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Permit RECEIVED City of Tigard • c:c7m:vluxrry DEVELOPMENT DEPARTMENT JAN 1 5 2021 . N • CITY OFTGARD 11 . Request for Permit Action BUILDING DIVISION 1 l i„;A R t) 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertnits@tigard-or.gov FROM: ❑ Owner KApplicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or individual) cWO{ P rCAtiom 9 do . Mailing Address: ,D• a c / ?t( g City/State/Zip: ( .- (r QP-- 5 72.- ' 'zT rt3 Phone No.: '5 05" Z'qZJ/` l 96 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTORff�A ON PERMIT(do not cancel permit). Permit#: Lot. 2.0 2-o — to '-'3 _) Site Site Address or Parcel #: Project Name: 13r c a 15 7 5tA9,0 Subdivision Name: Lot#: r ,.fi.au. `eO �jno EXPLANATION: 0_1 Signature: gp.,,lbee, Date: ( --15'" 2e 2/ Print Name: /4141 She u Lt. Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund oh • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. 7Z t sc0 — .se-, v-o — /(.6 S J", ?u 6 , ?6 tr 9r1° Route to Sys Admin: Date By Route to Records: Date 3 B, Refund Processed: Date el- !/7,7.j By <12O Invoice Processed: Date By Permit Canceled: Date / 5, Z/ 131:.40 Parcel Tag Added: Date By 1:\Building\Forms\RegPermi t:\ction_f 923 I4.doc /cM 5 /S/L/ ld/i Z/" 041t `V.S /5/_ /t/ZZ/zc) h 1,1 g TIGARD City of Tigard February 4, 2021 Power Plumbing Co PO Box 19418 Portland, OR 97280-9418 Re: Permit No. PLM2020-00430 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 11642 SW Pacific Hwy, 140 Project Name: Brick's Barber Shop Job No.: N/A Refund Method: ® Check#238158 in the amount of$64.96. ❑ Credit card "return"receipt in the amount of$ 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 job was cancelled. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, r<cOc Dianna Ornelas Building Division Services Supervisor Enc. 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard T c A R D 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 Power Plumbing Co. DATE: 2/1/2021 TO: PO Box 19418 Portland, OR 97280-9418 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 431514 Case#: PLM2020-00430 Date: 10/22/2020 Address/Parcel: 11642 SW Pacific Hwy Pay Method: Cash Project Name: Brick's Barber Shop 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 Plumbing Permit Fees 230-0000-43101 $58.00 12%State Surcharge 100-0000-24001 6.96 TOTAL REFUND: $64.96 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff '' �� ,,, "" If under$12,500 Division Manager D. L. Ornel 14 If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA,SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 14CITY OF TIGARD RECEIPT 41 S S , 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Brick's Barber Shop Site Address: 11642 SW PACIFIC HWY 140 IN Receipt Number: 436244 - 09/03/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2020-00430 $-64.96 Total: $-64.96 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 238158 DHOWSE 09/03/2021 $-64.96 Payor: Power Plumbing Co. Total Payments: $-64.96 Balance Due: $64.96 Dnr,o 9 .,f I CITY OF TIGARD RECEIPT t. > 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Brick's Barber Shop • Site Address: 11642 SW PACIFIC HWY 140 �1/L(G Receipt Number: 431514 - 10/22/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2020-00430 Sink 230-0000-43101 $50.04 PLM2020-00430 12% State Surcharge-Plumbing 100-0000-24001 $8.70 PLM2020-00430 Minimum Fee Adjustment-Plumbing 230-0000-43101 $22.46 Total: $81.20 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 6946957 PUBLICUSER107 10/22/2020 $81.20 Payor: Total Payments: $81.20 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD PLUMBING PERMIT mm ' • COMMUNITY DEVELOPMENT Permit#: PLM2020-00430 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2020 T f G Parcel: 1S136DB02400 Jurisdiction: TIGARD Site address: 11642 SW PACIFIC HWY 140 Project: Brick's Barber Shop Subdivision: AZOIC TERRACE Lot: 1 Project Description: Interior plumbing:Adding(2)sinks. Contractor: POWER PLUMBING CO Owner: CHAMPION, RONALD V&ROBERTA E PO BOX 19418 16449 LEXINGTON CT PORTLAND, OR 97280 LAKE OSWEGO, OR 97034 PHONE: 503-244-1900 PHONE: FAX: 503-244-8825 FEES Quantity Description Date Amount 2 ea Sink 10/22/2020 $50.04 Specifics: 1 12%State Surcharge- 10/22/2020 $8.70 Plumbing Type of Use: COM 22 ea Minimum Fee Adjustment- 10/22/2020 $22.46 Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $81,20 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 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: Permittee Signature: fl 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. Plumbing Permit Application ECEIVED Building Fixtures �i�"11 t tliz OFFICE ICE USE OM 1 City of Tigard 0 C T 2 '. 