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Permit Support Document (2) r) t rj City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT'' y g i III III III Re quest for Permit Action P/2'/ze 1 Tic;A R l) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.Agard-or.gov RECEIVED TO: CITY OF TIGARD MAY 18 2020 Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 CITY OF TIGARD Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerr 4a ertON FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) G d 13 i' L(11&/,'.J6-- Mailing Address: p 40 .e x „2_ City/State/Zip: 5.7- /441-'1 L.- / O ci 9 2/3 7 Phone No.: . O 3 ,-"s i — f y l -7 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): Pi CANCEL/VOID PERMIT APPLICATION. MO' FUND PERMIT FEES (attach copy of original receipt and provide explanation below). II INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: FPS - &DO/Z Site Address or Parcel#: /eiaz 7 542 !A✓Gt 4Gl e,7 l s- Project Name: Subdivision Name: p Z-/i`t / 14 Lot#: EXPLANATION: p p� oil-6,0 de__ 40,,,, t 0/.cc .Lcnr .S ?Irk". � .. 4r0/.,G.l hefAvG G /Lreic dp /v, /LtS7` c/.ss P? /i . ! -PS 14-_,/1-.4/i--. Ty' has 41-to, ac(06-0,l 7t /4S7z)17-001'`t. Signature: ~t!��"rv� g-/Date: ` 0 Print Name: J /'Z /7j;hie-wait/ 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. "( .0 f G� , A r, /�0I 3 T 6 7 s rzautas 7a ti S / 'f6 r0 o /€ .- Route to Sys Admin: Date /dl.I,e) By Route to Records: Date if rzie By Refund Processed: Date /� � B Q Invoice Processed: Date By Permit Canceled: Date �p/�/2.) Byi) 0 Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_1 518.d/6c !NI if TIGARD City of Tigard September 2, 2021 G&B Plumbing PO Box 92 St. Paul, OR 97137 Re: Permit No. FPS2020-00012 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 14037 SW Walnut St Project Name: Fern Ridge,Lot 2 Job No.: N/A Refund Method: ® Check#240415 in the amount of$86.06. ❑ Credit card "return"receipt in the amount of$ 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): Permit was created in error as work was completed under master permit MST2019-00144. Fees in the amount of$193.96 were transferred to master permit;refund difference of$86.06. If you have any questions please contact me at 503.718.2430. Sincerely, 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 11111 City of Tigard T I G 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 TO: G&B Plumbing DATE: 8/27/2021 PO Box 92 St. Paul, OR 97137 REQUESTED BY: Dianna Ornelas TRANSACTION INFORMATION: Receipt#: 429085 Case#: FPS2020-00012 Date: 4/21/2020 Address/Parcel: 14037 SW Walnut St Pay Method: CreditCard Project Name: Fern Ridge,Lot 2 EXPLANATION: Permit created in error and scope of work was completed under MST2019-00144. Fees in the amount of$193.96 transferred to MST;refund difference of$86.06. IIMPUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount_ Cash Over 100-0000-48001 $86.06 I TOTAL REFUND: $86.06 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager (e4A,,t..,/e...,...._) If under 25 000 Department Manager er P g If under$100,000 City Manager If over$50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: Date: `Pl y/rii By: .eL'' I:\Building\Refunds\RefundRequest.doc x 09/01/2010 i CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Fern Ridge, Lot 2 Site Address: 14037 SW WALNUT LN /1.�FC A an Receipt Number: 436289 - 09/04/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID FPS2020-00012 $-86.06 Total: $-86.06 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 240415 DHOWSE 09/04/2021 $-86.06 Payor: G&B Plumbing Total Payments: $-86.06 Balance Due: $86.06 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 • -- 503.639.4171 T t,..;t I Project Name: Fern Ridge, Lot 2 Site Address: 14037 SW WALNUT LN alb CjiAn- .. Receipt Number: 429085 - 04/21/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID FPS2020-00012 Cash Over 100-0000-48001 $86.06 Total: $86.06 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 6291006 PUBLICUSERO 04/21/2020 $280.02 Payor: Total Payments: $280.02 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Fern Ridge, Lot 2 Site Address: 