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Permit (186) e TIGARD City of Tigard June 24, 2019 Associated Plumbing Co. 200 NE Victory Ave., #C Gresham, OR 97230 Re: Permit No. PLM2019-00134 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: 13727 SW Pacific Hwy, #300 Project Name: Brim Hall Dance Academy Job No.: N/A Refund: ® Check#232386 in the amount of$28.02. El Credit card "return"receipt in the amount of$ . El Trust account"deposit"receipt in the amount of$ . Notes: Refund permit fees paid for change in scope of work to remove drinking fountain. If you have any questions please contact me at 503.718.2430. Sincerely, , ,.....0...,,,, ./..ztzryi_e__ Dianna Howse Building Division Services Coordinator Enc. I:\Building\Refunds' dfiinis4aVit flgAberpaTh gfhPfegon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov 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: Associated Plumbing Co DATE: 6/10/2019 PO Box 1827 Gresham, OR 97030 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 422457 Case#: PLM2019-00134 Date: 4/3/2019 Address/Parcel: 13727 SW Pacific Hwy,#300 Pay Method: CreditCard Project Name: Brim Hall Dance Academy EXPLANATION: Refund 100% of permit fees for drinking fountain removed from permit. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Plumbing Permit 230-0000-43101 $25.02 12%State surchage 100-0000-24001 3.00 TOTAL REFUND: $28.02 APPROVALS: SIGNAT ES/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 FOR ACCELA SYSTEM ADMINISTRATION USE ONLY t Case Refund Processed: Date: .r By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 U 4CITY OF TIGARD RECEIPT 1 2 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Brim Hall Dance Academy Site Address: 13727 SW PACIFIC HWY 300 Receipt Number: 434453 - 05/21/2021 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2019-00134 $-28.02 Total: $-28.02 PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 232386 DHOWSE 05/21/2021 $-28.02 Payor: Associated Plumbing Co. Total Payments: $-28.02 Balance Due: $0.00 14 y.- CITY OF TIGARD RECEIPT S . • 13125 SW Hall Blvd.,Tigard OR 97223 q 503.639.4171 TIG 1RT") Project Name: Brim Hall Dance Academy Site Address: 13727 SW PACIFIC HWY 300 Receipt Number: 422457 - 04/03/2019 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2019-00134 Drinking Fountain 230-0000-43101 $25.02 k PLM2019-00134 Expansion Tank 230-0000-43101 $12.51 PLM2019-00134 Fixture/Sewer Cap 230-0000-43101 $25.02 PLM2019-00134 Primer 230-0000-43101 $12.51 PLM2019-00134 Lavatories 230-0000-43101 $50.04 PLM2019-00134 Water Closet 230-0000-43101 $50.04 PLM2019-00134 Water Heater 230-0000-43101 $37.52 PLM2019-00134 12% State Surcharge-Plumbing 100-0000-24001 $25.52 Total: $238.18 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 113060 PUBLICUSER201 04/03/2019 $238.18 Payor: Brad Marshall/Associated Plumbing Company Total Payments: $238.18 Balance Due: $0.00 Panc 1 of 1 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED 1111 �+ Request for Permit Action APR 4 2019 T I t,A k 1) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tiga,i-- : F TIGARD ION 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 ��!sApplicant ❑ Contractor ❑ City Staff Check(/)one REFUND OR Name: INVOICE TO: (Business or Individual) ntjSO c / Ae ' i`7/v /#1 G ( Mailing Address: /C © /. C1 ye" e ,P2 7 City/State/Zip: 6/2> /f ft-1 , Q/2_. 9 70 3 0 Phone No.: _s-e 3 - 1/9 —/9 , PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): _--�. ANE- OID PERMIT APPLICATION. REFUND P 1 RMIT FEES (attach copy of original receipt and provide explanation below). 111 Z FOR FEES DUE (attach case fee schedule and provide explanation below). Permit#: / L-/`'/ a p/ 9 -- 0 0 /3 c f Site Address or Parcel#: /3 7. 7 Sty) off-e rS C /die// 3 0Z0 Project Name: At z5,ft-/ve., e.9-.5 Subdivision Name: Lot#: / EXPLANATION: R.-CI-7 d-z/ , ,/V//-(/\/ 7-iru Al 7e?A✓ ./ -4/`7 061 70 /7- --c-fa A I.6) I' Signature: " Date: if �1 a0 I Print Name: 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. f 2 0-70 3. Please allow 3-4 weeks for processing refund requests. S S . G—Zy Z ,5 Zr Route to Sys Admin: Date By Route to Records: Date-S A'/.