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Permit RI City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT V 0 1 0 Request for Permit Action TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov 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 El Applicant El Contractor ,City Staff Check(1)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): 3 CANCEL OID PERMIT PPLICATION. 12,11" 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 #: Ei--i2 01-6/ COO/1/ Site Address or Parcel#: 9650 1019 -/IJaibA c Project Name: / J 1 Vi/e}- Subdivision Name: n • Lot#: EXPLANAION: �2N I r �o1 (2± Li P-S7 , ■r 1.0 0et_ R3tLtHArl . Signature: Date: i/i /5 Print Name: "Ca6g,E _ 49-6-ISI/,1 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. / L� Td}/�! 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. 75!0-0 - O oo AS re) G7. ao /6.b I OR OFFICE USE ONLY Route to S s Admin: Date j vim B Route to Records: Date �� B Z Refund Processed: Date -' _ . By 3� Invoice Processed: Date By Permit Canceled: Date °27 e /,,,5 By .7'.rr Parcel Tag Added: Date By 1:\Building\Forms\RegPermit:'tction_092314. oc - q TIGARD City of Tigard February 26, 2015 Grey Wolf HVAC Inc. Attn: Leann Osborne 7306 NE 37th Ave. Vancouver,WA 98665 Re: Permit No. ELR2015-00014 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 9650 SW Washington Square Rd. Project Name: Ivivva Job No.: N/A Refund Method: ® Check#216569 in the amount of$67.20. ❑ Credit card"return" receipt in the amount of$ 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 permit was not required. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, id Ilk 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 far 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: Grey Wolf HVAC Inc DATE: 2/19/2015 Attn: Leann Osborne 7306 NE 37th Ave. REQUESTED BY: Dianna Howse Vancouver,WA 98665 TRANSACTION INFORMATION: Receipt#: 199102 Case#: ELR2015-00014 Date: 1/22/2013 Address/Parcel: 9650 SW Washington Sq Rd Pay Method: CreditCard Project Name: Ivivva EXPLANATION: Per applicant's request as permit was not required. Refund 80%of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No Refund Esaniple .BuildingPermit Fee Example: 2300000-43104 $Amount Restricted energy permit fees 220-0000-43103 $60.00 12% State surcharge 100-0000-24001 7.20 TOTAL REFUND: $67.20 APPROVALS: SIGNA • 'ES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$23,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: I Date: 0?/-6/!..5 By: *Y 1:\Building\Refunds\RefundRequest.doc x 09/01/2010 01/14/2015 13:45 Grey Wolf (FAX)3603268506 P.002/003 Electrical Permit All iIVED FOR OFFICE IiSE ONLY Received 11111 - City of Tigard 2015 Dot-; : r /� Permit No.: £tse ao<s—ax'/ " 13125 SW Hall Blvd.,Tiger 9 Plan Review Phone: 303.7182439 Fax: 503.598.1960 2015 ..: other Permit. NQ"air y-cceook rlcinxU Inspection Line: 503.6301 ' OF TIGARD DateReady/By: MIL El See Page 2for Internet: www.tigarC I LDING DIVISION Notified/Method: Supplemental Information ❑New construction E Addition/alteration/replacement Please check all that apply(submit I sets of plans w/items checked below); ❑Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition 0 Other: where the available fault current ❑Marinas and boatyards. I 7(75 n- o I, re{ovffr -loaf∎1 K r exceeds 10,000 amps at 150 volts or ❑Floating buildings. less to ground,or exceeds 14,000 ❑Conunercial-use agricultural ❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations, buildings. ❑Multi-family ❑Master builder El Other: ❑Fire pump, ❑Installation of 150 KVA or - ❑Emergency system. larger separately derived system. ' XI,*-1,-II ,r,� ?J ?_(�1 �1 i Ci s 11(S 0 Addition of Dew motor load of 0"A", `B","1-2",`1-3", Job no.: Job site address" ':5 SW Washington Square Rd. 1ooHPormore. occup f� 0 Six or more residential units. ❑Recreational vehicle parks. 7 City/State/ZIP:Portland,OR 97223 404- O ❑klealth.oare facilities. ❑Supply voltage for more than ❑hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name:Ivivva Af ies. 0 Service or feeder 600 amps or more. .. I:lap5,.;XGj'p,33/t III;1. Cross street/directions to job site: Description Qty- urea Total • New residential single-or multi-family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4 Tax map/parcel no.: En.add?500 sq.ft.or portion 33.92 1 trap p Limited energy,residential tM "t 1, ,'..-r:�x' t �,�frorkj5�+}riit 1 nd �a,��,!�� {y. i (with above sq.ft.) 75,00 2 Ll.:.+:.�w..ul..� KIS::,....v:utl::•�,y'A3r',\i 0P A 'SS.�'SGwY:. .1. . .Y..�..._ - Limited energy,mufti-family 75,00 2 relocating existing sensor residential(with above ft. Services or feeders installation,alteration,and/or relocation .Fy:;:�" ,.•- ti ,—" 200 amps or less 100.70 2 ..4. `•$�y �'�©�n�rflr0�> ��� � ' :��: ...