Loading...
Permit TIGARD City of Tigard February 6, 2014 ADT LLC Attn: Lori McMurphy 7989 SW Cirrus Dr. Beaverton, OR 97008 Re: Permit No. ELR2013-00159 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11330 SW Plum Terr Project Name: Kohlhoff Job No.: N/A Refund Method: ❑ Check# in the amount of$ ® Credit card "return" receipt in the amount of$67.20. Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit" receipt in the amount of$ Comment(s): Per applicant's request as customer cancelled job. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, "1/ i 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 Ill q City of Tigard TIGARD 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: ADT LLC DATE: 1/30/2014 Attn: Lori McMurphy 7989 SW Cirrus Dr REQUESTED BY: Dianna Howse Beaverton, OR 97008 TRANSACTION INFORMATION: Receipt#: 192133 Case#: ELR2013-00159 Date: 7/8/2013 Address/Parcel: 11330 SW Plum Ter Pay Method: CreditCard Project Name: Kohlhoff EXPLANATION: Per applicant's request as customer cancelled job. Refund 80%of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Electrical Permit 220-0000-43103 $60.00 12%State Surcharge 100-0000-24001 7.20 TOTAL REFUND: $67.20 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff A7---d--e__ 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 FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: „/6 //S/ By: �(/4/ I:\Building\Refunds\RefundRequest.doc x 09/01/2010 Jan. 23. 2014 9:21AM No. 0281 P. 1 CC City of Tigard •• COMMUNITY DEVELOPMENT DEPARTMENT 7/1 " Request Permit Action q TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • www.tird-or. ov 'I U: CITY OF TIGARD ED Building Division Services Supervisor JAN 2 3 2014 13125 SW Hall Blvd.,Tigard;OR 97223 CITYOF TIGARD Phone: 503.718.2430 Fax: 503,598.1960 twww.tigard-or.gov BUILDING TIGARD FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff (check one) REFUND OR Name: ADT LLC V 0 1 0 INVOICE TO: (Business or Individual) aity Mailing Address: 7989 SW Cirrus Dr City/State/Zip: Beaverton, OR. 97008 Phone No.: 503-469-7241 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):. ® CANCEL/VOID PERMIT APPLICATION. . ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). 0 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: ELR2013-00159 Site Address or Parcel#: 11330 SW Plum Ter Project Name: Heather Kohlhoff Subdivision Name: Lot#: EXPLANATION: Customer cancelled burglar alarm installation Signature: --C Z.:„.' CC■C'(11 Date: 1/23/14 Lori Mclqurphy Print Name: 75'. x , ko = 6 Q, o-0 /5..7-0 1 x rere T Refund Policy 67.a a /4 i Po 1. The Director or Building Official may authorize the refund Of /n/E2� a) any fee which was erroneously paid or collected. �C N b) not mote than 80”/a of she land use application fee when an application is withdrawn or canceled before any review effort has been expended, c) not more than 9O%of she and use application fee for issued permits. d) nor more than 50%of the building plan review fee when an application is canceled before any plan review effort has been expended. e) nor more than 13 t1%of the building permit fee for issued permits prior to any inspecnon requests. 