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Permit (125) IN ii City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ,(' Request for Permit Action oc1 i 418 T I cr,t R C) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-cir TO: CITY OF TIGARD t' 1 DIVISION Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner g Applicant ❑ Contractor ❑ City Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) 5 ism ro.(A- S 1�dp Mailing Address: pp t ,,„ ?3tc3 City/State/Zip: 7/3„ra Ca, 9 7. 8, Phone No.: S[3 lc:Act `I 9 t o -00:-k; cell # Si:-3-syr-tire ,to PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 1 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 #: L' • art LG t.01 - r0 Site Address or Parcel#: f l 705 S 4) pc,,e t t Ni,) a iV r 7- Project Name: h,.. t?V KG L lxn e.), C,.,i S l,1,, Subdivision Name: is 13 to LO re dpi, Lot#: EXPLANATION: LL„54‘,0.,N 1 pp dam. �� lt/»ii �z- ,. • .. '— , _ �- . We,S is el az2._ 4D G,,. d,-Tr cr-r--.,,A '- Ro v.....44-:915.v.....44-:915. C‹5*-,,,a- I V1,rk- %i _\ Signature: Sv SUFI- Date: 911-rig Print Name: Deb, S,, 1 5i4 - 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. 5`7 fp 7. .SFV "- �z/. o?7 _- .7`5 7s 6' fid , 77 /.S, 4 FOR OFFICE USE ONLY Route to Sys Admin: Date Alt /V By !.., . Route to Records: DateV 2. /y By r Refund Processed: Date /0‘,//e— B i a. Invoice Processed: Date By Permit Canceled: Date B �,% Parcel Tag Added: Date By m I:\Building\Forms\RegPeutAction 062314!doc. 11,1• TIGARD City of Tigard November 29, 2018 SignCraft Signs,LLC Attn: Debi Scott PO Box 23636 Tigard, OR 97281 Re: Permit No. ELC2017-00937 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11705 SW Pacific Hwy Project Name: Al-Basha Gyros Job No.: N/A Refund Method: ® Check#230488 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 signs under this business name. 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 : a City of Tigard I G A R D Accela Refund Request TThis 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: Signcraft Signs,LLC DATE: 11/16/2018 PO Box 23636 Tigard, OR 97281 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 414649 Case#: ELC2017-00937 Date: 12/20/2017 Address/Parcel: 11705 SW Pacific Hwy,X Pay Method: Check Project Name: Al-Basha Gyros EXPLANATION: Per applicant's request customer cancelled signs under this business name. Refund 80% of permit fees. rti p 5"n'. k t k T ,y :A.. az ''.5 t"'§' °i°' :.k'd..a�'xd' ..'�. ';i,> m"'. ',...<. ;"i���.4 .�., a ,aa.��.w:�r„�:P ms's � � z �, der:. a`i) o e r_A ar a- +a x , is ® i g p-pan Electrical Permit Fee 220-0000-43103 $54.27 12%State Surchar.e 100-0000-24001 6.51 TOTAL REFUND: $60.78 APPROVALS: SIGN TURES DATE: 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$50,000 Local Contract Review Board t���t� F.W['$:�w.to"0"^ SM. I -- A• .$104� W Case Refund Processed: Date: I B : w!ti I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2017-00937 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/11/2018 Parcel: 1 S136CD00100 Jurisdiction: Tigard Site address: 11705 SW PACIFIC HWY X Project: Al-Basha Gyros Subdivision: None Project Description: Sign lighting for(1)sign. Lot: None Contractor: SIGNCRAFT SIGNS LLC Owner: PACIFIC CROSSROADS PROPERTIES IN 8900 SW BURNHAM, E109 BY WYSE INVESTMENT SERVICES CO TIGARD, OR 97223 1501 SW TAYLOR ST STE 100 PORTLAND, OR 97205 PHONE: 503-639-4910 PHONE: FAX: 503-639-4999 FEES Quantity Description Date Amount Specifics: 1 ea Sign or Outline Lighting 12/20/2017 $67.84 1 ea 12%State Surcharge- 12/20/2017 $8.14 Type of Use: COM Electrical 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 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may Dbkof -ru es o -pt questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permi'ee ig . ire: I> gr.g4._-- 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 R :, r :i E J F(M.01 Il( I: I sl (P0.1 City of Tigard ReceDEC 2 0 2017 eB ,_ 7 ',' Permit#: _- cc 14 oi 