Permit 41 CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
': COMMUNITY DEVELOPMENT Permit #: FPS2011 -00091
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/27/2011
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9502 SW WASHINGTON SQUARE RD J03
Project: Wetzels Pretzels Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Fire alarm.
Fees paid for after hours inspection.
Contractor: PARADIGM CONSTRUCTION LLC Owner: PPR WASHINGTON SQUARE LLC
10260 SW GREENBURG RD SUITE 400 2235 FARADAY AVE STE #0
PORTLAND, OR 97223 CARLSBAD, CA 92008
PHONE: 503 - 452 -6922 PHONE:
FAX.
FEES
Description Date Amount
Specifics: Permit Fee - COM 07/27/2011 $112.96
12% State Surcharge - Building 07/27/2011 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 07/15/2011 $45.18
Class of Work: ALT Type of Const: IIB Houlry Building Rate 07/15/2011 $180.00
Occupancy Grp: A - Height: ft Hourly Building 12% State Surcharge 07/15/2011 $21.60
Stories: 2 Info Process /Archiving - Lg Sheet (over 07/27/2011 $8.00
11x17)
Info Process /Archiving - Sm Sheet (up to 07/27/2011 $2.00
Commercial Sprinkler System: 11x17)
Sprinkler Required: Sprinkler Type: Houlry Building Rate 07/26/2011 $180.00
Standpipe Required: Hazard: Hourly Building 12% State Surcharge 07/26/2011 $21.60
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Yes Alarm Type: Automatic
Pull Station Required: Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $584.90
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $3,598.00
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 Notifica •• • -nter. 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 • destions to OU by ca ' • : 50 .232.1987 or 1.800.332.2344.
Issue. By: ee. 'e/ `, ^ Permittee Sign. re: v —
Call 503.639.4175 by 7:00 a.m, for the next available inspectio : •te.
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.
CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit #: FPS2011 -00091
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/27/2011
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9502 SW WASHINGTON SQUARE RD J03
Project: Wetzels Pretzels Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project Description: Fire alarm.
Fees paid for after hours inspection.
Contractor: PARADIGM CONSTRUCTION LLC Owner: PPR WASHINGTON SQUARE LLC
10260 SW GREENBURG RD SUITE 400 2235 FARADAY AVE STE #0
PORTLAND, OR 97223 CARLSBAD, CA 92008
PHONE: 503 - 452 -6922 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Permit Fee - COM 07/27/2011 $112.96
12% State Surcharge - Building 07/27/2011 $13.56
Type of Use: COM Plan Review - Fire Life Safety - COM 07/15/2011 $45.18 _
Class of Work: ALT Type of Const: IIB Houlry Building Rate 07/15/2011 $180.00
Occupancy Grp: A -2 Height: ft Hourly Building 12% State Surcharge 07/15/2011 $21.60 C'
•
Stories: 2 Info Process /Archiving - Lg Sheet (over 07/27/2011 $8.00
11x17)
Info Process /Archiving - Sm Sheet (up to 07/27/2011 $2.00
Commercial Sprinkler System: 11x17),,
Sprinkler Required: Sprinkler Type: Houlry Building Rate 07/26/2011 $180.00
Standpipe Required: Hazard: Hourly Building 12% State Surcharge 07/26/2011 $21.60 ,
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Yes Alarm Type: Automatic
Pull Station Required: Smoke Detectors Req: Yes
Battery Calcs Provided: Yes Cut Sheets Required: Yes
Total $584.90
Valuations: Required Items and Reports (Conditions)
Sprinkler Valuation: $0.00 4 fr R CF -ww) r03• ti
Residential Square Footage: 0
Fire Alarm Valuation: $3,598.00 -V z- "9"lb . /e?/, 90
4 E.—AAA/6 7 - 0 3G /°/' -•c' cc—ss c76 By P/Sht
Avb A.E utr_AiE' Ta C,2. rT cm -p e#.946 -470, (eh
This permit is issued subject to the regulations contained in the Tigard " Nfuniapal o e, State of OR. Specialty Codes and all •
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 day 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:
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.
at . '
Building Permit Application
Fire Protection System FOR R OFFICE USE ONLY
City of Tigard { ®C I� Received f
IIII �� c DDate/I3 • Permit No.: i
13125 SW Hall Blvd., Ti gar, � ` a" �� `�
' �O Plan Review ► ®
:I "- Phone: 503.718.2439 Fax: 5N,,,
8 t \ \\�� ,9,6 ". Date /By: 5 �� Other Permit.
