions.
Debbie Adamski
Senior Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
fV/P/
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Electrical Permit ApplicatiO�ll l•`OR OFFICE USE ONLY
City of Tigard Date/By:Received B p �� Permit No.: �/�/20�.11-40��
- " 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 �+ 3 Date/By: Other Permit:
Ti G A R n Inspection Line: 503.639.4175 Date Ready/By: �^/0/5(�,Q, turn WI See Page 2 for
Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method: 0 �'/V`'� Supplemen;I InA`mation
tvlstoNlc c�Ut , i REV•IE e
TYPE OFg t4DINGD -'r'� y��� , PL N REVIEW
❑New construction ® Addition/alteration/replacement Plea cltfcltl that a..ly(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 ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑installation of 75 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A", E","l-2","1-3
Job no.:2750 I Job site address: o ar iOOHP or more. occupancy.
1 U ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard OR �t/r A I"e' ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: /0,0 I Project name:Triangle Commons ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 145.15 4
Ea.add'l 500 sq.ft.or portion 33.40 1
Tax map/parcel no.: 'Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
Move Horn Strobe to Accommodate TI 75.00 2
residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) I Fax:( ) 200 amps or less 66.85 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 133.75 2
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
❑ APPLICANT I ® CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: Fire Protection Services Inc B.Fee for branch circuits
Contact name:David M Phipps without service or feeder fee, 46.85 2
PP first branch circuit
Address:5573 SW Arctic Dr Each add'l branch circuit 6.65 2
Miscellaneous(service or feeder not included)
City/State/ZiP:Beaverton Or 97005 Each manufactured or modular 2
90.90 dwelling,service and/or feeder
Phone:(503)590-3732 Fax: :(503)628-6214 Reconnect only 66.85 2
E-mail:phipps@fpsnw.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s)or limited-
Business name: Fire Protedtion Services Inc energy panel,alteration,or
Address:5573 SW Arctic Dr extension.Describe: I Page 2 75.00 2
City/State/ZIP:Beaverton,OR 97005 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone:(503)590-3732 I Fax:(503)628-6214 Investigation per hour(I hr min) 62.50
CCB Lic.: 154333 ,It, t I Electrical Lic.: CLE3488 I Suprv.Lic.: 4120LEA Industrial plant per hour 73.75
/ft frt ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: rat//� Subtotal: 75.00
Print name: David M Phipps �� Date: 8/26/12 Plan review(25%of permit fee):
��t�'i , /6 State surcharge ° it EE 4
Authorized signature: % jam TOTAL PERMIT FEE: 84.00
This permit app ation expires if a permit is not obtained within 180
Print name: David M Phipps Date: 8/26/12 days a • it has been accepted as complete.
• Number of inspections allowe. .- '
1:\Building\Permits\ELC-PennitApp.doc 05/23/06 440-4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
I Burglar Alarm
Garage Door Opener*
n Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
r1 Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-260-260)
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
n Landscape Irrigation Control*
❑ Medical
H Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems: —
*No licenses are required. Licenses are required
for all other installations
I:\Budding\Permits\ELC-PermitApp.doc 03/23/06