2020 Received U g Re eiv I Pei me:\'n. /�/�/y,.yam,�,,,�? 13125 SW Hall Blvd.,Tigard,OR 972 y �dw (� v tiOre r�/'�61 (,VW Tt'TY OF TIGARD Plan Review Phone: 503.71 R.2439 Fax: 503.59R.1 b Other Permit No. ➢ate By': e Inspection Line: 503.639.4175 BUILDING DIVISION -� ��'�� 1 G A 1:t) D .RcadylBy: J n- �ruris: el See Page 2 for Internet wwvv.tigard-or.gov Notified Method: kri2/ ,2,e v/ Supplemental Information TYPE OF WORK FEE'. SCHEDULE 0 New construction 0 Demolition For special information use checklist Description I Qty. I Ea. I Total ^®Addition/a)teration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 ❑ I-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78 CIAccessory building ❑Multi-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑ Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION ANDr LOCATION Site utilities: Job site address: I"U47. `�5 YA(..YT 1 L H w Catch basin or area drain 18.76 City/State/ZIP: ' ©� Z Z 7� Drywell,leach line,or trench drain 18.76 / J Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: I LI O Project name: arh-rti- chop Manufactured home utilities 50.03 Cross street/directions to job site: �y�at 3 3-r � ,5')_ IV Manholes 18.76 tee t(J� V a'y /- Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: /5/367 g,;,1 4�o Backfowpreventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 \ c S Clothes washer 25.02 4 ( 2 1 ✓ I ✓i, Dishwasher 25.02 i y _ (J/' et /0 4 C�LQ/{ - S%Y`c�C" z Drinking fountain 25.02 / rr J' re e.r r�trLc lr t rt Ste/ Y3,.jC- _ Ejectors/sump 25.02 l•, PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: PO 0104. 9)Lt,vvi b iY/ (0 . Medical gas(value:S_) Page 2 (,Af + ,�► Primer 12.51 Contact name: -T05►1. ( /, Jp/�, Roof drain(commercial) 12.51 Address: 4 O _( D X ,_I Li I P' Sink/basin/lavatory ,1. 25.02 56,041 City/State/ZIP: PO Y'7 I L0` 1 t al 7 Z4 V Solar units(potable water) 62.54/ Phone:( ))) ZN(.f..../ya-b Fax::(9,3) 2-'1f-f its'-- Tub/shower/shower pan 12.51 E-mail:, ✓1l,'Clap0 iN- 4.-pi L4.0'1191)I ( $0. zurvii Urinal 25.02 rfrRA Water closet 25.02 CO CTOR Water heater 37.52 Business name: QO,A 1�� Pf �I h,,,,.2.:‘, p p Water r te WV 56.29 Address: i1 t 1 v S� u/h4W 6/WC- Other: 25.02 City/State/ZIP: /n ,/ 04 9 72. 7-3 Subtotal 5,O it Phone:( 5 .JU I'/P ax:( riU� a . ,/_o Minimum permit fee: S72.50 -7) CCB Lie.: SZ 3-Is- Plumbing Lic.no.: 3 i f-LS�Pp� Plan review (25%of permit fee) State surcharge(I2L6 of permit fee) $,-70 Authorized signature: ` r�i/;S r TOTAL PERMIT FE`�'`7�� .a�sr�, Print name: J /Ir u�� / 110 S Date:/D/J� „./a This permit application expires if a permit is not obtained within o da}'s (/N / after It has been accepted as complete. •Fee methodology set by Tri-County Building Industry Service Board. IABuilding'Permits PLMU-PemrilAppdoc Ill 01i09 4104616Tn0:W-COMAIT'8, Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee(ea) Total Square Footage: Permit Fee: Footing drain-I"100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater S327.54 Sewer-each additional 100' 37.52 Water Service- 1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation: Permit Fee: Storm&Rain Drain- I st 100' 62.54 $1.00 to$5.000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 55,001.00 to$10.000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) _ Teta each additional$100.00 or fraction thereof,to II and including S10.000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $I48.50 for the first 110,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including 525,000.00. Inspections outside of normal business 90.00/hr S25,001.00 to$50,000.00 $379.50 for the first$25,000.00 and$1.45 for hours(minimum charge-2 hours) each additional$100.