Permit n CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
"IF:: . COMMUNITY DEVELOPMENT Permit #: FPS2010 -00078
Date Issued: 07/28/2010
7i6`•RL? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 300
Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
Project: LPL Financial
Project Description: Relocating (5) sprinkler heads and adding (1) pendent.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555
CALIFORNIA ST 49TH FL Permit Fee - COM 07/28/2010 $61.85
12% State Surcharge - Building 07/28/2010 $7.42
PHONE: Plan Review - Fire Life Safety - COM 07/28/2010 $24.74
Contractor:
AFP SYSTEMS INC
19435 SW 129TH
TUALATIN, OR 97062
PHONE: 503 - 692 -9284
FAX: 503 - 692 -1186
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Height: ft
Stories:
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: Yes
Total $94.01
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: 0
Residential Square Footage: 0
Fire Alarm Valuation: 0
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503. - - - - .800.33
Issued By: / Permittee Signature:
ajo
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
JUL -22 -2010 THU 10:13 AN AUTOMATIC FIRE PROTECT FAX NO 5036921186 Pr 02
ii iIdin Permit A Beat'
Fire Protection System CEIVE
deity of Tigar ! Receive ,� _
,� , ° 13125 sW Ball f�Ivd,, Tigard, OR 97713 2 ` i n • ado : • 7 e 1 v 6 / Penn''''' F �)O 1.0 v`/\ : 1
Phony 503.639,417! Pax: 509.598.1960 Nun Review wlJ
1 1 t. It 1) hispection Lino: 503.639.417S CITY OF TIGARD alto R ndyloy: �rher. +l. 49 al'J (d— , r,
Tiltetact; www.tigatd.orgov 1 Notified/Method! r. Soo 1 i icn 2 for
BUILDING DIVISION i 5ilpi tcmemnl rnfor n nlion
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t..,w ' lt>, rf21 1ZlEgIbA, TA [; l,�l'YD��1eAM111laYA'W�T,Tf!!
Q New construction 0 6:''.'; ' ciitton perm fees' are based an the value of the work performed,
t/._ itioltlpdtcratton/replucemeni El Other: Indicate the vnluc (rounded to the nearest dollar) of all
� `c'+,, t,v I ;.; t 111 ''i1 ti,l:A`rl: ll {�f ti4 ,(1QAjSr, L�t �l N, 1 1' S f. equipment, materials, labor, overhead, mud the profit for the
r
T ^T!'' 1 .:, I " ; I work indicated or th is applicatlan.
Y
01• and gamily dwelling N Conmercial/industrial Valungon: $
❑ Accessory building 0 Multi- family Number of bedrooms:
0 Master builder ] Other. Number of batltroants:
re r� 1 /�r�� ` IV ,��j �.Ay (� y� h /
� 11 A { :. 1 ,,15 } I tt 41 _ r : nrQJI: 1! Y ^.' ,4'. ,`. {' 1SM\, '� AV`Y�,A., V 1 1' 11 1 t ea I �
rye
r, i I r Y , , i i t , Total mnnbcr of floors:
Job site address:
�''`�� ref? II' _It ;Lai New dwelling area:
> w squuro feet
1 Onragc %nrport wren; S
City/Slate/ZIP:
StltlrPolclg /api. no.: quart feet
•� Project � 1,_
1 «I tl +' Covered porch urea: squuro feet
Cross street/directions to job alto: -
Deck area: square feet
Other structure fires; square feet
Subdivision: J'T L.t O-�* X ... ; , .: 0' .. ..
Two ma parcel no.. Lot no.: Permit foes* are based on the value of alto work perforated,
lndlcnte the value (rounded to the nearest dollar) of all
'1 � ' ` t`' I r 141A'.t',1r!1`l�r�}�Q¢Y+I' Q,[i;r } I. i.0: i ' ,Ir ; '�, ..'V: +N. -1 equipment, materiels, labor, overhead, and the profit for the
' l i t k a , t ,t, ,r r u ;i:4y i .rA p r work indicalcd on this application.
� WWI ��l 1 k L_�� Valuation: S
k.6110 \ 0 , " I • iA ik. Existing building area; `[( square feet
:'! R �tOPk:R l Y Now building arru: square feet
54* F,lt.l.;:•.k '`r I�,,, t' • t 01.J *. IV,'iy*3:14r. 1 , • +: Nuntbero'
Address: iypc ofcansEruction:
City /Slate/7,IP: Occupancy groups:
Phone:( ) Fax :( ) Existing:
w:
'� nr l
New:
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I ti+'' 1 1 ,l ;, a �f i :h lil i, l a
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Business name: ..;?.;;::;::;1;i:::',:.',
'..ia 4 .:.::a;,:,.:0. ,h' t � Mfr i. I'I t 1 1
Contact name; All contractors and subcontractors nro required to be
licensed with the Oregon Construction Contractors Board
Address: tinder ORS 701 and may be required to be licensed in the
city/state/ZIP: Jurisdiction to which work is being performed. lithe
appllrnnt Is exempt from licensing, the following rcnsots
ripply:
Phone: ( ) I Pa :: ( � )
E -moil:
I ' .. : : I , ,.. 1 �0,iii „ 0445 I i i� 41 \11: 1 I t h : fi r �1 ,, I 7 . ' ' Ira • - r
DnStlteSS name: lirlI �1 . �+ 0_,.