14037 SW WALNUT LN Receipt Number: 429085 - 04/21/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID FPS2020-00012 Cash Over 100-0000-48001 $86.06 Total: $86.06 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 6291006 PUBLICUSERO 04/21/2020 $280.02 Payor: Total Payments: $280.02 Balance Due: $0.00 Page 1 of 1 q CITY OF TIGARD RECEIPT a 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 1 FGARD Project Name: Fern Ridge, Lot 2 Site Address: 14037 SW WALNUT LN -11Z 9--0 S r-Y--- Receipt Number: 429551 - 05/28/2020 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID FPS2020-00012 $-193.96 Total: $-193.96 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Fund Transfer DHOWSE 05/28/2020 $-193.96 Payor: Total Payments: $-193.96 Balance Due: $0.00 I Page 1 of 1 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT COMMUNITY DEVELOPMENT Permit#: FPS2020-00012 T I G A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/21/2020 Parcel: 2S 104BC 10500 Jurisdiction: Tigard Site address: 14037 SW WALNUT LN Project: Fern Ridge,Lot 2 Subdivision: FERN STREET SUBDIVISION Lot: 2 Project Description: Fire sprinklers permit due to site grade. Contractor: G&B PLUMBING&SONS INC Owner: K5 URBAN PROPERTIES&MANAGEMENT PO BOX 92 PO BOX 25571 ST PAUL, OR 97137 PORTLAND, OR 97239 PHONE: 503-868-1417 PHONE: 503-292-9344 FAX: FEES Description Date Amount Specifics: Fire Protection System Permit-RES 04/21/2020 $246.45 12%State Surcharge-Building 04/21/2020 $29.57 Type of Use: SF Info Process/Archiving-Lg$2.00(over 04/21/2020 $4.00 Class of Work: ALT Type of Const: VB 11x17) Occupancy Grp: R-3 Height: ft Stories: 2 Commercial Sprinkler System: Sprinkler Required: Sprinkler Type: Standpipe Required: Hazard: Density: 0 Design Area: 0 K Factor: 0 Commercial Fire Alarm System: Fire Alarm Required: Alarm Type: Pull Station Required: Smoke Detectors Req: Battery Calcs Provided: Cut Sheets Required: Total $280.02 Valuations: Required Items and Reports(Conditions) Sprinkler Valuation: $0.00 Residential Square Footage: 0 Fire Alarm Valuation: $0.00 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. 2.1987 or .800.3 .2344. Issued By: Permittee Signature: 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. Building Permit Application Fire Protection System FOR OFFICE USE O\I.I City of Tigard RECEIVED Received : aa Permit No.:�,Q 1 • — IN 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review I r I Phone: 503.718.2439 Fax: 503.598.19601 AN Al ry 202o Date/By: ...2.0 Other Permit (37—y j.1...,ry�/Lill T I l A R D Inspection Line: 503.639.4175 • Jt11Y 1 Date Ready/By: , / I` sa See Page 2 for (s. Internet: www.tigard-or.gov �Y OF ��GARD Notif d/M�eehhod.�/// �C/�('J Supplemental Information ,ri TYPE OF VSQIODI REQUIRED DATA:1-AND 2-FAMILY DWELLING 1W New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application re_ I-and 2-family dwelling ❑Commercial/industrial Valuation: :, ,- � ❑Accessory building IDMulti-family Number of bedrooms: A /C#- z2Z ElMaster builder El Other: Number of bathrooms: $ YA/70 JOB SITE INFORMATION AND LOCATION Total number of floors: ?/ Job site address: '4 V(' } sky) W 0 h4't .i New dwelling area: 343(1 square feet City/State/ZIP: � 0 ILGarage/carport area: 44 L square feet Suite/bldg./apt.no.: V Project name: ,$t Ay. gA& €- Covered porch area: 31 0 square feet Cross street/directions to job site: Sw **vibe, ru&c L T L trw C E Deck area: square feet u Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: (14,01.c)e- Lot no.: ?j Permit fees*are based on the value of the work performed. Tax map/parcel no.: 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. Valuation: $ Existing building area: square feet New building area: square feet PROPERTY OWNER ❑ TENANT Number of stories: Name: l<5 U a lo cv, 1 Ore�vi,-t'�t„S A �.". p,,wct— Type of construction: Address: Too WOX Z ✓s 1 Z �" Occupancy groups: City/State/ZIP: iO tAkCvU DNC 41A.Z't-3 Existing: Phone:(S3) Z�� 63 4 4 Fax:( ) v�+ New: %APPLICANT 0 CONTACT PERSON NOTICE Business name: g V.``p. 4 . %Lc A. k,p DE S All contractors and subcontractors are required to be Contact name: C.