2. Refunds will be returned to the original Payer in the saint method in which payment was received. Please allow 24 weeks for processing refunds. FOR OFFICE USE ONLY Rte ro Sys Admin: Date /923 /'/ B Rtc to Bldg Admin: Date A. 6 /y_BX 12j4i Refund Processed: Date �4,j y By �" • Invoice Processed: Dare By Permit Canceled: Date I /'/ B%,tf,* Parcel Tag Added: Date By Receipt# Dare Method , Amount$ I.\Building\Forms\RegPermitAcnon.doc Rev 05/25/1012 II' I ri ,em s-t— C 6. l! F.,..0 r1/4 L N t>4. e 1,0 FuJ 6.6- 1 y u CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 14 COMMUNITY DEVELOPMENT Permit #: ELR2013 -00159 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/08/2013 Parcel: 1 S133DB10700 Jurisdiction: Tigard Site address: 11330 SW PLUM TER Project: Kohlhoff Subdivision:3CHOLLS FERRY ROAD TOWNHOME; Lot: 33 Project Description: Low voltage for burglar alarm. Contractor: ADT LLC Owner: KOHLHOFF, HEATHER A 2815 SW 153RD DR 11330 SW PLUM TER BEAVERTON, OR 97006 TIGARD, OR 97223 PHONE: 503 - 469 -7241 PHONE: FAX: 503 - 469 -7110 FEES Description Date Amount Specifics: Restricted Energy Permit 07/08/2013 $75.00 12% State Surcharge - Electrical 07/08/2013 $9.00 Type of Use: SF Class of Work: ALT Total Number of Systems: Audio & Stereo: N Security Alarm: y Garage Door Opener: N HVAC: N Vacuum System: N Other: N Other Desc: Total $84.00 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 thr• - - - - 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By / .d/ . 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. 07/03/13 01:46PM HP LASERJET FAX 5034697139 p.01 • Electrical Permit Applicat' pEIVE City of Tigard Ku °;��d Permit No.. UatGL' 1,3 l / , 3 l/� .. ,! £A••�d�0 1 3 — o40/5"1 ! 0 * i 3125 SW Hall Blvd., Tigard, OR 9722 k� ew Phone; $O3,7i8,2439 Fax; 503.SVR,1 3 2013 "Other t'ennu: �- Dmc/t1 : T { (.; ,t It I) Inspection Line: 503.639.4175 pate Ready/By; "'�- lh al i .� EA See Page 2 for I nternet; www,tigard- or.gov • Notified/Methrui! Suppkmental Information 5'S ^'rl >I .,f �1, 1 ,6�i�I`nF (r v„ r � x I . + pry ' (••; ,' ; .p y � . 4 ,f - r� � A m"� it ri � (i„ r ve X 11 l�V ,7;., M1, rg y�� ttf�l� ( r F'It dii. W 1��ti� r l(,• <I + 1t I � M�, y p;�e • yM� t p � r 11 ,f(11 ^' r f 1, , I, 1� 1/•I Ir, � : ol1 �y L ��! (1 yF °`r)id�il( {o> �r ,� e; 1 p' jazzA'.JU'w A,a.c.Odci4r^%� ,,' .' ,,,,4 Q); ;4,,'.a10- .x..,,oa:, L'U.S 1, 1 N. Mil � :,i ;l , ,4. _ •, 'a%� --•: ,o;: ' . il orttrd lar:mo '„ It ,, k ,, u` 1 �n I ti f, It ,.,:,/ , ,» • New construction El Addition /altcration/replacentent ....Please check nil that apply submit 1 secs of plans whtems ch mew); © Service or feeder 4(w /snips or more 0 Building over three stories. 0 Demolition {y 0 Other: where the available (trap current 0 Marinas and boatyards, � r" � \ I M , ` I � a � S�'� � r 4 . l:y;o�v , , r ,i �y �t �r, ggs��, WA�,•e , +( :h y -:t t ( ∎., T s � „ tjs , . 5 ' , + � t, a , tp,� , ,{, 7n, a !Mk' } , , � t •/f hy , �tr)���i; I�r,, `J I r • `i { 4.,, , exceeds 10,000 amps at 1170 volts or 0 Monthly, buildings, itlit.: iQ t ¢ At f ,q,, , , . Y, ,: rWl({Iv1.11' ,,LL..t1vU).