Y' ni ;; a "i r lfla /r eb arf
• 4, 1 Permit fee: -"-
ofperndt fee);
City /SAn a /7, -7• L 1 ,
C A ? 0
Stale surcharge (l2Yo �
per' ( 3) (D cs) �� Fax: ( ) FLS plan review (40% of permit fee);
CCU lie,; -���
+ v I me u on [+ rlJrario►t, C1 )
Total permit fees: r e( LI. _
Authorized signal tai e �
Amount received:
1i #���*� ` � +,r '!' bls permit application explresIfa permit 1 not obtained
Print name m e _ . t , s . A' bale: _ �� i
within L1;0 drays rifler It has been accepted 113 complete.
l * Fee methodology set by WI- Comity Building industry
r:InpndbrSVPenuG .'PPS- PcrmltAt?,.raoo 021 Service Board.
44 16 1 7 T(1)/02/COMA,UA)
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City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
.aa�l
Tit
October 29, 2010
AFP Systems Inc.
19435 SW 129th
Tualatin, OR 97062
Re: Permit No. FPS2010 -00078
Dear Sir /Ms.:
The City of Tigard has processed a refund for overpayment of permit fees on the above
. referenced permit for the following:
Site Address: 10200 SW Greenburg Rd., #300
Project Name: LPL Financial
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $24.74.
❑ Trust account "deposit" receipt in the amount of $
Notes: FLS plan review charged in error; refund 100% of fee.
If you have any questions please contact me at 503.718.2430.
Sincerely,
,,,(1,;( •
Dianna Howse
Building Division Services Coordinator
Enc.
I: \Building\ Refunds\ Administration \LtrRefund- Ovcrpay.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
F ir City of Tigard
T[GARD 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.PermitAction 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: AFP Systems Inc. DATE: 10/22/2010
19435 SW 129th
Tualatin, OR 97062 REQUESTED BY: Dianna Howse
Branden Taggart
TRANSACTION INFORMATION:
Receipt #: 178844 Case #: FPS2010 -00078
Date: 7/28/2010 Address /Parcel: 10200 SW Greenburg Rd., 300
Pay Method: CreditCard Project Name: LPL Financial
EXPLANATION: FLS plan review not required; refund 100% of fee.
REFUND INFORMATION: •
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
FLS Plan Review 2300000 -43108 $24.74
TOTAL REFUND: $24.74
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager
If under $25,500 Department Manager r-_ 4: /GrXL
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONL
Case Refund Processed: I Date: 1 /1/2 `00 1 By: 1 x
1: \Building \ Refunds \RefundRequest.doc x 09/01/2010
° Community Development
1 1 1 111 o.
Request for Permit Action
- 1 - 1(
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 ity Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) /J r Y5Ie v s TA IC .
Mailing Address: 1 .1 13 C Eck) /
City/State /Zip: T /A.4 A1'W , d( q 70
Phone No.: 3 — CI _-- gpB'9
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CEL 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 #: PS D- 010- -uvU e
Site Address or Parcel #: 1 0)-do at) . (,try eivbLt P.A. It 3
Project Name: LPL 1 ,\AiUNC ;c41
Subdivision Name: Lot #:
EXPLANATION: F ■ re- - L 4e S c e- p1 AA) vie v i e c_,) -1-<-- Nc?t
,�- � ; reed , 424 /lam S' -h.) , iV( ej.
Signature: f - , _ Date: 7,z , , 40
Print Name: 6'? --- na ootr
Refund Polity
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80 of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% of the building permit fee 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 S s Admin: Date 7 MAI B Rte to Bid: Admin: Date i Z ' /il B , 117
Refund Processed: Date/' /2.7 to By -• y Invoice Processed: Date By
Permit Canceled: Date Ai 9- By ,/PTY Parcel Tag Added: Date By
Receipt # /?•j 54/ Date Jf ho Method C _ Amount $ 9 Yr D /
I:\ Building \forms \RegPemntAction.doc Rec 07/26/07
CITY OF TIGARD RECEIPT
II p . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 180215 - 10/29/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
FPS2010-00078 $ -24.74
Total: $ -24.74
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 059016 DHOWSE 10/29/2010 $ -24.74
Payor. Candis Bayne, AFP Systems Inc.
Total Payments: $ -24.74
Balance Due: $24.74
•
Page 1 of 1
• CITY OF TIGARD RECEIPT
I,
E >s _ 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 178844 - 07/28/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
FPS2010 -00078 Permit Fee - COM 2300000-43104 $61.85
FPS2010 -00078 12% State Surcharge - Building 1003100 -24001 $7.42
FPS2010 -00078 Plan Review - Fire Life Safety - COM 2300000 -43108 $24.74
Total: $94.01
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 059016 BTAGGART 07/28/2010 $94.01
Payor: Candis Bayne / AFP Systems Inc.
Total Payments: $94.01
Balance Due: $0.00
Page 1 of 1