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Permit � CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT I'1 3 • COMMUNITY DEVELOPMENT Permit#: ELR2015-00122 T!GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2015 Parcel: 1 S 135AB00900 Jurisdiction: Tigard Site address: 10200 SW GREENBURG RD 400 Project: Bridgewell Resources Subdivision: METZGER,TOWN OF Lot: 9 Project Description: Low voltage for HVAC Contractor: AMERICAN HEATING Owner: 5035 SE 24TH AVE PORTLAND, OR 97202-4765 PHONE: 503-239-4600 PHONE: FAX: 503-239-7038 FEES Description Date Amount Specifics: Restricted Energy Permit 05/06/2015 $75.00 12%State Surcharge-Electrical 05/06/2015 $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: 0 Fire Alarm: 0 HVAC: 1 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. ATTE z =gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00 0 through OA' '-52-001- You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3 2.2344. Issued % � _ � �' 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 Applica lOR Oi 0 l It I I 11.1 '��CEIVED Received City of Tigard Date/B : 5ffifirMAA I Permit No.: fj—/L rj��a . 13125 SW Hall Blvd.,Tigard,OR 97�Av c Phone: 503.718.2439 Fax: 503.59 . tq�Ipp 6 2015 Date/By: Other Permit:{/���' Q/ T I C.A I,D Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for Internet: www.tigard-or.gov CITY OF Tlr`q�p Notified/Method: Supplemental Information BUILDING OlViSI O N 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 ❑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 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. 0 Addition of new motor load of ❑"A","E","1-2","1-3", Job no.: 115030 Job site address: 10220 SW Greenburg Road IoOHPormore. 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.:#400 Project name:Bridgewell Resources ❑Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description p 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 168.54 4 Ea.add'I 500 sq.ft.or portion 33.92 1 Tax map/parcel no.. Limited energy,residential 2 DESCRIPTION OF WORK (with above sq.ft.) 75.00 Limited energy,multi-family 75 00 l 2 ow volt wiring and T-stats 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 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 Owner signature: Date: Branch circuits–new,alteration,or extension,per panel 2 ® APPLICANT ® CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 Business name:American Heating Inc. each branch circuit B.Fee for branch circuits without Contact name:Brandon Hutchinson service or feeder fee,first 56.18 branch circuit Address:5035 SE 24th Ave. Each add'l branch circuit 7.42 2 City/State/ZIP:Portland,OR.,97202 Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 Phone:(503)239-4600 Fax::(503)239-7038 dwelling,service and/or feeder Reconnect only 67.84 2 E-mail:b.hutchinson @americanheating.net Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name:American Heating Inc. Signal circuit(s)or limited-energy I See ..--/ 00 panel,alteration,or extension. Page 2 r r 2 Address:Brandon Hutchinson Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr City/State/ZIP:Portland,OR.,97202 Investigation(1 hr min) 66.25/hr Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is �/ CCB Lic.: 33135 Electrical Lie.: 26993CRE S rv.Lic.: 2640LEB specifically listed(%2 hr min) lir • Suprv.Electrician signature,required: j ELECTRICAL PERMIT FEES �/�J(� Subtotal: 7S<- Print name: T Steve Young Date: .K./5 Plan review(25%of permit fee): ,____— State surcharge(12%of permit fee): 'lam Authorized signature: ,,,,, t‘i---- TOTAL PERMIT FEE: 3 y t� •/ This permit application expires if a permit is not obtained within 180 Print name: Brandon Hutchinson Date: v /S. days after it has been accepted as complete. • Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Fee for all residential systems combined $75.00 Description Ion. 