���S L L�L� licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 1 O 90 )L 25 5}I jurisdiction in which work is being performed.If the City/State/ZIP: V0A.A`C•^ik 0 V- 6\ Li g applicant is exempt from licensing,the following reasons q apply: Phone:(S,03) 241 2. `5A I Fax::( ) E-mail: / j CC��`CONTRACTOR BUILDING PERMIT FEES* Business name: L�.C Q y 1�n �� (Please refer to fee schedule) Address: � pl 4�% G\Z j Permit fee: City/State/ZIP: r '�q�?L bi/ ( pt-t34- State surcharge(12%of permit fee): FLS plan review(40%of permit fee): Phone:(Sc, ) 136 5 ,, ax: 3 s.1q (5444 (Due upon application submittal.) CCB lic.: 18 �3� Total permit fees: 1 Amount received: Authorized signature: �( This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: --V\ \ try,. Date:) 2142,DZ� * Fee methodology set by Tri-County Building Industry Service Board. rtBuilditgtPemvts\FPS-PemiitApp_03 16.doc 440-4613T(I 1/02/COM/WEB) City of Tigard: Fire Protection Permit Checklist Page 2-Supplemental Information Describe work to be done: 1.) Type of Work: 2.) Addition/alteration only to sprinkler heads: 3.) Addition/alteration only to alarm devices: 0. New system Number of sprinkler heads: Number of alarm devices: ❑ Addition or El 1-10 heads: Affidavit required and El 1-5 devices: Affidavit required and Alteration (3)copies of sketch showing area (3) copies of sketch showing area to existing of work within building structure of work within building structure system El 11+heads: Plan review required and ❑ 6+ devices: Plan review required and (3) sets of plans. (3) sets of plans. Additional description of work: Type of System (Complete A,B, C or D as applicable): A.) Commercial Sprinkler Sprinkler Type El Wet El Dry Additional Standpipes Information: Sprinkler Supply Line El Yes ❑ No Hazard Group Density Design Area K.Factor Sprinkler Project Valuation: $ B.) Type I- Hood Fire Suppression System Hood Project Valuation: I $ C.) Fire Alarm Submittal shall Battery Calculations El Yes include: Individual Component ❑ Yes Cut Sheets Fire Mann Project Valuation: $ D.) Residential Sprinkler (Stand Alone System) Square Footage: Permit Fee: 0 to 2,000 $198.75 1 2,001 to 3,600 $246.45 3,601 to 7,200 $310.05 7,201 and greater $404.39 Sprinkler Project Square Footage: sq. ft. Fire Protection Permit Fees Project valuation subtotal(see A,B&C above): $ Permit fee based on project valuation (see fee schedule): $ Permit fee based on square footage(see D above): $ State Surcharge (12%of permit fee): $ FLS Plan Review(40%of permit fee): $ TOTAL: $ 1:\Building\Permits\PPS_PermitApp_031016.doc 2 Dianna Ornelas From: Julie Drinkwater Sent: Wednesday, May 27, 2020 8:31 AM To: Felipe Perez Cc: Dianna Ornelas Subject: Fern Ridge, Lots 1 &2 Attachments: Invoice.pdf Hello Felipe The revision for Fern Ridge, Lots 1 & 2, for the fire sprinkler systems, are now ready. Because the fees for the system for Lot 2, have been voided and will be transferred from the fire protection safety permit to the master building permit, no additional fees will be due. The balance due for Lot 1, is $261.18. Attached please find the invoice for your review. To pay the fees online, you can go to our website: https://aca.accela.com/TIGARD/Default.aspx. From there, click on the Building tab, enter the permit number in the Record Number field, and click Search. Please let us know once the fees have been paid so that we can make the permits ready for you to pick up. Thank you Julie Drinkwater Permit Technician Assistant City of Tigard I Building Department 13125 SW Hall Blvd Tigard, OR 97223 503-718-2804 DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule." 1 Fee List Page 1 of 1 Crtt�Gg.-- /2 F(A14A SWR2019-00138-Starbucks Menu Add Delete Void Invoice Invoice&Pay ReCalc Help Fee Calc.Factor: Job Value(Contractor)$0.00 v Fee Total $27,176.50 Showing 1-3 of 3 ❑ Invoice Date Fee Item Quantity Unit Assessed ❑ 217957 05/02/2019 Sewer Connection Fee 4.81 Dwellings ❑ 217958 03/20/2020 Sewer Connection Fee 3 Dwellings ❑ 217959 03/20/2020 Cash Over 9,776.5 Dollar Am Page 1 of 1 https://ay.accela.com/portlets/fee/feeList.do?mode=list&module=Building 5/21/2020