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Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT III Request for Permit Action T I G A It D 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 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) Mildren Design Group Mailing Address: 4875 SW Griffith Dr, Ste. 300 City/State/Zip: Beaverton, OR 97005 Phone No.: 503-244-0552 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): 0 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). Permit#: BUP2020-00228 Site Address or Parcel#: 13010 SW 68th Parkway, Ste 140 Project Name: Fiduciary Benchmarks Subdivision Name: Lot#: EXPLANATION: Customer was over charged $410.11 due to a data input error. / i Signature: _ i/�y/// Date: 11/16/2020 Print Name: Eggie Mal.onado Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: _ Date 7 ld j2_, By.4 Refund Processed: Date 7/6/2.1 By .pQ/1 Invoice Processed: _ Date By Permit Canceled: Date v/�j1-- By,t•V Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_1 05 8.doc 11111 p TIGARD City of Tigard September 10, 2021 Mildren Design Group 4875 SW Griffith Dr, Ste 300 Beaverton, OR 97005 Re: Permit No. BUP2020-00228 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 13010 SW 68th Pkwy, 140 Project Name: Fiduciary Benchmarks Job No.: N/A Refund: ® Check#240493 in the amount of$410.11. ❑ Credit card "return"receipt in the amount of$ . ❑ Trust account"deposit"receipt in the amount of$ . Notes: Due to data entry error, customer was overcharged on permit fees;refund 100% of overpayment. If you have any questions please contact me at 503.718.2430. Sincerely, /C.,,rfit/y.aret--S.---- Dianna Ornelas Building Division Services Coordinator Enc. I:\Building\RefundsJrinliagn axsielayLoilLJ6aregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov City of Tigard r c n R a 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: Mildren Design Group DATE: 9/6/2021 1 W 68th Pl Beav 005 REQUESTED BY: Dianna Ornelas P75 std 67.2-1 /7 b# . 3 0-6 AE4-11E7L.Ton1 i O►�- ?7 00 TRANSACTION INFORMATION: Receipt#: 431666 Case#: BUP2020-00228 Date: 11/4/2020 Address/Parcel: 13010 SW 68th Pkwy, 140 Pay Method: CreditCard Project Name: Fiduciary Benchmarks EXPLANATION: Due to data entry error,customer was overcharged permit fees. Refund overpayment of$410.11. REttINDTMAYRIVUTIt:l:tvt: Fee Description From Receipt Revenue Account No. R c.cksnd Example: Building Permit Fee Example: 2300000-43104 . $Amount Cash Over 100-0000-48001 $410.11 TOTAL REFUND: $410.11 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,000 Department Manager If under$100,000 City Manager If over$50,000 Local Contract Review Board g yy,Ag ], 0. Case Refund Processed: Date: /© 'L./ By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT • 13125 SW Hall Blvd.,Tigard OR 97223 �.1 ) 503.639.4171 i Project Name: Fiduciary Benchmarks Site Address: 13010 SW 68TH PKWY 140 Receipt Number: 436372 - 09/10/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID B U P2020-00228 $-410.11 Total: $-410.11 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 240493 DHOWSE 09/10/2021 $-410.11 Payor: Mildren Design Group Total Payments: $-410.11 Balance Due: $410.11 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Fiduciary Benchmarks Site Address: 13010 SW 68TH PKWY 140 tO/t t`Gr Receipt Number: 431666 - 11/04/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID BUP2020-00228 Info Process/Archiving-Lg$2.00(over 230-0000-43135 $4.00 11x17) BUP2020-00228 Permit Fee-Additions,Alterations, 230-0000-43104 $53.27 Demolition BUP2020-00228 12%State Surcharge-Building 100-0000-24001 $6.39 BUP2020-00228 Plan Review 230-0000-43106 $34.63 BUP2020-00228 Cash Over 100-0000-48001 $410.11 {— Total: $508.40 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 6992453 PUBLICUSERO 11/04/2020 $508.40 Payor: Total Payments: $508.40 Balance Due: $0.00 Page 1 of 1 Building Permit Application 8 -I0/29N-0 Commercial RECEIVED FOR OFFICE USE ONLY City of Tigard Received �-y DateBy: • 2ao Permit No.: r ,20-00228 II • 13125 SW Hall Blvd.,Tigard,OR 97223 0 C T 2 (1 2020 ,7 Plan Review Phone: 