Permit ip
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
ill - n
2 , f. COMMUNITY DEVELOPMENT Permit #: ELR2009 -00087
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/13/2009
Parcel: 25101 CB00100
Jurisdiction: Tigard
Site address: 8100 SW HUNZIKER RD
Subdivision: Lot: 0
Project: Huttig
Project Description: Additional burglar alarm: (11) motions, (8) doors, (2) kp. Job No. 83- 04302 -7
Owner: FEES
HUTTIG, INC Description Date Amount
555 MARVILLE CENTER DR, PO BOX 1041 Restricted Energy Permit 03/13/2009 ,$75.00
CHESTERFIELD, MO 63006 12% State Surcharge - Restricted Energy 03/13/2009 $9.00
PHONE:
Contractor:
ADT SECURITY SERVICES INC
2815 SW 153RD DR
•
BEAVERTON, OR 97006
PHONE: 503 - 469 -7212
FAX: 503- 469 -7114
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm:
HVAC: Instrumentation: Total $84.00
Intercom /Paging: Landscape /Irrigation:
Required Items and Reports (Conditions)
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other:
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. AT EN IT ON Ore.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 010 through OAR ° _ :61 6 100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.,246.6699 or 1.800 332.2344.
Issue By: I 6)-4/1A-C-1 i Permittee Signature: _,:� "r ��-
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 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.
6 Zty of TZgdYd, Oregon 0 13125 SW Hall Blvd. 0 Tigard, OR 97223 �K ,, �,,)
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August 27, 2009 1.:: .'.'... :
ADT Security Services
2815 SW 153r Rd.
Beaverton, OR 97006
Attn: Stephanie Pate
Re: Permit No. ELR2009 -00087
Dear Ms. Pate:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 8100 SW Hunziker Rd.
Project Name: Huttig
• 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 applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
,I • 1 /
Dianna Howse
Building Division Services Supervisor
Enc.
1: \ Building \ Refunds \Administrat ion \LtrRefund- Cancelpermit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard- or.gov o TTY Relay: 503.684.2772
CITY OF TIGARD RECEIPT
1,
-
II Q . 1 3125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
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Receipt Number: 175006 - 08/27/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELR2009-00087 $ - 67.20
Total: $ -67.20
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 022513 DHOWSE 08/27/2009 $ -67.20
Payor: Stephanie Pate- ADT Security
Total Payments: $ - 67.20
Balance Due: $67.20
Page 1 of 1
CITY OF TIGARD RECEIPT
1 _ 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
Receipt Number: 2009 -00593 - 03/13/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELR2009 -00087 12% State Surcharge - Restricted Energy 100- 0000 - 207020 $9.00
ELR2009 -00087 Restricted Energy Permit 220 - 0000 - 431510 $75.00
Total: $84.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 022513 DADAMSKI 03/13/2009 $84.00
Payor: Stephanie R Pate - ADT Security
Total Payments: $84.00
Balance Due: $0.00
•
, - Mal 09 10:58a Stephanie Pate 503-489 . p.2
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Electrical Permit Application ..,.''.': ••••.. : . FOR OFFICE USE ONLY . . . . :• •• • ,.• :•:•• •-• •
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City of Tigard
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MAR 1 1 7009 , , Nutt freet/Methrl; - 17a , .. •1 Supplemental Inforrnattoo
, . TYPE OF W(11th; • PLAN REVIEW .
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r Ncw constmetion E Additioni;herniltWariARD l'Icase7hccli Al Mat avply (submit 2 wt. of Ott, kv■it tt
ti ehetted locinw)'.
111 DemolitiOn ° °tiler! BUILDING DIVISION 0sc,ic..: or kcclor 400 ifIVIT)S Of Om ru 0 /Wilding over Lima: sit:Tien.
where the LiViiii:rble 1;w11 col 0 Minas r1n5 tso;nyia-L.
CATEGORY (W CONSTRUCTION cpcp:6510.000 mnps at 150 volL. cir 0 NOM mg buildiqp.
-.-..-. ..., .,- less to ground, or exec e( le 1 4,000 0 Cottunercittl :11;64%a:hind • 0 1 - and 2-family dwelltrig El Commercial/industrial 0 Accessory builtling smos for ntl other ilavaliano laujidinga.
