Loading...
Permit n CITY OF TIGARD ELECTRICAL PERMIT ``". j , • COMMUNITY DEVELOPMENT Permit#: ELC2016 00305 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2016 Parcel: 151260000300 Jurisdiction: Tigard Site address: 9585 SW WASHINGTON SQUARE RD Y04 Project: Starbucks Kiosk Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S Project Description: (1)sign lighting Contractor: TUBE ART SIGNS&SPORTS DISPLAYS Owner: PPR WASHINGTON SQUARE LLC 4243-A SE INTERNATIONAL WAY PO BOX 847 MILWAUKIE, OR 97222 CARLSBAD, CA 92018 PHONE: 503-653-1133 PHONE: FAX: 503-659-9191 FEES Quantity Description Date Amount 1 ea Sign or Outline Lighting 04/13/2016 $67.84 Specifics: 1 ea 12%State Surcharge- 04/13/2016 $8.14 Electrical Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $75.98 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 - - 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. . ENTION: Orego law re. 'res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-r11-0010 through OAR 952 r0 .090. You may obtain a copy of the rules or direct questions to OUNC by calling 5'02.1987 or 1.800.332.2344. Is ed By: �� _; Permittee Signature: ', ! IA 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. CP Electrical Permit Applic AEIV ' FOR OFFICE USE ONLY Cityof Tigard Received �" Permit No.: g Li��U 12 ��j�j Date/By: /3 �(/� �L.���Jr' �QQ�J�'^ lig13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �q Phone: 503.718.2439 Fax: 503.59 196Q) # y w Date By: Other Permit: PaO/T��3 J f I c 1 p,1 Inspection Line: 503.639.4175&,I 1 w.,� t&i,?l:4i A,I) Date Ready/By: orris: 0 See Page 2 for Internet: www.tigard-or.gov BUILDING N , rI O� Notified Method: I Supplemental Information TYPE OF WORK Authorized signature: D New construction ID Addition/alteration/replacement Print name: Deborah Tolke I ❑Demolition ❑Other: CATEGORY OF CONSTRUCTION PLAN REVIEW ❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building Please check all that apply(submit 2 sets of plans w/items checked below): 0 Service or feeder 400 amps or more ❑Building over three stories. ❑Multi-family 0 Master builder 0 Other: where the available fault current ❑Marinas and boatyards. JOB SITEINFORMATION AND LOCATION exceeds 10,000 amps at 150 volts or 0 Floating buildings. '`�� less to ground,or exceeds 14,000 ❑Commercial-use agricultural Job no.: 127829/1 Job site address:.93 6W Washington Square Rd. amps for all other installations. buildings. cl5g, 0 Fire pump. ❑Installation of 150 KVA or City/State/ZIP: Tigard,OR 97223 0 Emergency system. larger separately derived system. Suite/bldg./apt. 1E- Project name: Starbucks Coffee El Addition of new motor load of ❑"A","E","1-2","1-3", 100HP or more. occupancy. Cross street/directions to job site: SW Greenburg Rd. ❑Six or more residential units. ❑Recreational vehicle parks. 0 Health-care facilities. 0 Supply voltage for more than ❑Hazardous locations. 600 volts nominal. 0 Service or feeder 600 amps or more. Subdivision: Washington Square Mall Lot no.: R2365 FEE SCHEDULE - Description I Qty. I Fee. I Total I Tax map/parcel no.: New residential single-or multi-family dwelling unit. DESCRIPTION OF WORK Includes attached garage. 1,000 sqft.or less 168.54 4 connect hanging wall sign to existing circuit Ea.add'I 500 sq.ft.or portion 33.92 1 Limited energy,residential 75.00 2 (with above sq.ft.) 0 PROPERTY OWNER 23 TENANT Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Name: Starbucks Coffee Renewable Energy 0 See Page 2 Address: PO Box 94027 Services or feeders installation,alteration,and/or relocation _ 200 amps or less 100.70 2 City/State/ZIP: Seattle,WA 98124 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Phone: Fax:( ) __, 601 amps to 1,000 amps 301.04 2 Owner installation:This installation is being made on property that I own which is not Over 1,000 amps or volts 552.26 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Temporary services or feeders installation,alteration,and/or Owner signature: Date: relocation ® APPLICANT 0 CONTACT PERSON 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Business name: Tube Art Group 401 amps to 599 amps 168.54 2 Contact name: Deborah Tolke Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Address: 4243-A SE International Way above service or feeder fee, 7.42 