503-718-2439 Fax: 503-598-1960 Date/By: / /----- 4/ 20 f f) Related Permit: TI GA[:D Inspection Line: 503-639-4175 CITY OF i iGARD Date Ready/By: 1 Ed See Page 2 for Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. — Indicate the value(rounded to the nearest dollar)of all I]Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ 1-and 2-family dwelling IM Commercial/industrial Valuation: $ ❑Accessory building ❑Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 13010 S.W 68th Parkway, Ste. 140 New dwelling area: square feet City/State/ZIP: Tigard, OR 97223 Garage/carport area: square feet Suite/bldg./apt.#: I Project name: Fiduciary Benchmarks Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: Lot#: Permit fees*are based on the value of the work performed. Tax map/parcel#: Indicate the value(rounded to the nearest dollar)of all equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. No construction with this permit. This permit is for obtaining occupancy in space Valuation: ^��$ "�"��1if°. previously permitted as speculative TI under permit number BUP2020-00178 and Existing building ree.:5b;1z,F� s ivare feet7 6 0,e to separate from vacant space. Tenant to be office use. New building area: 56,12 — square feet ® PROPERTY OWNER 0 TENANT Number of stories: 2 Name: Pacific Northwest Properties Type of construction: Ill-B Address: 6600 SW 105th Avenue, Ste. 175 Occupancy groups: B City/State/ZIP: Beaverton, OR 97008 --- Existing: B Phone:( ) Fax:( ) New: B ® APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES* Business name: (Please refer to fee schedule) Mildren Design Group Structural plan review fee(or deposit): . 2'.40 Contact name: Curt Trolan FLS plan review fee(if applicable): Address: 4875 SW Griffith Dr, Ste. 300 City/State/ZIP: Beaverton, OR 97005 Total fees due upon application: Phone:( 503)244-0552 I Fax::i 503)244-0417 Amount received: ---------- — E-mail: curt@mdgpc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR — roof-top mounted PhotoVoltaic Solar Panel System. Business name: No construction with this permit Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address: Solar Installation Specialty Code checklist. City/State/ZIP: Permit fee(includes plan review $180.00 and administrative fees): Phone:( ) Fax:( ) State surcharge(12%of permit fee): $21.60 CCB Lic.: Total fee due upon application: $201.60 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Curt Trolan Date:2020-10-27 I * Fee methodology set by Tn-County Building Industry Service Board. I:\Building\Permits\BUP_COM_PernutApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB) • - it Coordinator Review ❑ Cons 'ons "Met"prior to issuance of building permit ❑ Approved, I T Released: Date: Notes: Revisions (after Building Submittal on Revision Notice 1: Date Sent to :.lica • Revision Notice 2: Date Sent to A.:i .:.t: Revision Notice 3: Date Sen • Applicant: ❑ SDC Fees Entered: ash Co Trans Dev Tax: es ❑ N/A Tigard Trans SDC: ❑ Yes ❑ N/A Parks SDC: ❑ Yes N/A ❑ OK t. sue Permit • .proved by Permit Coordinator: te: I:1Building\Forms\BldgPermitRvw_COM NoLandUse_111819.docx City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 111 " Plan Submittal Requirements Matrix Commercial & Multi-Family - New, Additions or Alterations TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov Type of Submittal # of Plans (Includes new, additions and alterations.) Required at Submittal Demolition Permit 2 (site plan is required showing location and square footage of all buildings to be demolished,erosion control plan and tree protection,if applicable) Site Work 3 (must include location of all accessible parking) Plumbing (site utilities) 2 Building 3 Fire Protection System 3 Mechanical 2 Plumbing (building fixtures) 2 Electrical 2 Solar Photovoltaic 2 (Requires check list for prescriptive installation. If not prescriptive installation,engineering is required.) Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for contractor, City of Tigard,Washington County, and Tualatin Valley Fire &Rescue), if applicable. I:\Building\Permits\BUP_COM_PemiltApp.doc Rev.03/05/2019