0 Multi-family 0 Master builder 0 Other 0 Vire pump. D insomiwn of '7: KVA or
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- 3 LtIltreCncY 6 YSIVIn• irlTiVr SCparow(y derived nrtern
.10}3 SITE INFORMATION AND i_ocitTioN
D AthiiLio. a ro,nv motor toad of
I 00tir 1)7 1111,11,, OCcupancy.
Job I:Ia.:0 1 _ 7 I Job site adcirt:s:,. e: / 00 6W te h sr'
0 Sir; ■o• more n-siderait4 ucit. D Reer pal.,
IL'Ill. fwitilics. C.I Nunn ly ,,, 19 th: (0.1' m pre (Ilan
City/Stat(t/ZiP: - 77 L p q7,2.2 3
, OH locatioi s. stte volts no ntud.
Suite/bldg./apt, no.: 1 Project name:/-k- 5: 4.5w . . 4 . ,.. ic 1. ,=1Sctl-VIC7',7 Oi kedCr hip ampt. or mare.
CIICDUE};
Cross Street/directions to job site: --u,s‘ripo.n I 1.1 1 I '"''L.
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Now residential single- oe multi rtwelnog wiji.
Jacludes attached garage.
_..,... , ..„ .... — -
S'ubtlivision: Lot no,: 1.000 t;(l. fl., Of ks s
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, ':•', _____ -., - - - Ea. addl 500 .sq, It or portLyn ' 145.15
33.40 1
Tcx7r. inap/parcCS no.;
Limited socre,y, rct-aduntial
75.6( 2.
DESCRIPTION OF WORK .... (with itbo, sq. It)
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---....- ...... -_ _ .. ,. -
Limited , ...;ncrgy. Enulti - ,4/c/4 ,1 : ///,707,.A.,...r- r,boeies „?... l<1 rtsiaciui., (WIT11711/1)V1: M. ft.) 1 75.00 i 2
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Services or feeders tnirallation ancr.lition, ariehtur retoes
2.00 amps or less ' 80.30 2
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PERTY OWN! 1=1 T ENANT
201 ampt4 ;(1 400 ri p
arzi ..
1 Uti.,S7 2
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1 50.60 2
Name: 201 amps to WO amps
• • - ......,_ - OW amps to 1,000 amps 24(3.60 2
---
Address: ..._
Over 1,000 amps or volts 454 65
City/Staie/Z11 Temporary Sorvic•xts or feeder.: Itltit2 I InT ju iii, Altera 110)1, liticl/or
relocat ion
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PlrOne: ( ) I Fax; ( ) 200 amps or lusa f
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Owner installaiioW1 thstiallution ix 'xing made On property that I 0wnwhich is not 201 tt111)4 10 0 40 amps
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i ntended for sale, least:, rent, or exchange, according to ORS 447, 4l9, 0(3, and 701, 4 01 amps to 5k19 amtv 133.75 ; 2
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litrauch elr.cotlis - new, orterarioll,..or t, uIvo
°att.:"
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1 , APPLICANT ONTA('T PR SON I • - S above scry tee or ftiOder Ice,
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oath hrzincli circuit
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sinesame'
S. Fee for branch circui ts
withow servioc or feeder fee,
Contact name: KE A,g..4 US 46 h 5 2
i first to circuit
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i 12.1iscUnnonws 0i.orvioc or fusion not iiwitttli ,
Cily/StnteZIP:
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Phone; (-50__; ) *7- 7 2../7._ _.
, ,x:: ) 1 1 Each martufaCt‘irt.tti or modular
] ttwatrig, titnice• am.lim titttntc-i itt) 00
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CONTR,AC:l'OR __,.. , ....,..
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Pump Or rin circle
, 5it or outline lip,htinp.
' 5340
53,40 1
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Sig,nril etrcuit(s) or limited- I
1.30SitICSS. nine! AD 1' SECURIT y
energy pa n1, o herazion. or
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Address! 2815 SW )53" DR talent:too, Otntcribc: 1 tart4.7,t2 2 75.00 2.