•, • ,1 ,J ,. less to ground, Or exceeds 14000 0 Commercial use agricultural 0 I- and 24family dwelling 0 Commercial /industrial 0 Accessory building amps for all o11117 instatlptions. buildings. ® MU(u- family ❑ Master builder 0 Other: 0 Fire pump. i 0 insinuation of 75 KVA or 1. P. F'' i °I 1 i . T . ' ; ,. -� E.. � s ; r,r)77�, Y ? i ;it , rfT:;,c = 0 Emergen s j l ar g er wp+ trarcl y derived Y , d' I ' r � ' 1 :I.ir ' t P : N l „ Iki,1 ' ,,,, ''o ( s p , p 2 I I; , - Ir ed s stem. ' a a ( r, • gal • s, der n , a n t / .ra .( , .. , r r.. !,;..;;L ©Addition OF new motor 16(sd or © "A" "F" "1-2", "1 Job no-: 814 -51095 Job site address: 1 1330 SW Plum Terr I? HP or more. i occupancy - - -•- -••-•- ___—. ___,,,,,�,- 0 six or mine residential dints. ❑ RccrcA(iunat vehicle prim City/State/ZIP: Tigard, OR. 97223 0 Health-care facilities, 0 Supply voltage I'm more titan --- - 0Hazardous I(a:ant:as, I 600 volts nominal, Suite /bldg. /apt. no.: Project name: Heather KohlotT CJ Service or feeder anima or more. - .,...,,.,.. " .................., --- -_"_. ....._ ,,9, 1' �I'' ."err - S ' F q w Yr� y, ,e (' r ,(F 14E FYi y, l 11 +( w)? l'4 i t2, h ll�!�lii' CCUSS street/directions to job site; inicriotion tx, tee. Tgm1 1 r _ , .. _.... ,......_.., ,. . ... .............. New residential single or muiti•famity dwelling unit. Includes ara•e, Subdivision: r Lot no,: 1,00) sq. 0. or less . j 168.54 d — Ea. 001'1 500 so. n. or potion 3392 I Tax map/parcel no.: --, j a ra ', Limned energy, residentidl it° nl ( r7, ^n < <i: n r; ,> 1 75.00 2 ,. , rr :. 7r's • d 9 ( 6'I u , ( nv (with Above s( ft.) 'll ,!q , , • ,r, a n f a, atr iutr u e4d n O , s ' „) d .., ii„ ;•`:.t4r }• , �rvii(i1 ;; >t,14'. ✓;F:r�11'r,:.,- r i - - --- Limited energy, mulii'Ii rliIy 75.00 2 Low voltage burglar alarm install residential lwi�hNt wci ,�, (i�� � � � _ '"" " --- -- ---- ---- -- Services or fecricrs inc Ifation alteration, andJrN' relocation � r 200 amps or less i 100,70 2 147''. ;' Y.i k4: ii k il ,, a , l i ?4;.. � ;l4 , 4,v 1 9f {,, ! II R +� � /' l i, t : r ' 201 amps to 4l)0 amps 1 13.1_ 2 t , i • ,.,T' • r' ), ; 1; a` aAJ (✓} 'r affil Si I t art 1, , Ulil l.:r:m.wta',. g, - P P --� . 401 amps to 600 amps . 200.34 + 2 Name: - T ....................„..,...,.,...._.-..._.,,.,..,.,,- ......,....m,.....,.,.,...,.., •. 601 amps t0 1,000 amps 101 l)4 2 Address: Uvcr 1,01X1 amps a or volts 1 552.26 2 - __....,_.. �...,_..._.... .............. lfceders ias..w,,..._atio •- alter- -__.__ •---.. /o --- r . � .�� � » ». ��- "_��" » ","""�.- "�""""� �'• �." �`-" �- .��"'.- "�"�." "�'", ».., °..,,., . " ".,.•"�".`""" •I•em(wrary servicOS nrttlllatinn ,alteration, andlo City/State/ZIP: ,c. relocation Phone: ( ) Fax: ( ) 200 amps or less - 99,36 -- O w ne r Installation: This installation is being made on property that I own which not 201 amps to 400 amps 1 1212,5.08 _ ^ - ^ 2 is intended for sale, lease, rent, or exchange, according to OR 447, 449, 670, and 70!. 401 amps to 599 amps T 168 54 �' 2 Branch circuits •- now alteration or extension pe ,panel' Owner signature: , • , Date: A. Fee for branch circuits rlrh r _ ,. l it t 4. r r,n ,u 7 3 }, above service or fecdc fcc 1 t t �''r R ■ ! r 2, • r ,r iI •4yi �( i k r ,brae /e h 1� Fe) li INA'; ( , )7 ) 7 ;S, 1G:: 1 ti,9 0 A tt i e . , M r L1y1i4 each branch circuit 7.42 Business name: 13. Fee fos branch circuits )vi /hm<r M- - ---_...,,- ,_,.,,_„•„•,,.