2 each branch circuit City/State/ZIP: B.Fee for branch circuits without y Milwaukie,OR 97222 service or feeder fee,first 56.18 2 Phone: 503-653-1133 Fax: : 503-659-9191 branch circuit Each add'I branch circuit 7.42 2 E-mail: dtolke@tubeart.com Miscellaneous(service or feeder not included) CONTRACTOR Each manufactured or modular 67.84 2 dwelling,service and/or feeder Business name: Tube Art Group Reconnect only 67.84 2 Address: 4243-A SE International Way Pump or irrigation circle 67.84 2 City/State/ZIP: Milwaukie,OR 97222 Sign or outline lighting 1 67.84 &.7.S 1 2 Signal circuit(s)or limited-energy See Phone: 503-653-1133 Fax: 503-659-9191 panel,alteration,or extension. Page 2 2 Each additional inspection over allowable in any of the above CCB Lie._70956 ��mi% Electrical ic.: 37554 CLS Suprv.Lic.: 366 SIG Additional inspection(1 hr min) 66.25/hr 1 Investigation(1 hr min) 66.25/hr Suprv.Electrician sign ture,require Industriat plant(1 hr min) 78.18/hr Print name:_ Ken Schultz Date: ' 't - Inspections for which no fee is 90.00/hr �/ specifically listed(%F hr min) ELECTRICAL PERMIT FEES 1\Building\Permits\ELC PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB May. 19. 2016 7: 34AM No. 0755 P. 1 IiiiC4 ity of Tigard •• COMMUNITY DEVELOPMENT DEPARTMENTacuvEn ■ Re uest for Permit Action T i is n k r) 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 • www,tigard-A 6v1 9 20 TO: CITY OF TIGARDV 1 ��j�liiv°G�. Building Division ter. pi, ['� ,c,j() 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-5984960 TigardBBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑X Applicant ❑ Contractor E City Staff Check(✓)one REFUND OR Name: ' INVOICE TO: (BusinessOrindividu&l) Tube Art Group Mailing Address: 4243-A SE International Way City/State/Zip: Milwaukie, OR 97222 Phone No.: 503-653-1133 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): U CANCEL/VOID PERMIT APPLICATION. Q REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). 0 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: ELC2016-00305 Site Address or Parcel#: 9585 SW Washington Square Rd YO4 Project Name: Starbucks Coffee Subdivision Name: Washington Square Lot#• EXPLANATION: The project was canceled by Starbucks. Signature: ,,,,,......_ _, • Date: 5/19/2016 Print Name: D ebo ra To e 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. 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. 67, P./- _C-u' a2 7 /3..5'7 P,/V — 6 . 5/ /r g 5, 99 7o d .7, /..5', r2 O Route to Sys Admin: Date s, /9 ih By Route to Records: Da;e /7 , By Refund Processed: Date (,(i ff� ,.:1.By Invoice Processed: Date / By Permit Canceled: Date .572.41/4, By .C! - Parcel Tag Added: Date By I:\Building\Forms\RegPerrnitncuon_OO2314.Q oc : m 111 •I - TIGARD City of Tigard June 3,2016 Tube Art Group Attn: Deborah Tolke 4243-A SE International Way Milwaukie, OR 97222 Re: Permit No. ELC2016-00305 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 9585 SW Washington Square Rd Project Name: Starbucks Kiosk Job No.: N/A Refund Method: ® Check#221224 in the amount of$60.78. ❑ Credit card "return" receipt in the amount of$ . 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 customer cancelled job. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, '4d2'607(7- e 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 IIII 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 for 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: Tube Art Group DATE: 5/26/2016 Attn: Deborah Tolke 4243-A SE International Way REQUESTED BY: Dianna Howse Milwaukie,OR 97222 DA TRANSACTION INFORMATION: Receipt#: 403203 Case#: ELC2016-00305 Date: 4/13/2016 Address/Parcel: 9585 SW Washington Square Pay Method: Check Project Name: Starbucks Kiosk EXPLANATION: Per ■applicant's request as customer cancelled job. Refund 80%of permit fees. y. Fee`D?*1.1 t*-Pi4m Re + ipit It 'eliu'e i44 tt c , .; t , e Example: Bpulding Permit i ee`_ , IAampl A QO0o9 43104" o : t Sign Lighting 220-0000-43103 $54.27 12% State Surcharge 100-0000-24001 6.51 TOTAL REFUND: $60.78 APPROVALS: SIGZTURES D TE: If under$5,000 Professional Staff 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 FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: %/./2 By: 42V-- I:\Building\Refunds\RefundResuest.doc x 09/01/2010