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Permit ELECTRICAL RESTRICTED ENERGY PERMIT `� CITY OF TIGARD II Permit #: ELR2009 -00067 C .' COMMUNITY DEVELOPMEN Date issued: 12/30/2009 T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S125DC07200 Jurisdiction: Tigard Site address: 7131 SW ASH CREEK CT Subdivision: ASH CREEK ESTATES Lot: 5 Project: Ash Creek Estates Project Description: Home theater & security systems FEES Owner: Description Date Amount ASH CREEK PROPERTIES LLC 12/30/2009 $67.84 12655 SW NORTH DAKOTA ST Restricted Energy Permit TIGARD, OR 97223 12% State Surcharge - Electrical 12/30/2009 $8.14 PHONE: Contractor: GLOBAL SECURITY & COMMUNICATION 3212 MAIN ST VANCOUVER, WA 98663 PHONE: 360 - 693 -1900 FAX: 360- 906 -9692 Type of Use: SF Class of Work: NEW Total Number of Systems: Audio & Stereo: Y Security Alarm: Y Garage Door Opener: N Total $75.98 HVAC: N Vacuum System: N Required Items and Reports (Conditions) Other N Other Desc: 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. ��� P ermittee Signature: li'� "AP, - < 4. 7 7 / Issued By: 'r�.+C OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. Date: OWNER'S SIGNATURE CONTRACTOR INSTALLATION ONLY Date: SIGNATURE OF SUPR. ELEC' LICENSE NO. Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. City of 7 Zgard, Oregon ° 13125 SW Hall Blvd. ° Tigard, OR 97223 1,1 • ..„.. U1 January 8, 2010 Global Security & Communication 3212 Main St. • Vancouver, WA 98663 • . Attn: Jeff Isaak Re: Permit No. ELR2009 -00067 Dear Mr. Isaak: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 7131 SW Ash Creek Ct. Project Name: Ash Creek Estates Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $60.78. ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as work was completed under MST2009- 00184, all encompassing. 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. 1: \ Building \ Refunds \ Administration \LtrRefund- CancelPermit.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 .. www.tigard or.gov • TTY Relay: 503.684.2772 City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Global Security DATE: 1/8/2010 3212 Main St Vancouver, WA 98663 REQUESTED BY: Dianna Howse Attn: Jeff Isaak TRANSACTION INFORMATION: Receipt #: 176424 Case #: ELR2009 -00067 Date: 12/30/09 Address /Parcel: 7131 SW Ash Creek Ct. Pay Method: CreditCard Project Name: Ash Creek Estates EXPLANATION: Per applicant's request as the work was covered under MST2009- 00184. • REFUND INFORMATION: - • Fee Description From Receipt Revenue Account No. ; Refund Exampl [BUILD] Permit Fee - - Example:.245- 0000 - 432000 . $Amount Restricted Energy Permit 2200000 - 43103 $54.27 12% State Surcharge 1003100 -24001 6.51 TOTAL REFUND: $60.78 APPROVALS: If under $ 00 0 Professional Staff CLA6\ �c -� •�al ;c If under $7,500 Division Manager If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board • • FOR ACCELA SYSTEM ADMINISTRATION USE ONLY ' : • • Refund Request Reviewed: Date: / " //O By: 454 Case Refund Processed: Date: //ii, B L_ I: \Building \Refunds \RefundRequest.doc 04/13/09 C l 12. • ooh? City of Tigard, Oregon a 13125 SW Hall Blvd. o Tigard, OR 97223 R-1 � 1 1 ko) a rkto Fel C ub; 0may January 8, 2010 Global Security & Communication 3212 Main St. Vancouver, WA 98663 . Attn: Jeff Isaak Re: Permit No. ELR2009 -00067 Dear Mr. Isaak: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 7131 SW Ash Creek Ct. Project Name: Ash Creek Estates Job No.: N/A Refund: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $60.78. ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as work was completed under MST2009- 00184, all encompassing. 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. 