Permit ��
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00236
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8g00800 /2008
PARCEL:
SITE ADDRESS: 16055 SW 74TH AVE ZONING: I -
SUBDIVISION: FANNO CREEK ACRE TRACTS LOT: JURISDICTION: TIG
PROJECT: NW SKI AND WAKE SPORTS
Project Description: Installing (1) protective signal system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
JOHN DUNCAN ADT SECURITY SERVICES, INC
JANICE LEE 2815 SW 153RD DR
7060 SW PALMER WAY BEAVERTON, OR 97006
BEAVERTON, OR 97007
Phone: Contact #: PRI 503- 469 -7212
FAX 503- 469 -7114
Reg #: ELE 26- 209CLE
FEES LIC 59944
Description Date Amount SUP LEA389
[ELPRMT] ELR Permit 8/7/2008 $75.00
[TAX] 12% State Surch 8/7/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
C —______
Issued By: /��, � Permittee Signature: �"P 7. GQ Jjd/�
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'N: DATE:
LICENSE NO:
Cali 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.
A,pr 10 09 02:25p Stephanie Pate 503-469 p.1
Building Divisioxi
Request for Permit Action or Refund
City a 1'i and ~l e2 00 g a3
TO: CITY OF TIGARD F I V E D
Permit System Ad,mf nistrator
13125 SW Hall Blvd., Tigard, OR 97223 APR 10 2009
Phone: 503.718.2430 Fax: 503.598.1960
FROM: ❑ OwncT ❑ Applicant 2 Contractor ❑ " iiystaft
(check onc)
Name: ADT Security Services
(Business or Intfividual)
Mailing Address. 2815 SW 153`" Dr.
City/State/Zip: Beaverton OR 97006
Phone No.: 503-469-7100
PLEASE 'T'AKE ACTION FOR THE ITEM(S) CHECKED
X CANCEL PERMIT APPLICATION.
® REFUND PERMIT FEES.
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit -4:~d0 4' ~d
Site Address or Parcel
Project Narne:
Subdivision Name: Lot
EXPLANATION:
Si ature: Date:
Print Name: Stephanie Pate
1. The %kild ng Offiiciat may authorize the rafund of:
a) any fee which wps crronenu.ly paid or eonecled,
b) not more than SO pemmt of die permit fie for issued IKrrnile prior to any incncction nqumq,
c) not more than RO pacent of plan reviow fee when an application is canceled beforc any plan review effort his been expended,
2, Refunds will he mmed to the original Payer in the same rnahod m which payment was rcccivod,
FOR OFFICE USE ONLY
Vte to Sys Admin: i Date $ ROo to Bldsz Admin: Date. ;
Refund Yroctssed: Date 7 $ Invoice Processed: Date >ay
Pennit Canceled: Date B #iYCC1 23 Added: Datc 13
Rccei t # Date Method Amount S
I:~buildmg%llormsWogPcriniWction-Bldg.doc Rcv 101[7105
RN City of Tigard
Accela Refund Request E- t Quo
3c0
This forth 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: ADT Securitv DATE: 8/20/09
2815 SW 153`" Dr.
Beaverton, OR 97006 REQUESTED BY: Dianna Howse
Attn: Stephanie Pate
TRANSACTION INFORMATION:
Receipt 2008-2797 Case ELR2008-00236
Date: 8/7/08 Address/Parcel: 16055 S%V 741h Ave.
Pay Method: CreditCard Project Name: NW Ski & Wake Sports
EXPLANATION: Per applicant's request as customer cancelled job. Refund 800,1'0 of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Exam le: 245-0000-432000 $ Amount
LPRM'IELR Permit 220 0000 431510 $60.00
AX 120,'o State Surcharge 100-0000-207020 7.20
TOTAL REFUND: $67.20
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager OL".A,
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: 13
Case Refund Processed: Date:
I \Budding\Kefunds\RefundRcquc;t.doc 04/13/09
2 2 oK7)F . ,
City of Tigard, Oregon ~ 13125 SW Wall Blvd. a Tigard, OR 97223
August 27, 2009
ADT Security Services
2815 SW 153` Dr.
Beaverton, OR 97006
Attn: Stephanie Pate
Re: Permit No. ELR2008-00236
Dear Ms. Pate:
The City of Tigard has canceled the above referenced pernut(s) and enclose a refund for the
following:
Site Address: 16055 SW 74"' Ave.
Project Name: NW Ski & Wake Sports
Job No.:
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $67.20.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicants request as job was cancelled. 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.
I:ABuilding\]tefunds\Adnunistration\LtrIZefund-CancelPermit.doc 01/16/07
Phone: 503.639.4171 ® Fax: 503.684.7297 ® www.tigard-or.gov o TTYRelay: 503.684.2772
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: E x) i- REQUIRED ON GREEN INSPECTION CARD.
✓ Code I Inspection Description 1 PASS Date I By ✓ Code I Inspection Description I PASS Date I By 1
•
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG- Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post /beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 'Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wit proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG- Structure set -up MEC - Mechanical Permit
280 Insulation 605 Post /beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab
910 Sprinkler rough -in PLM - Plumbing Permit
•
915 Fire alarm rough in 305 Plumbing underslab
310 Crawl drain
920 Suppression trip test 315 Post /beam plumbing
995 Misc. inspection:
998 Alarm final 320 Plumbing rough -in
999 _ Sprinkler final 322 Shower pan
330 Water service
335 Rain drain
340 Storm drain •
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection • 599 Final inspection
I:\ Building \Forms \InspCard- AOP- Blank.doc 02/02/07
Aug 06 03 12:13p Stephanie Pate 503-469 p.2
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