Permit (54) 08/02/2018 12:42 5032064900 1 J
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City of Tigard • COMMUNITY DEVELOPMENT OPMENT DT:PART."MENT AUG 2 2018
0 Request for Permit Action Cm'of IGARI)
T I t.i A l-.r;l 13125 SW Hall:Blvd, -Tigard, Oregon 97223 •503-718-2439 • mmtigaliagaiNG rovicioN,
TO: CITY OF TIGA.RD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigatdBuilclingPetmits@tigard-or,gov
FROM: ❑ Owner ❑x, Applicant ❑X, Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:INVOICE TO: CBUHil1CPR Or indivvt o.i) Hannah Sign Systems
Mailing Address: 1660 SW Bertha Blvd
City/State/Gip: Portland, OR 97219
Phone No.: 503-9468373
PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (✓):
CANCEL/VOID PERMIT APPLTC.A.TION.
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/REPLA.CE CONTRACTOR ON PERMIT (do not cancel permit),
0--Le Ao/r,— oe 24,
Permit#:
Site Address or Parcel#: 12011 SW 70th Ave #2S101AB90131
Project Name: Benchmark Physical Therapy
Subdivision Name: Red Rock Creek Condo Lot#: 3
EXPLANATION: Si• s/non-illuminated
Signature: r
Date: 8/2/2018
Print Name: Dave Lanphere
Refund Policy
1, The city's Community Development Director.,Building Official Of 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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 SO°/n of the application or,permit fcc 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
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Route to S res tldrrsi,zt: Date By Route to Records: Date / . By
Refund Processed: Date 3 / , B ,y . Invoice Processed: Date F3 •
Pcr,.mit Canceled: Date gr/, B ,e ,;, 'axed T _Added: Date B
T;\BuildineForms\ltegPcrmiiAciinn_09 31•,doe
III
TIGARD
City of Tigard
August 9,2018
Hannah Sign Systems
Attn: Dave Lanphere
1660 SW Bertha Blvd
Portland, OR 97219
Re: Permit No. ELC2018-00426
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 12011 SW 70th Ave
Project Name: Benchmark Physical Therapy
Job No.: N/A
Refund Method: ® Check#229387 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 sign is non-illuminated and permit was not
required. 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
T I G A K D 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: Hannah Sign Systems DATE: 8/3/2018
1660 SW Bertha Blvd
Portland, OR 97219 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 418616 Case#: ELC2018-00426
Date: 7/26/2018 Address/Parcel: 12011 SW 70th Ave.
Pay Method: CreditCard Project Name: Benchmark Physical Therapy
EXPLANATION: Per applicant's request as sign is non-illuminated and permit not required. Refund 80%
of permit fees.
a
i i �tl i A A '. 6 �,,; t4 B M b $ 7 t 0 6 9 8
Electrical Permit 220 0000 43103 $54.27
12% state surcha.•e 100-0000 24001 6.51
TOTAL REFUND: $60.78
APPROVALS: SIGGNTURE 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
Case Refund Processed: Date: `1 S
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2018-00426
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/26/2018
T I c.;;�I?Cr 9 Parcel: 2S101AB90131
Jurisdiction: Tigard
Site address: 12011 SW 70TH AVE
Project: Benchmark Physical Therapy Subdivision: RED ROCK CREEK CONDO Lot: 3
Project Description: Sign lighting for(1)new intemally lit wall sign located on the south facade.
Contractor: HANNAH SIGN SYSTEMS INC Owner: TIGARD CH HOLDING LLC
1660 SW BERTHA BLVD 515 NW SALTZMAN RD#898
PORTLAND, OR 97219 PORTLAND, OR 97229
PHONE: 503-946-8373 PHONE:
FAX: 503-206-4900
FEES
Quantity Description Date Amount
1 ea Sign or Outline Lighting 07/26/2018 $67.84
Specifics:
1 ea 12%State Surcharge- 07/26/2018 $8.14
Electrical
Type of Use: SF
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 oth: 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 is ance, or if w•, is suspended for more the 180
days. ATTENTION: Oregon law requires yo to follow the rules adopted by the Oregon Utility Notifi•1tioCenter. hose rules are set forth in OAR
952-001-0010 through OAR 95 1-009 You y obtain a co of the rules or direct questions to OUNC by callin r ..32. •= •r 1.800.332.2344.
Issued By: 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 Application FOR OFFICE USE ONLY
eived
City of Tigard RECLJVHb.rn :
11111 - V 13125 SW Hall Blvd.,Tigard,OR 97223 1/� �! - l� / L
an Review
Phone: 503.718.2439 Fax: 503.598.1960DateB Related Permit#: t f` e . ) d
Inspection Line: 503.639.4175 2jUN nn Ready Date/By: !a See Page 2 for
TI GA R D
Internet: www.tigard-or.gov U Notified/Method: �. Supplemental Information
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®New construction ❑Additlon/alteratLe>(�uI e Please check all that apply(submit 2 sets of plans w/items checked):
❑ e0ri �[°^ DIVISION
1 ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Other: where the available fault current 0 Marinas and boatyards.
/; % 27ti%iii` ° yid r/%i �/ Q exceeds 10,000 amps at 150 volts or 0 Floatingbuildings.
/�` O%� / �% d buildm s.
0 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 Multi-family 0 Master builder ❑Other: 0 amps umall other installations. buildings.
Fir/ %� 0 00 ai/ii
0 Installation of 150 KVA or
0 0 < z' 3 '''' wz %%% 'f////// ❑Emer enc s stem.
//rr,� /rrir /:(a.. (4)':"'; �/fria /�, ,2/iia ��a���/�/// g Y Y larger separately derived
Job#: Job site address:/Zp w 077,1 ❑Addition of new motor load of system.
l/ f 7 4y l00HP or more. ❑"A","E","1-2","I-3",
City/State/ZIP: "n A4 S m.2- 172z-5 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: g t,yyt,9-izc___ 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: ,/'//
/// /// ,� � .
Description
New residential single-or multi-famQtyily dwellingEach unit.Total
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
v r/i i�ar ,iiaii/ijia Ea.add'l 500 sq.ft.or portion 33.92 1
�� / ' Limited energy,residential
1 (with above sq.ft.) 75.00 2
`t Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy
yr ,,,,,Y oa'oroaao
" ' �//o„
/// % u °a �, 6'''3� / lam ❑ See Page 2
H;,� " / Services or feeders installation,alteration,and/or relocation
Name: OFA .00'14., - 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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
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