- T_- _„__- _,_„ -,_, - service or kcder 1'ee. Ost 56.I g 2 COO WI. Marble: branch circuit .. _.,...,... .,....» --- „ ._ __.._ _ . w_____ _ __ w Each add'1 branch circuit - 7,42 2 Ntiscellattetws (scrvke Or feeder not included,,,, _, ,_ -, Each monutitctuut or m u�alert City/State/ZIP: tit 67.84 dwelling, service and/or t' bzr Phone: ( ) Fax; : ( ) ttccoonect only 7 67,84 2 W .... _w.W.W, .._.. - .. W _ „W __ ........ - -,. Pump or irrigation circle • 67.84_ _2 E•anail: - -- MEOW "i ''I S r at ' , . nu } '" . h'aj r ;:, ;i;: 7ti t r ;, v” >.i�;: - Sinn or outline lighting 67./34 ,.,.. ,..» , ..,,.2 . rrl3r a v'ra l''u .,,.;s 4`i :,,,44�IIti;41. 1,,.�• •, � j 'r } i i ,t, ., ;',1',,,;, t; I ' a l t ) i1 +c ^^'•.v r.(i "r, . %;t ;lr >; r `r ti circtnt s or limiie energy 75.1X) Business name: ADT 1.LC _ _panel, Aeration, or extension, Pa e 2 2 -... ,w_.__ _, �.. _ Each additional inspec ;on over allowable in anvof the above_ - Address: 2815 SW t!t3 "t Dr Additional inspection (t h min) Gfi.25% hr - - Lie.: 196%0 Investigation (1 hr min) 66.25/ hr City/State/LIP: Beaverton, OR. 97006 ...-. —. ..�. . ,.,._. .,. _..,_.,,.. ,.,�._ ___ ..,.....M -- - _ µ -.-,..W,.,.,... „ _ ...... — Industrial plant (1 hr mini 78.18 / hr Phone: (503) 469-7241 Fax: (503) 469 -7110 inspiwtions for tvhicl, air t r Is - — (- ---^ - — -- -- - -- -- _ )0.00/ hr r si " i x.cilically listed li hr I u (::C:13 Electrical I i - • 21.FA ;;�' ^, n --m^r^ -r -,.- * , tv�;rsn:; ,, 6 t) 1 rICCI teal Lie.: (_'1.,15317 r Sllll V. •f ' y ' � i , . h, � , '' ,., -. 1 •i i :, rr , ' �.,1 1 7 �- �- _:i:. uu:..:_:,mi� � e�'Y',�, ..I � r1t �,r��Ytd�N. � �al �Yl,`w.,.� { i ue31:,�.5 I Snbtntail 75.00 Suprv. Electrician signature, required: °^� a.,,.,.........._._._- .__ _..._ .._ , -. „_.-,.._..,„ Plan rev ic %ofpcmtitfec): Print name: Eric Willard . Date: 7/3/13 State surcliarge (12% of permit fee); 9.00 N OTAl. PERMIT' FEE: _._.._..84,00 Authorized signature: This permit applkation a plres if rt permit is not obtained within 180 Print name: - _ Date: • days after it s been accepted as complete. ,-___- -- Number of inspections al owed per permit. l: VlulloingV 'crmitaLC•PormnAppAne 07/Ol /l0 44e 40I %7111 /u5!(:UtiVN'FA 07/03/13 01:46PM HP LASERJET FAX 5034697139 p.02 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ��i Ye i I '��'411 {yy ai �� 9M' nw , P . .{ .} y� m'ptV I N r M11i'�U (31'! �v`1��4v�� �1,�rrS 4 ,,c{ . e , � i�i���` ��+ �r�����Bhi�G' ���. u�1t�1i�. �> r" rird�n� , ?, +h�;�t'�,r(��:��,t ". Fee for a residential systems combined ... $75.00 Check Type of Work Involved: El Audio and Stereo Systems* Ej Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: ... .... _. c 1,, pp ' � p r;a • �, c r. 'gyp e "pu},� i! 6, i ,'c WRAF r r�(; r _ • ,� _ _ � Fee for each commercial $75.00 system (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Bailer Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation Ei Intercom and Paging stems El Landscape Irrigation Control* ❑ Medical Ej Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other • • Total number of commercial systems: *No licenses are required. Licenses are required for all other installations r MwlanreTenwusGL•PCrmuApp.UUC mrouw