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Permit
CITY OF TIGARD PLUMBING PERMIT ' - COMMUNITY DEVELOPMENT Permit #: PLM2010 -00306 Date Issued: 09/23/2010 TIGARD 13125 SW Hall Blvd., T OR 97223 503.639.4171 Parcel: 2S113AB00500 Jurisdiction: Tigard Site address: 16083 SW UPPER BOONES FERRY RD 130 Subdivision: Lot: 0 Project: State Farm Project Description: Interior plumbing for TI: (2) sinks and (2) water heaters. 9/23/2010: REPRINTED PERMIT WITH CORRECT FIXTURE COUNT Owner: FEES G &S FC LLC Quantity Description Date Amount 16850 SW UPPER BOONES FERRY RD SUITE 2 ea Sink 09/23/2010 $50.04 A 2 ea Water Heater 09/23/2010 $75.04 PHONE: 503 - 639 - 0108 15 da 12% State Surcharge 09/23/2010 $15.01 Contractor: MARXMEN PLUMBING & CONSTRUCTION INC 9665 SW 163RD AVE BEAVERTON, OR 97007 PHONE: 503 - 579 -2200 FAX: Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $140.09 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 a• : •ted by the Ore on Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may 0. . . copy of the es or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: / Permittee Signature: • /l Call 503.639.4175 by 7:00 a.m. for an Inspection that business d • • . 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. v CITY OF TIGARD PLUMBING PERMIT 0 COMMUNITY DEVELOPMENT Permit #: PLM2010 00306 T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2010 Parcel: 2S113AB00500 Jurisdiction: Tigard Site address: 16083 SW UPPER BOONES FERRY RD 130 Subdivision: Lot: 0 Project: State Farm Project Description: Interior plumbing for TI: (4) sinks and (4) water heaters. Owner: FEES G &S FC LLC Quantity Description Date Amount 16850 SW UPPER BOONES FERRY RD SUITE A 4 ea Sink 09/21/2010 $100.08 PHONE: 503-639-0108 4 ea Water Heater 09/21/2010 $150.08 1 12% State Surcharge - 09/21/2010 $30.02 Plumbing Contractor: MARXMEN PLUMBING & CONSTRUCTION INC 9665 SW 163RD AVE BEAVERTON, OR 97007 PHONE: 503 - 579 -2200 FAX: Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $280.18 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 • ''n 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules : dopta s by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You a, • 1 ain a copy of the rules or direct questions to 0 . C by calling 503.246.6699 or 1.800.332.2344. Issued By• /f / Permittee Signature: i i i Ali■- .y CaII 503.639.4175 by 7:00 a.m. for an inspection that business da 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 ; _ ; 00 Building Fixtures FoR oFFlcl: I;sONLY : ON City of Tigard �� 10 Received Permit No.: • 13125 SW Hall Blvd. Tigard, OR 97 22 �0 Date/By: 21 1377_ /Ur,aof�ra )3a1n g r � Plan Review ■ Phone: 503.639.4171 Fax: 503.598.1960 *- JDateJBy: Other Permit No.: &A/ Vk� ...00( Inspection Line: 503.639.4175 O c ' � \CIN TJo / ` ero T I G A is D Internet: www.ti g g ard -0r. o v `` �By: IU"s See Page 2 for f` � w`n D�V` trfied/Method: 71:76, S upplemental lnformadon S TYPE OF WORK gk1WD�NG FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist Description I Qty. 1 Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTI SFR (1) bath 312.70 ❑ 1- and 2- family dwelling ommercial/industrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Ar., Site ut ilities: Job site address: I �g3 S- u) ('LPrev- One Wu' Catch basin or area drain 18.76 City/State/ZIP: 1 Drywell, leach line, or trench drain 18.76 l I g A I Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: iyr6 P roject name: 51- AA r d4 Manufactured home utilities 50.03 Cross street/directions to s : 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: 1 Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 44 % 1 V {L _ T. Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ 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 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory d� 25.02 / ©p, 0 8 City/State/ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) - - Tub /shower /shower pan _ 12.51 E -mail: Urinal /1)3 25.02 CONTRACTOR t7 Water closet //�� 25.02 Water heater 1. [1 37.52 14.0eff6D 1 �t Business name: M pR. xi�t IN, u. Min 13 \ Water piping/DWV 56.2' Address: 9 (010 S.W. , b 3 A vc- Other: 25.02 2.5 ), !b City/State/ZIP: 41 caveYzp /AS. V t. Subtotal I . ' . ( b - Phone: (5(51)57e Fax: ( 503 ) 574 -z Minimum permit fee: $72.51 - CCB Lie.: i 2 t(/') 43 if IN _ PI ,ing Lic. no.: 3y -/bi f a Plan review (25% of permit fee) ( .3 p). ///ll1 /5 , O / State surcharge (I2% of permit fee) • Authorized signature: '144 4 ■ lt 1 O . TOTAL PERMIT FEE Print name: MOCK c Fr'1 / D46L- 1 - / 0 1 ' ° P� Tm't app6e as bs ia permit is nc obtained in 1; 'days • 71 1 after fter it t has been n accepted as complete. mplete. � � � *Fee methodology set by Tri -County Building Industry Service : . , IABuildirg \Permits\PLMU- PamitApp.doc 10 /01/09 440- 4616T(10/07JCOM/WEB) R A fur • 9/11 63.? 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 - 1 ° 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 p 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 ", Plan Review for Plumbing Installations please indicate work performed by fixture. Failure to Plan review is required for any of the following. accurately report fixtures could result in increased sewer fees * . Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and Fixture Type: Replace greater, except systems designed and stamped by licensed Previous Capped Added Existing engineer. Baptistry/Font ❑ New exterior plumbing site utilities for any complex' structure Bath - Tub /Shower as defined in OAR918- 780 -0040. - Jacuzzi/Whirlpool Car Wash - Each Stall ❑ Medical gas and vacuum systems for health care facilities. - Drive ❑ Any multipurpose fire sprinkler system. - Drive Thru Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR91 8 80 Dishwasher - Commercial - Domestic Submit 2 sets of plans with any of the above. Drinking Fountain Eye Wash Isometric or Riser Diagram Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings that meet the qualifications above. -4" Car Wash Drain Garbage - Domestic Disposal - Commercial - Industrial Comments regarding fixture work: Ice Mach./Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory i4 - Bradley - Commercial *Note: If the fixture work under this permit results in an -Service increase of sewer EDUs, a sewer permit will be issued and Swimming Pool Filter fees assessed for the sewer increase must be paid before the Washer - Clothes Water Extractor plumbing permit can be issued. Water Closet - Toilet Urinal Other Fixtures: I:\Building\Permits\PLMF - PermitApp.doc 2 I di 2otb - ob,3c>k, City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 NI fi October 6, 2010 Marxmen Plumbing & Construction Inc. 9665 SW 163` Ave. Beaverton, OR 97007 Re: Permit No. PLM2010 -00306 Dear Sir: The City of Tigard has processed a refund for fees on the above referenced permit(s) for the following: Site Address: 16083 SW Upper Boones Ferry Rd. Project Name: State Farm Insurance, Ste. 130 & 200 Job No.: N/A Refund: ® Check #67085 in the amount of $140.09. ❑ Credit card "return" receipt in the amount of $ ❑ Trust account "deposit" receipt in the amount of $ Notes: Refund overpayment of permit fees after applicant reapplied for two additional permits for two separate suites under PLM2010- 00310, Ste. 120 and PLM2010- 00311, Ste. 110. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. I: \Building\ Refunds \Administ ration \LtrRefund- RefundOnly.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard - or.gov • TTY Relay: 503.684.2772 s: City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Marxmen Plumbing & Construction DATE: 09/24/2010 9665 SW 163r Ave. Beaverton, OR 97007 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 179511 Case #: PLM2010 -00306 Date: 09/21/2010 Address /Parcel: 16083 SW Upper Boones Ferry Pay Method: Check Project Name: State Farm EXPLANATION: Refund for adjustment to decrease plumbing fixtures on permit. REFUND INFORMATION: • Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000 -43104 $ Amount Plumbing Permit Fee 2300000 -43101 $125.08 12% State Surcharge 1003100 -24001 15.01 TOTAL REFUND: $140.09 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager I tiDG.s 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 9,/ Case Refund Processed: 1 Date: I 9/44g/49 1 By: 1 'i�''*y -- 1: \Building \Refunds \RefundRequest.doc x 09/01/2010 Community D evelopment TIGARD Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ® City Staff (check one) REFUND OR Name: Marxmen Plumbing & Construction Inc. INVOICE TO: (Business or Individual) Mailing Address: 9665 SW 163r Ave. City/State /Zip: Beaverton, OR 97007 Phone No.: 503 - 579 -2200 (Mark) PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( ✓): ❑ CANCEL PERMIT APPLICATION. ® REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: PLM2010 -00306 Site Address or Parcel #: 16083 SW Upper Boones Ferry Rd., Ste. 130 & 200 Project Name: State Farm Subdivision Name: Lot #: EXPLANATION: Refund portion of permit fees. Applicant reapplied under PLM2010 -00310 and PLM2010- 00311. /A //o ip Signature: 1 t Date: 09/24/2010 Dianna Howse Print Name: Refund Policy 1. The Director or Building Official may authorize thc refund of: a) any fee which was erroneously paid or collected. b) not more than 80° /o of thc land use application fcc when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of thc land use application fee for issued permits. d) not more than 80% of the building plan review fcc when an application is canceled before any plan review effort has been expended. c) not more than 80% of the building permit fcc for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rte to Sys Admin: Date By Rte to Bldg Admin: Date /o 4 /iv By Refund Processed: Date 9,i23 /O By4Z / Invoice Processed: Date By Permit Canceled: Date ,/ By Parcel Tag Added: Date By Receipt # / 795// Date 9 a /pp Method C Amount $ I:\ Building \Forms \RegPermitAction.d c Rev 07/26/07 CITY OF TIGARD RECEIPT U E 8 .. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD I Receipt Number: 179567 - 09/23/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2010 -00306 Sink 2300000 -43101 $50.04 PLM2010 -00306 Water Heater 2300000 -43101 $75.04 PLM2010 -00306 12% State Surcharge 1003100 -24001 $15.01 Total: $140.09 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 19461 DHOWSE 09/23/2010 $140.09 Payor: Marxmen Plumbing & Construction Inc. Total Payments: $140.09 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD RECEIPT a IN E 131 25 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD grk Receipt Number: 179566 - 09/23/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2010 00306 $ 280.18 Total: $- 280.18 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 19461 DHOWSE 09/23/2010 $- 280.18 Payor: Marxmen Plumbing & Construction, Inc. Total Payments: $ - 280.18 Balance Due: $0.00 Page 1 of 1 Ilti CITY OF TIGARD RECEIPT V 0 . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD 02/6 /A 4 c, Receipt Number: 179511 - 09/21/2010 . CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2010 -00306 Sink 2300000 -43101 $100.08 PLM2010 -00306 Water Heater 2300000 -43101 $150.08 PLM2010 -00306 12% State Surcharge - Plumbing 1003100 -24001 $30.02 Total: $280.18 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 19461 BTAGGART 09/21/2010 $280.18 Payor: Marxmen Plumbing & Construction, Inc. Total Payments: $280.18 Balance Due: $0.00 Page 1 of 1