TIGARD Inspection Line: 503.639.417 Date Ready/B . `/, See Page or
Internet: www.tigard - or.gov J" '��G «O Notified / Method: L 1 Supplemental Information
®�
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IRED`DA 1, M LY:`DWEL
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El 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
'xa:,�., CATEGOI2Y.. 0 : CON'TRUCTZ�v
x:,. w:" `; a i'"
: t, work indicated ated on this application.
S
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $
El Accessory building III Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
<JOB'.'S1TE ". I ORMATION' AN' D 'O < eti�TION: -s
>os> ` �,��,;;.� wnY . E ...r:,sx x���:z_;. �£,�. ,la. Gam. , . � „�,. ,
” Vim/ N ,o:'/,N��, x ,., \� f�"etix/s`'�c: `... .. � .r �,x\ ,. _ , la Total number of floors:
Job site address: 9 WASHINGTON SQUARE ROAD New dwelling area: square feet
City /State /ZIP: TIGARD, OR, 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Wetzel's Pretzels TI Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQI71RI5°D(' COMM ° CI?ivl� I USE'GIITCKLISi 1
Subdivision: Lot no.: 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
z ':•,: W work indicated on this application.
. `
"�. � " _:��'` � �DESCI
RP'TION " ,. „ , , �.
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_. e -..,.. as ,, a: _ d, -, ...,s�a�..,s,• ,e`._C• ".. .....- '�":� u ^ -, .!,,.. ,.... _3_.- \Q� \s;;. .,
TI SPACE - ADDING ONE SMOKE DETECTOR TO FIRE ALARM SYSTEM Valuation: $$3,598.00
Existing building area: square feet
New building area: square feet
t:- , , ,,�_,. ,,,,o :;_ ;fi <s, : g
fix ' ; ,• " "
PROPERTY ERt' =: % t; N ,
®� Q4b N „ „'` ,,, , TENANT': ” " " »'\ 1,, :: s . ; Number of stories:
. _� .�vT `�- �,:F•:ao � ate a�„ -.. > : x7�,a�„✓65 �'�' ,.- ... ..;•Se$ :.. � n ®�`��- .. ... . . . ... .._...... � ,.
Name: ROGER OTT - WASHINGTON SQUARE MALL Type of construction:
Address: 9585 SW WASHINGTON SQUARE ROAD Occupancy groups:
City/State /ZIP: TIGARD, OR, 97223 Existing:
Phone: (503) Fax: ( ) New:
, �x�:�P,.: �:�a: � °r�� �;: fi x , M M '� ":
`P `I
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L CANT � ��.-
CONT T:PE �� „•:,,.
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TECHNOLOGIES r....
Business name: SIEMENS INDUSTRY - BUILDING TECH
' ES All contractors and subcontractors are required to be
Contact name: CHARLES HUGHES) (Al 5 ”) —� �^ 1/-3 1 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 15201 GREENBRIER PARK AY, SUITE A4 6\ 5-03_7-0_ 7)). jurisdiction in which work is being performed. If the
City /State /ZIP: BEAVERTON, OR, 97006 J applicant is exempt from licensing, the following reasons
�'t^d✓� --w ei' k apply:
Phone: (503) 207 -1900 Fax: : (503) 207 -1901
E -mail: charles.hughes @siemens.com --
ca TRAC�rO
r "=
:E
„���,- BUILDING ° S �; ".
Business name: PARADIGM CONSTRUCTION `>> t(Pl *• ;,..A•., =.: v
Permit fee:
Address: PO BOX 607
City /State /ZIP: BEAVERTON, OR , 97075 State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (503) 209 -3976 Fax: ( ) (Due upon application.)
CCB lie.: 186506 Total permit fees:
Authorized signature: 144114 Amount received:
This permit application expires if a permit is not obtained
Print name: CHARLES HUGHES Date: 07/05/2011 within 180 days after it has been accepted as complete.
* Fee methodology set by Tri -County Building Industry
Service Board.
1:\Budding\Permits \FPS- PermitApp.doe 02/01/11 440- 4613T(I l /02 /COM /WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
:.Descrxbe.work;.t "o;.be done: «�,,., �';; . <_:� rs• <y��:,::,. �..,..,....•� �:.•
.�>.,.. ` " , xF �� � , ., . , o .. > � ......� -. .. ,: � :',fir, ,.,..�c r. 11 =a=r:.y,g.erFa ti
1.) ❑ New 2.) Modification to sprinkler heads only:
® Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
i:``�,� .: ^:� .- , <;..�,�:, '
.;. ; - �.:x,:`. <.� S yr �'r� °•: �F�: ?,`..: � #i, = `� „_ ".
s #e Com rclete E1 B' D : : '.. •°., ,> : ,F=.�. <;:.