�� �h � �'a�ti� !�_✓.i:. 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 leas 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: Date: I Branch circuits-new,alteration,or extension,perpanel --D i ?.) „,, ,-if. (, . !>TC/1a1-riv-,-Ii -1a1.;r'e) I - A.Fee for branch circuits with .. __ T _. ------ ----_.- above service or feeder fee, Business name:Grey Wolf HVAC,1ne. each branch circuit 7.42 2 B.Fee for branch circuits without Contact name:Darrell Osborne service or feeder fee,first 5t5 18 2 branch circuit Address:7306 NE 37th Ave. Each add'.branch circuit 7.42 2 City/State/ZEE':Vancouver,WA 98665 Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 Phone:(360)635-6117 Pax::(360)326-8506 dwelling,service and/or feeder Reconnect only 67.84 2 E-mail:dosborneg greywolihvae.cotn _ Pump or irrigation circle 67.84 2 -.^ ..-'.'- , .. .' .'- �4 -, .'A o . _ '':. ' ., '.—r L,,; Sign or outhnc lighting 67,84 2 Business name:Grey Wolf HVAC,Inc. Signal circuit(s)or limited-energy 1 See 77 er panel.alteration,or extension. __ Page 2 / 2, Address:7306 NE 37th Ave. Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/fir City/State/ZIP:Vancouver,WA 98665 Investigation(I hr min) 66.25/hr Phone:(360)635-6117 Fax:(360)326-8506 Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lin.: 165139 Electrical Lic.:....• 114 Suprv.Lie.: QP116 s cifical listed /hr rain Suprv.Electrician signature,rcquir•d: , Subtotnl: C� Plan review(25%of permit fee): ._- Print name: Ryan Hardin: � Date: r ! ZC/> - Q �� State surcharge(12%of permit fee): 7 Authorized sign . -- jli i!4:rte —+ TOTAL PERMIT FEE: QC/.OU Print name: Darrell Osborne I Date:01 (6 . (�(t This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. • Number of inspections allowed per permit. 1:1);uilding\Perenits1E1.0 PermhApp_e1.ejitRdoe 14Y 05/21/2013 440-45151(11/05/COM/Wm 01114/2015 13:45 Grey Wolf (FA)03603268506 P.003/003 Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: e. ti.... 4 ,i_,., tip.., d! Fee for all residential systems combined... $75.00 litticintion Qty. Bee ro • 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 to 25 kva 200.34 2 ❑ Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to So kva 301.04 2 ❑ Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with 552.26 2 n Heating, Ventilation and Air Conditioning OAR 918-309.0040) * Solar generation systems in excess of 25 kva: System Each additional kva over 25 7.42 3 ❑ Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional inspection over allowable in any of the above: ❑ Other: charged at an hourly(1 thr mitt) 66.25/hr 1 Inspections for which no fee is 90.00/hr s o citicall listed 4 hr min) 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 n Audio and Stereo Systems days after It has been accepted as complete. Number of inspections allowed per permit n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ® HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling (1 Other Total number of commercial systems: 1 *No licenses are required. Licenses are required for all other installations 1.13uilding\Permits\EL.C_PermitApp ELR ERB.doc Rev 0521!2011 01/14/2015 13:45 Grey Wolf (FAX)3603268506 P.0011003 Grey Wolf HVAC,INC.certified MBE contractor 7306 N.E. 37`"Avenue,Vancouver,WA 98665 E-mail: nancyw @greywolfhvac corn Office:360-635-6117 Fax: 360-326-8506 8506 Fax To: City of Tigard Building Dept. From: Nancy Wilde Fax: 503-598-1960 Pages: 3 pages including cover Phone: 503-718-2439 Date: 1/14/2015 Re: Low voltage permit CC: file ❑ Urgent ❑ For Review 0 Please Comment ❑ Please Reply ❑ Please Recycle • Comments: Good afternoon, Here is the low voltage permit application. The corresponding mechanical permit is MEC2014-00606 in case that helps Let me know if you need anything else. I understood from my phone call that we can pay online once the fee has been determined, My contact information is above in the heading. Thank you! L;70-A6'(4, . 6 01/0812015 08:04 Grey Wolf 43603268506 P.001/001 Grey Wolf HVAC,INC.certified MBE contractor 7306 N.E.37?"Avenue,Vancouver,WA 98665 E-mail: nancyw@greywolfhvac.com Fax: 360-635-6117 0-326 85017 �� Fax: 360-326-8506 Fax To Tigard Building Dept.—Debbie From: Nancy Wilde Fax: 503-598-1960 Pages: 1 pages including cover Phone: Date: 1/8/2015 Re: Low voltage permit CC: file ❑ Urgent ❑ For Review ❑Please Comment ❑Please Reply ❑Please Recycle • Comments: Good morning Debbie, I just wanted to send you a quick note to let you know that I really appreciated all of your help with our permit application. I told you I would send it over first thing this morning, but I forgot that I would need signatures. It may take awhile to get the electrical supervisor signature as he is out in the field. Have a wonderful day!