1: \Building \ Refunds \ Administration \LtrRefund- CancelPermicdoc 01/16/07 Phone: 503.639.4171 0 Fax: 503.684.7297 o www.tigard- or.gov o TTY Relay: 503.684.2772 CITY OF TIGARD RECEIPT V E Q 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Xrci4 Al %, Receipt Number: 176514 - 01/08/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELR2009 -00067 $ - 60.78 Total: $ -60.78 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 110330 DHOWSE 01/08/2010 $ - 60.78 • Payor: Anthony J Gomez, Global Security & Commu Total Payments: $ -60.78 Balance Due: $60.78 • Page 1 of 1 CITY OF TIGARD RECEIPT a . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 176424 - 12/30/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELR2009 - 00067 Restricted Energy Permit 2200000 -43103 $67 ELR2009 -00067 12% State Surcharge - Electrical 1003100 - 24001 $8.14 Total: $75.98 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 110330 DHOWSE 12/30/2009 $75.98 Payor: Anthony J Gomez, GLobal Security & Communication Total Payments: $75.98 • Balance Due: $0.00 Page 1 of 1 01/05/2010 TUE 9:32 FAX 3609069692 Global Security 2002/002 m Community Development _. " ) El Request for Permit Action JAN 20i . 2. i UAL TIGARD - TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov FROM: ❑ Owner p Applicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) G I f) / >, ! . J 2f tA.P �� Mailing Address: 3 212 c.,1) S`F City/State /Zip: U avo. `,&) ft Q. C 6 66.E Phone No.: /1(?' b / (at ' PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ['/ CANCEL PERMIT APPLICATION. Q REFUND PERMIT FEES (attach receipt, if available). ' ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit # : itp a - 00067 Site Address or Parcel # : l i S I St/t flrSll Cyec k. Ct • • Project Name: II 6 t 4O I • l U t Al0004 `wte..5 ,ASIA Ct-e Lk- � S t ti e, Subdivision Name: r ([ Lot # : EXPLANATION: . 16�7Jz Gpplet(C- 0- ct.ft eca✓ysSl;/).. eie cc, / : i p-eckvv li ...Crc.7"--0•0 5 — 6 0 I 87 . A Signature: Date: r5' /0 Print Name: ka 1 S Refund Policy. 1. The Director or Building Official may authorize the refund of: . a) any fee which was erroneously paid or collected. • b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effon has been expended, c) not more that 80% of the land use application fee for issued permits. �� '2 d) not more than 80% of the building plan review fee when an application is canceled before any plan review effon has been expended. l c) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. • FOR OFFICE USE ONLY Rte to Sys Admin: Date By Rte to Bldg Adnun: Date / . /O B I•'' 6 )l ' 7 Refund Processed: Date e , B Invoice Processed: Date By 1J Permit Canceled: Date / e jv B ri7 Parcel Tag Added: Date By Receipt # Date ' Met od Amount $ I:\ Building \Forms \RegPennitAaion.doc Rev 07/26/07 12/29/2009 TUE 15:19 FAX 3609069692 Global Security 12001 /003 r • ~ I RECEIV ,, Electrical Permit Application I�oR aiid i ii olvi Y SW Hall Blvd., Tigard, OR 97223 Q�2 mug � City of Tigard 1312 DEC 2 9 20 ;,ll : Review ©�' li:� rm No. - Boo b ' M .5 flan Review Phone: 503.639.4171 Fax: 503.598.1960 Other o F le /U 9 7�?1 Th Ins lcctiou Linn. 503.639.4175 • ., .. . . . . CITY OF.TIGA 1 , y to See Page 2 for BUILDING DIVI 1Q e lad l l . tads: .. . Internet: W \VW.I 01'.gOV c<I /MClhorf: •' - Supplemental Information (� .. . ' • - TYPE OF WORK • . . - PLAN REVIEW . /� - New construction construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 scls of plans w /items checked below): ❑ Scrvlce or feeder 400 amps or mow ❑ Building over three stories. ❑ Demolition ❑ Other: when; the available fault cuncnt ❑ Marinas and boatyards. • CATEGORY OF CONSTRUCTION cxcccds 10,000 amps at 150 volts or ❑ Floating buildings. less to round, or exceeds 14,000 g ❑ Commercial-use agricultural /� [j'1 - nd 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for alt other installations. buildings. ∎ , j ulti- family ❑ Master builder ❑ Othcr: ❑ Dire pump. ❑ Ins ;allation KVA or . .. . ❑ Emergency system Im ;qcr separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A" 'I:' "!-2":' 1 Job no.: Job site address: Cie/if-6g tom or mom. occ r [ l • ... U _ _ ❑Six of move ICSi[fenlLef units. ❑ fiCCll'1110 ;1a1 vehicle parks. Clly /SIate /ZIP: t5 / (L2. , ❑ Ilcalnh -cal; facilities. ❑ Supply voltage for more dean ❑ hazardous locations. 