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(ieviState/.7.1P; BEAVERTON OR 97006 PAO additional 4:spot:flog over allowable to ;tote 0 I the abo vy
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Per inspoetion •(:.2 50
Phone: (503)469-7:A2 I_Fax: (503) 469-71141 ---r—
lmm-‘44,:ilicm per hour (i h7 min) 1 G2.50
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CCB Lie.: 59 ] Electrical [iv.; 26209CLE Suprv. Lie,; LEA3N9 trldiEtiinl plant plzr op,. h 73,25 I
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- .... I.r. PERNIET rux
Suprv. Electrician signature, - " re
75.00
SIJIalotal:
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Print nom: KEN KRAUS - , .....
.... . of permit fee):
. :. 1 Date: 7 "Zll %Win ( 25%
,----- . // Staitt surchtirru( 12% f p ItN
oermit ): 9.00
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ultittri7.ct.1 Nitt,Litillifl... a•-eer.• 4( /"/ TOTAL PItl-vvi ft fiLL7
Date:
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'flaiNT;;;;ii op plteati on expire if ,i perrr is not uhtetnej wt Ow
Print name: I
dun alter it hit* beta accepted m. complete
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' Nuttithn of iiispect tom allowed Jilt 1(14t51.
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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: ADT Security Services DATE: 8/20/09
2815 SW 153r Rd.
Beaverton, OR 97006 REQUESTED BY: Dianna Howse
Attn: Stephanie Pate
TRANSACTION INFORMATION:
Receipt #: 2009 -593 Case #: ELR2009 -00087
Date: 3/13/09 Address /Parcel: 8100 SW Hunziker Rd.
Pay Method: CreditCard Project Name: Huttig
EXPLANATION: Per applicant's request as work is being done by another contractor. Refund 80% of
permit fees.
REFUND INFORMATION: • .
Fee Description From Receipt Revenue Account No. -Refund
Example:..;[BUILD] Permit Fee Example: 245 - 0000 - 432000 $ Amount
Restricted Energy Permit 220 - 0000 - 431510 $60.00
12% State Surcharge 100- 0000 - 207020 7.20
TOTAL REFUND: . $67.20
APPROVALS:
If under $500 Professional Staff
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: ' cc' 4 ;:l By: r !: —
Case Refund Processed: Date: d'72 �f0- y By:
1: \ Building \Refunds \RefundRequest.doc 04/13/09
Mar i9 09 07:53a Stephanie Pate 503469 p.1
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uildYn g Dlivisg®
i' J Request for Permit Action Refund
Cz o Ti and 1 L V k fLl%
TO: CITY OF TIGM » MAR I 200;
Permit System Administrator
OF - 13125 SW Hall Blvd., Tigard, OR. 97223 �'f NG DI
Phone' 503.718.2430 Fax: 503.598.1960 B�1I6'D�VISIO
FROM: ❑ Owner ❑ Applicant
(acetone) Contractor 1 City Staff
Name: ADT Security Services
(Business or Individual)
Mailing Address: 2815 SW 153' Dr.
City /State/Zip: Beaverton OR 97006
Phone No.: 503 -96'2— 1 76 99
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (
JJ CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES,
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: FL /z 020o 9 - coo g7
Site Address or Parcel #: <W O D 5 CO gl/4j2/ -67e /(
Project Name: / 7 rj 4-
Subdivision Name:
Lot #:
EXPLANATION: 2.
/ 2141.
/ /2,-
Signature(,!r7 ,a,x6c:., -e
Step P
anie
Date: � //°9 Print Name: ate
RC1vnd
Poiira
I. The Building Official may authorize the refund of
a) any fcc which was erroneously paid or collected.
b) not more than ft() percent of the permit fee for isseui permits prior to mty inspection requests,
c) not more than 8O percent of plan review fee when an application is ctmcalod before any plan review effort has been expended.
2. Refunds will be returned to th4 original Payer in the Sane method in which payment was received.
OR UFrcc �.<I tir U\ i,
Rte to S Admin D /(.
B Kie to Bldg Admin: Date , .27 C. ;: B
Refund Processed: Date X 27 tye" By . ' invoice Process Date
Permit Canceled: Date , ,l7 C : B
Reeei • t # --- % � Parcel Ta _ Added: Date
Date Method Amount $
I:\BuildingU ormckRegPonnitAcTon- Bldb.doc Rev HMI 7/01