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr S50,001.00 and up $742.00 for the first S50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 or fraction thereof. Subtotal: Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Plan Review for Plumbing Installations Quantity by Fixture Type Plan review is required for any of the following. Fixture Type for Replied Please check all that apply. Work Perforated: Capped Added Relocate Baptistry/Font ❑ Any new commercial building with water service 2"and greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water Aspirator ❑ Medical gas and vacuum systems for health care facilities. Dishwasher: Commercial ❑ Any multipurpose fire sprinkler system. Domestic ❑ Any complex structure as defined in OAR9 18-780-0040. Thinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: -2" 3" Isometric or Riser Diagram 4" ❑ Isometric or riser diagram is required for new buildings -Car Wash Drain Garbage -Domestic non-food that meet the qualifications above. Disposal: -Domestic food related -Commercial food related -Industrial food related Ice MachJRefrig.Drains Comments regarding fixture work' Oil Separator(Gas Station) / SQ-l a n f/Jt a / / J Rec.Vehicle Dump Station Shower: -Gang J 6LPL{dC1/ Ykt -Stall Sink: - ayBar non-food related -Bradley • -ComiServ/Util food related -Service *Note: If the fixture work under this permit results in an Swimming Pool Filler increase of sewer EDUs,a sewer permit will be issued and Washer-Clothes fees assessed for the sewer increase must be paid before the Water Extractor WaterCloset-Toilet plumbing permit can be issued. Urinal Other Fixtures: I:1Building Pennits\PLMF_PermitApp.doc 08/04%2011 2 Accumulative Sewer Tally _ Tenant Name: BRICK'S BARBER SHOP SWR# SWR2020-00169 TIGARD Site Address: 11642 SW PACIFIC IIWY 140 PLM# PLM2020-00430 Parcel#: 1S136DB02400 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values Baptisery/Font 4 0 0 0 0 0 Bath: -Tub/Shower 4 0 0 0 0 0 -Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash: -Each Stall 6 0 0 0 0 0 -Drive through 16 0 0 0 0 0 Cuspidor/Water Aspirator 1 0 0 0 0 0 Dishwasher: -Commercial 4 0 0 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 2 4 2 4 -3 inch 5 0 0 0 0 0 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 HP) 16 0 0 0 0 0 -Commercial(to 5 HP) 32 0 0 0 0 0 -Industrial(over 5 HP) 42 0 0 0 0 0 Ice Machine/Refrigerator Drain 1 0 0 0 0 0 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Stariun) 6 0 0 0 0 0 Rec.Vehicle Dump station 16 0 0 0 0 0 Shower: -Gang(per head) 1 0 0 0 0 0 -Stall 2 0 0 0 0 0 Sink: -Lav/Bar-Non-Food Related 2 0 0 0 0 0 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-Food Related 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 0 0 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 . 0 2 4 2 4 Current Fixture Value 4 divided by 16= 0.250 Current EDU 1 EDU= $5,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 4 divided by 16= 0.250 over (under) $ 1,450.00 Enter EDU Change Here 0.250 * *Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.Ol. I Notes: Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 10/21/2020 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be submitted to the City of'1'igard Building Division to redeem credits towards future system development charges. I:\Building\Sewer Tally\SeauerTallySheet_5800_070119.xlsx Branden Taggart From: Branden Taggart Sent: Wednesday, October 21, 2020 4:40 PM To: Kristie Bramwell Subject: Brick's Barber Shop: PLM2020-00430 & SWR2020-00169 - 11642 SW Pacific Hwy. Attachments: Invoices.pdf Hi Josh, The plumbing and sewer permits for Brick's Barber Shop are ready to issue now. I have attached invoices above for you to reference, and the fees due are as follows: Brick's Barber Shop Permit# Fees Due PLM2020-00430 $ 81.20 SWR2020-00169 $ 1,450.00 Total: $ 1,531.20 You can pay the above fees online through our website: https://aca.accela.com/TIGARD/Default.aspx. From there,click on the Building tab, enter the permit numbers in the Record Number field, and click Search. If paid online, please notify us at tigardbuildingpermitsPtigard-or.gov, and I will issue these permits and place them in our open conference room adjacent to our outer Permit Center lobby to be picked up between the hours of 8:00 a.m. and 5:00 p.m., Monday through Thursday. We are closed on Fridays. Furthermore,the permit fees for both permits will need to be paid before we can issue either of them. Please let me know if you have questions. Thank you, Branden Taggart . City of Tigard m , Senior Permit Technician Community Development 13125 SW Hall Blvd Tigard, OR 97223 (5O3)718-2449 brandent@tigard-or.gav 1