600 volts nominal. Suite /bldg. /apt. 00.: Project name: ,i p Woo j _1-., en ❑ Service or feeder 600 amps Or moan. �Qy� ,\p t FEE SCHEDULE Cross street /directions to job site: ucscrip0on _ - -'" J (11}:1 FCC. I 1'o101 1 ' New residential single- or multi-family dwelling unit. Includes attached garage. Subdivision: 7 Lot no.: ,, sq. II. or less i 168.54 4 Ca. add'I 500 sq. II. or portion _ _ 33.92 1 Tax map /parcel no.: Limited energy, resi(tcntial 67.84 -- 2 DESCRIPTION OF WORK (with above scull.) Limited energy, multi - family l !- 67.84 2 lL 0 ± QC�C r. residential (with above sq. ft.) 1 Services or feeders installation, alteration, and /or relocation _ 200 amps or Icss 100.70 2 • I ❑ PROPERTY OWNER ❑ TENANT • 201 amps to 400 amps 133.56 2 Name: 40! amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or voles 552.26 2 City /State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) l Fax: ( ) 200 amps or less 59.36 t Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 40! amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with . '• . 9 APPLICANT . .. ' � . - CONTAC'1' PERSON above service or feeder fee, 7.42 2 Business name: lv �� Fee for circuit �� � C C / c��.f' h� __ _ Q. Pee for branch cir Contact name: ] f! q .-- C ( without service or feeder fcc, SG. (8 2 '� ' first branch circuit _ t each add'I blanch circuit 7. Address: 3 • 7_ (Z AA -CiL/\ ,_4- 7.42 2 - - - -.� Miscellaneous (service or feeder not it _I City /State /ZIP: U C Vt.. 1.0 p\ Each manufactured or modular 67.84 2 / dwelling, service and /or feeder Phone: ( 360 6Y ---((( ) Fax: : ( "go ) q06'- � ( l j q2.___ Reconnect only _ 67.84 2 E-mail: e C v 6) 3(c, V 2, 19 .9 Pump or irrigation circle 67.84 2 . • CONTRACTOR • • Sign or outline lighting 67.84 2 Business name: (1 vi,x.( S cc t. __ i co ti n u, i 1 (4 I 0 fllg'gy p rcuit(s) limit � P -(h r ncr rand, alterati on, or ed- t (,! Address: "'2 i Z , v lc, b n CJ extension. Describe: Paget ~� p Y 2 City /State /ZIP: vO }; , � W. A- -l (Jfl Each additional inspection over allowable in any of the above �� Per inspection 66.25 Phone: o) 6 M lJ ) Fax: (1 �(�6 - yi CJ Investigation per hour (1 hr min) 66.25 CCB Lic.: CQ70 / Electrical Lic.: 2 - -711 C Le i3O1 Lic.:6(1 /FA ✓ lndusu•ial plant per hour 1 78.18 • 4 j - ELEC'1'RICAI.. PERMIT FEES Suprv. Electrician signature, required:, 7 /0/1//i / ii Subtotal: 67 -Q -( Print name: 7 Date: I �J Plan review (25% of permit fee): ce- �?Ct/(lP�✓lR `_-2. p S tate surcharge(12 %of permit fce): R,/ '7 Authorized signature: TOTAL. PERMIT PEE: -7c,.1& ( c " c ' This permit application expires if a permit is not obtained within 180 Print [mine: (� �� Ditto i2.2 I • o / days after it has been accepted as complete. 111 III Number of inspections allowed per permit. I: 13uilding il'crmils\Iil- C- I'crmi:App.doc 10 •140- 4615'r(I 1 /05 /COOVSVIiII 12/29/2009 TUE 15:20 FAX 3609069692 Global Security 2003/003 Electrical Permit Application - City of Tigard 2 c� Page 2 - Supplemental Information1 LIMITED ENERGY PERMIT FEES: RESIDENTIAL. WORK ONLY: Fee for all residential systems combined........ $67.84 Check Type of Work Involved: irrAudio and Stereo Systems j j Burglar Alarm Garage Door Opener Heating, Ventilation and Air Conditioning System* Li Vacuum Systems ❑ Other: COMMERCIAL. WORK ONLY: Fee for each commercial $67.84 system (SEE OAR 918- 309 0000) Check Type of Work Involved: U Audio and Stereo Systems - Boiler Controls n Clock Systems Data Telecommunication Installation n Fire Alarm Installation HVAC n Instrumentation - Intercom and Paging Systems n Landscape Irrigation Control" Medical n Nurse Calls U Outdoor Landscape Lighting - Protective Signaling Other Total ntunber of commercial systems: *No licenses are required. Licenses are required for all other installations 1∎13ni1din l'cmiMiGl'cnnitAp.doc IOr01i09