Permit Support Document (45) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELR2019-00042
13125 SW Hall Blvd.,Tigard Date Issued: 03/07/2019
Al'.T7 OR 97223 503.718.2439 Parcel: 2S102CB01804
Jurisdiction: Tigard
Site address: 13305 SW PACIFIC HWY
Project: Taco Bell 15347 Subdivision: None Lot: None
Project Description: Installation of 16 Low Voltage data cables. 3/7/19: REPRINT to change permit to(1)system for data
telecommunication.
Contractor: WACHTER INC Owner: WEBER COASTAL BELLS LIMITED
16001 WEST 99TH ST WEBER, EDUARD
LENEXA, KS 66219 840 CONGER ST
EUGENE, OR 97402
PHONE: 913-541-2500 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/07/2019 $1,200.00
12%State Surcharge-Electrical 03/07/2019 $144.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 16
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 Fire Alarm: 0
HVAC: 0 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 $1,344.00
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. 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 95 -001-0090. You ay obtain a co of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / �A
Issued By: ��'"[�' ,Qif 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.
q
TIGARD
City of Tigard
April 4, 2019
Thomas Allred
9250 River Oaks Dr
Bentonville,AR 72712
Re:Permit No. ELR2019-00042
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 13305 SW Pacific Hwy
Project Name: Taco Bell
Job No.: N/A
Refund: ® Check#231666 in the amount of$1,260.00.
❑ Credit card "return"receipt in the amount of$
❑ Trust account"deposit"receipt in the amount of$
Notes: Per applicant's request as they incorrectly entered (16) systems instead of(1) system
when obtaining the permit through online permit system. Refund 100% of the difference
between$1,344.00 paid and$84.00 for the actual permit fee for (1) system, for a refund of
$1,260.00.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
I:\Building\Refunds ctm`unis a iontraitefia'nlaY6Li;jdiegath4/69Tegon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
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City of Tigard
1 �� 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: Thomas Allred DATE: 3/29/2019
9250 River Oaks Dr
Bentonville,AR 72712 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 421949 Case#: ELR2019-00042
Date: 3/7/2019 Address/Parcel: 13305 SW Pacific Hwy
Pay Method: CreditCard Project Name: Taco Bell
EXPLANATION: Per applicant's request as they incorrectly entered(16) systems instead of(1) system
when obtaining the permit online. Refund 100%of the difference.
Restricted Ener3 Permit 220-0000-43103 $1,125.00
12%State Surchar:e 100-0000-24001 135.00
TOTAL REFUND: $1,260.00
APPROVALS: SIGNA R /DATE:
If under$5,000 Professional Staff � -
70
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review f- Board
� y
`-�" 1
A. �' .. T C .--�%. "..,,_ .®
Case Refund Processed: Date: cf..�7/1 By ,,14',
I:\Building\Refunds\RefundRequest.doc x 09/01/2010