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 n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 nBurglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 n Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance with 552.26 2 I I Heating, Ventilation and Air Conditioning OAR 918-309-0040) System* Solar generation systems in excess of 25 kva: Each additional kva over 25 7.42 3 H Vacuum Systems* >100 kva—no additional charge 0.0 3 HEach additional inspection over allowable in any of the above: Other: Each additional inspection is 66.25/hr l charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(/2 hr min) COMMERCIAL WORK ONLY: 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 HAudio and Stereo Systems days after it has been accepted as complete. Number of inspections allowed per permit. H Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC n Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* H Medical H Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 05/21/2013 MAY. 19. 2015 8: 58AM 5032397038 NO. 2300 P. 1 RECEIVED Iii City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit Action MAY 19 2015 TtCARD 13125 Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •wtivnw' i ai go :ITY OF 1 i(iARD ILBJNG DIVISION 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 VOID FROM: ❑ Owner J Applicant © Contractor ❑ City Staff 64�'/� % Check(f)one REFUND OR Name: INVOICE TO: (Bueinesa or Individual) American Heating Mailing Address: .5035 SE 24th ave City/State/Zip: Portland Oregon Phone No.: 503 236 4600 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL/VOID PERMIT APPLICATION. 0 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 PER IT(do not cancel permit). Permit#: ELR2015-00122 _ Site Address or Parcel#: 10200 SW Greenberg RD#400 Project Name: Sddgewell resources Subdivision Name: _ Lot#: EXPLANATION: Pneumatic Building Signature: 1-1-- Date: S--f7 .1,. Print Name: f tj{ev>o qY\ 1. The city's Comruunity Development Director,Building Official or City Engineer may authorize the refund o£ • Any fee which was erroneously paid or collected. • Nor 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°/n of the application or permit fec for issued permits prior to any inspection requests. 2. All refunds'will be rerumcd to the original payer in the form of a check via US!Instil service- - /5- • c 3. Please allow 3-4 weeks for processing refund requests. 7jr p-V - Goo . v-e, ' 9. cv - 7, .2 d _ I da-- 7. .,2-d t- /6 , .10 FOR OFFICE USE ONLY Route to S's Admin: Dare B Route to Records: Dare f ASTAIMIWRIIM Refund Processed: Date ,form B. '.�4 Invoice Processed: Date B' _Permit Canceled: Date , i, j B. ,•• F Parcel Ta,Added: Date By (:\Building\Forms\RegpetmitAcOOn_� _114.d. III . A T IGARD City of Tigard June 18, 2015 American Heating Attn: Brandon Hutchinson 5035 SE 24th Ave. Portland, OR 97202 Re: Permit No. ELR2015-00122 Dear Applicant: The City of Tigard has canceled the above referenced permits) and encloses a refund for the following: Site Address: 10200 SW Greenburg Rd., Ste 400 Project Name: Bridgewell Resources Job No.: N/A Refund Method: ® Check#217573 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 building is pneumatic. Refund 80% of permit fees. 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 Requenilbr 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 rebind checks to Accela System Administrator for distribution to applicant. PAYABLE TO: American Heating DATE: 6/4/2015 Attn: Brandon Hutchinson 5035 SE 14th Ave. REQUESTED BY: Dianna Howse Portland, OR 97202 TRANSACTION INFORMATION: Receipt#: 200608 Case#: ELR2015-00122 Date: 5/6/2015 Address/Parcel: 10200 SW Greenburg Rd#400 Par Method: CreditCard Project Name: Bridgewell Resources EXPLANATION: Per applicant's request as low voltage permit was not required for pneumatic building. Refund 80"0 of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No.. Refund Example: .Building Permit Fee Example:: 23(1)0000-43104 $Amount Electrical Permit Fee 110-000043103 $60.00 12"„State Surcharge 100-0000-24001 7.20 TOTAL REFUND: 567.20 APPROVALS: SIGNATURES/DATE: If under S5,000 Professional Staff If under$12,500 Division Manager If under S25,500 Department Manager If under$50,000 City Manager If over 550,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONL Case Refund Processed: I Date: I__ rp/t/�$ Br: � '.■ I:\Huilding\Refunds\Refundlkqucsr.d..c x(a')1111/20111