-/ By Refund Processed: Date /gyp 9' By Invoice Processed: Date By Permit Canceled: Date A/ 4-- By arcel Tag Added: Date By I:\Building\Forms\RegPemvtAction_120518.doc CITY OF TIGARD PLUMBING PERMIT 11111 � ' COMMUNITY DEVELOPMENT Permit#: PLM2019-00134 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/04/2019 T f{�tt.L� 9 Parcel: 2S103DD00400 Jurisdiction: Tigard Site address: 13727 SW PACIFIC HWY 300 Project: Brim Hall Dance Academy Subdivision: None Lot: None Project Description: ADD(1)expansion tank,(1)primer,(1)2"hub drain,(2)lays,(2)water closets and(1)water heater for new tenant. Contractor: ASSOCIATED PLUMBING CO Owner: VPT LLC 200NE VICTORY AVE"C" 610 SW ALDER ST STE 1221 GRESHAM, OR 97230 PORTLAND, OR 97205 PHONE: 503-492-1922 PHONE: 971-200-4906 FAX: 503-492-1923 FEES Quantity Description Date Amount 1 ea Drinking Fountain 04/03/2019 $25.02 Specifics: 1 ea Expansion Tank 04/03/2019 $12.51 1 ea Fixture/Sewer Cap 04/03/2019 $25.02 Type of Use: COM 1 ea Primer 04/03/2019 $12.51 Class of Work: ALT 2 ea Lavatories 04/03/2019 $50.04 Type of Const: 2 ea Water Closet 04/03/2019 $50.04 Occupancy Grp: 1 ea Water Heater 04/03/2019 $37.52 Stories: 1 12%State Surcharge- 04/03/2019 $25.52 Plumbing Total $238.18 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: GC/� 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. f Plumbing Permit Application Building Fixtures RECEIVE . City of Tigard APR - 2 2019 Received -r Permit ,v/ g III a 13125 SW Hall Blvd.,Tigard,OR 97223 DateBy: �/ J5®/9��7� f� Phone: 503.7182439 Fax: 503.598.196t fl Y OF TIGARD DateBy Review Other Permit N e G �!-�zvi9- 009s' TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION DateReadyBy: Juris: 13 SeePage2for Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑New construction 0 Demolition For special information use checklist Description Qty. Ea. Total Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling 20 Commercial/industrial SFR(2)bath 437.78 ❑Accessory buildingSFR(3)bath 500.32 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 /3?al,'7 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: "/�7l..>7- SG,i ��4L Catch basin or area drain 18.76 6 City/State/ZIP: .l J,_ S-i 2-'2-3 Doting leach line,or trench drain 18. 2 fFooting drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: 7,J,_, I Project name: 42//l l Manufactured home utilities 50.03 Cross street/directions to job site: N C '67.,Y ./ Manholes 18.76 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.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 1`I ';ti"', 12.51 Clothes washer �,I 1, �;;,ti 25.02 e,°/ 7-: 7 .- t a'"�� - Dishwasher u"�I4�ti�� 25.02 Drinking fountain t k' - 25.02 Ejectors/sump i �t'"' 5.02 0 PROPERTY OWNER 0 TENANT Expansion tank j 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: Medical gas(value:$ ) Page 2 Contact name: Primer / 12.51 Roof drain(comm ',I), 12.51 Address: Sink/basitoryZ 25.02 City/State/ZIP: Solar unitspotable-water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 UrE-mail: G?.. 5 C e /. .,i -L�� V; 4./� r .� Waternal 25.02 CONTRACTOR Water closet Z 25.02 Water heater / 37.52 Business name: T -rq-r-tstj �v es-„t/G Water piping/DWV 56.29 Address: .k / ' 7 Other: 25.02 City/State/ZIP: C9/�Jyid� , O„ �170fo Subtotal Phone: Fax: G Minimum permit fee: $72.50 ES-�3) fl-'9Z-i42 z (5-4) / .-i'Z. . CCB Lie.: 5--7 v Plumbing Lic.no.: 2.6.--4%/Z.,,17 ' Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: TOTAL PERMIT FEE Print name: „„. ,e,.0,/9 !G1/!e.5,4 Sly Date: ��-/ This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB) - 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-le 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 $327.54 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-1st 100' 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 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$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 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 $50,001.00 and up $742.00 for the first$50,000.00 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*. Quantity by Fixture Type Plan Review for Plumbing Installations Fixture Type for Replace/ Work Performed: Capped Added Relocate Plan review is required for any of the following. Baptistry/Font Please check all that apply. Bath -Tub/Shower ❑ Any new commercial building with water service 2"and Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thm 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic 0 Any multipurpose fire sprinkler system. Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink 2" j /AtiS Submit 2 sets of plans with any of the above. -3" Car Wash Drain Isometric or Riser Diagram Garbage Domestic-non-food 0 Isometric or riser diagram is required for new buildings Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice Mach./Refrig.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related Z- G-4-45 -Bradley -Commercial-food related -Service Swimming Pool Filter *Note: If the fixture work under thisermit results in an Washer-Clothes p Water Extractor increase of sewer EDUs,a sewer permit will be issued and Water Closet-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. OtherFi t_ -: r 1 y) C:\Users\Susan\Desktop\Documents\Permit Apps\Tigard Plmb.doc 2 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 13727 SW PACIFIC HWY 300, TIGARD, May 22, 2019 at 12:35:17 PM OR, 97223 Record Type: Record ID: Commercial - Plumbing PLM2019-00134 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS - NoCofO Comments: Previous corrections completed. Violation Summary: Inspector Contractor