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 r, r; t ,,n �e/g : ti Related Permit#: 774...1 ,i •7J`) Inspection Line: 503.639.4175 r T f G A P D ', „ ,,,,,,-7-) , t 3 Ready Dateffiy: Iuris: (: i n”i i R.r 0 age 2 f Internet: wwW.ttgard-otgov NotiSedlMethod: Supplemental Information TYPE OF WORK PLAN REVIEW ®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): CI or feeder 400 amps or more ❑Building over three stories. El Demolition ❑ ; where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRIJCfON exceeds 10,000 amps at 150 volts or 0 Hosting buildings. ElI-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use bicultural ElMulti-family 0 Master builder Other: 0 amps for all other installations. bait hallo Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: t-7 0S S i J ec c,t f i I"1 t<:y 100HP or more. ❑"A "E", 1-2","1-3 , City/State/ZIP: T►5.1„,...A o n ci l t 0 Six or more residential units. occupancy. []Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: 1 < ❑Hazardous locations. 0 Supply voltage for more than G�f'(1,�zS bon Cz,, 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description ( Qty I Each I Total f * New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: `28411/ 1,000 sq_ft.or less 168.54 4 S/3 4,L D L.)c`1,N.. 1 g `284 11/ Ea.add'I 500 sq.ft.or limon 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 Hook up new sign to designated sign curcuit (with above sq.ft) Limited energy,multi-family 7500 2 residential(with above sq.ft.) PROPERTY OWNER ElTEIYAN I, Renewable Energy 0 See Page 2 Services or feeders installation,alteration,and/or relocation Name: Pc t‘i cJ Crc›,5S C'o ek.A.5 Prop cr-i'i,e.,LU.e 6 200 amps or less 100.70 2 Address: $(a S.E. F3r\v,,..,nk 54_ t .SI-e. ttbcs 201 amps to 400 amps 133.56 2 City/State/Z1P: et,,_�J 401 amps to 600 amps 200.34 2 �"� 6 r L S- y 601 amps to 1,000 amps 301.04 2 Phone:(g03 ) 5-1 5_.ci Loy 5 Fax:( ) Over 1,000 amps or volts 552.26 2 Email: k Temporary services or feeders installation,alteration,and/or °-w.rc t. . 6/'y,)e•f<q. Cee iv, relocation Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2 Owner signature: Date: 401 amps to 599 amps 168.54 2 fia APPLICANT I © CONTACT PERSON Braneh circuits-:new,alteration,or extension,per panel A.Fee for branch circuits with Business name: n ._8 4 S h _ �Qo s L2��[1e�� �t S t`�� above fice or eeder fee, 7.42 2 each branch circ Contact name: ()ail Sts,1 S l Y a� B.Fee for branch circuits without Address: t 1 7o S SL.,.,, Pc c t 4C� ✓ brseanch it feederitfee,first 56.18 2 W y branch circuit City/State/ZIP: Tt S Z ca. q 3 Miscellaneous(service or feeder not included) Each add'I branch circuit 7.42 2 Phone:(93) (03 5 q g t b Fax::( ) aremodular dEwellingch servicemanufactud or and/or feeder 67.84 2 Email: 1y1-6 Q 5155 n r,- 4+ Pdl(,6e7vvN Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:SignCraft Signs llc Sign or outline lighting t 67.84 C,-2 xy' 2 Address:PO Box 23636 Signal circuit(s)or limited energy panel,alteration,or extension. 0 See Page 2 2 City/State/ZIP:Tigard OR 97281 Each additions[inspection over allowable in any of the above Additional inspection(1 hr min) 6625/hr Phone:(503)639-4910 Fax:(503)620-9568 Investigation(1 hr min) 90.00/hr Email:info@signcraftpdx.com Industrial plant(I hr min) 78.18/hr Inspections for which no fee is 90 00/hr CCB Lic.: 155420 Electrical Lic.: 724SIG Suprv.Lic.:. `f•i,74 Ci.S specifically listed(%hr min) Suprv.Electrician signature,requires ELECTRICAL T FEES Subtotal: 6-1.21 Print name: Keith Cox Date: 14.\ i i'I, ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): es ly, Authorized signature: c A 4F0' ,I TOTAL PERMIT FEE: gp Print name: John S This permit application expires if a permit is not obtained within ISO Date: 11 1q-i 7 days after it has been accepted as complete. I:\Buiiding�Permiu\ELC PermitApp M R ERE.doc Rev 06/17/2015 ° Number of inspections allowed per permit. 440.4615T(11/o51COM/6/EB