::: <T .; ' . .. of S. >._ > _` _•rCbr as:%a "' ``li "ca °ble �.,;
`
z=
A:; �" � er S r>x lder.
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
r
yin” e� T'- :� <Fi ss
reron S�'stem..�,. :;,,.
Hood Project Valuation: $
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n
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
_ Cut Sheets
Fire Alarm Project Valuation: $ 3598.18
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may"
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% e'nt a i S r ext .Stand t�a'o = � S ` ' s t e m� - � °:,
' , _ use'° ,,.,�:2—il i
Square Footage: Permit Fee: �,'�:'. �� W
0 to 2,000 $198.75 , r _. ; ": fi ; :
2,001 to 3,600 $246.45 ` ' s
i
3,601 to 7,200 310.05 ';_,''_ 4
7,201 and greater $404.39 ``M> ° -
Sprinkler Project Square Footage: sq. ft.
Fxre Proteetxori = => .e r `��
._;, ;.; ..� `_', >.,...., _, - P nit.Fees S ,..;_, ti
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: $
Plan review requires a completed application and 2 sets of plans at submittal. Plan review fees are required at submittal.
C: \CJI -I Temp \TIGARD FPS- PermitApp 440P- 093583.doc 02/01/11 2
\-------A—
lit .:.
. I 1 Community Development
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
FROM: ❑ Owner ❑ Applicant n Contractor K Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) pi t iLt y L€M 1 e_c t ,5 r i_/'t,v '
Mailing Address: K9,01 Nw 6 ,J 6-,e/E2 Pikky 4-
City/State/Zip: -e f} J tLT�,k) 64_ ? 76764
Phone No.: 606 — c b7 -- I 9cio (e,1{ -A- Las - c!!
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
n CANCEL PERMIT APPLICATION.
}n' 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 #: AO go / t- 0009/
Site Address or Parcel #: g,- A (..64.- ft ,
Project Name: LO LTA t., 's PktrA E.LS
Subdivision Name: Lot #:
EXPLANATION: r i ' ./11._ 1 42 bfv .i.t2L / (.4 I L _ ,
Ps fiki F .ice. Vag/// a )'(ti&fr J i -sFILIJ-0 A - L -
�Ly 2 t LIB, x116 Y05 .�
r
Signature: • L� _� I i ` i Date: 7x //
Print Name: --- Dg i e j 6- t d-4-7,4446A/
Refund Policy
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 SO% 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 �� Rte to Bld: Admin: Date / /0 �, : f jU "r
Refund Processed: Date f// /, B .►fir Invoice Processed: Date By
Permit Canceled: Date A09 By (: • Parcel Tag Added: Date By
Receipt # Date Method Amount $
1: \Building\ Forms \ ReqPermitAction.doc Rev 07/26/07
Mg CITY OF TIGARD
FEE AND PAYMENT HISTORY
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
IIIGM t
FPS2011 -00091 - 9502 SW WASHINGTON SQUARE RD J03, TIGARD, OR 97223
Revenue Payment
Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt # Due
Permit Fee - COM 230 -0000 -43104 $112.96 $112.96 $112.96 7/27/11 Credit Card 183428 $0.00
12% State Surcharge - Building 100 - 0000 -24001 $13.56 $13.56 $13.56 7/27/11 Credit Card 183428 $0.00
Plan Review - Fire Life Safety - COM 230 - 0000 -43108 $45.18 $45.18 $45.18 7/15/11 Credit Card 183274 $0.00
Houlry Building Rate 230 - 0000 -43104 $180.00 $180.00 $180.00 7/15/11 Credit Card 183274 $0.00
Hourly Building 12% State Surcharge 100 - 0000 -24001 $21.60 $21.60 $21.60 7/15/11 Credit Card 183274 $0.00
Info Process /Archiving - Lg Sheet (over 230 - 0000 -43135 $8.00 $8.00 $8.00 7/27/11 Credit Card 183428 $0.00
11x17)
Info Process /Archiving - Sm Sheet (up to 230 - 0000 -43135 $2.00 $2.00 $2.00 7/27/11 Credit Card 183428 $0.00
' 11x17)
Houlry Building Rate 230 - 0000 -43104 $180.00 $180.00 $180.00 7/26/11 Credit Card 183413 $0.00
Hourly Building 12% State Surcharge 100 - 0000 -24001 $21.60 $21.60 $21.60 7/26/11 Credit Card 183413 $0.00
Totals for Fees $584.90 $584.90 $584.90 $0.00
Receipt # Payment Method Check # Payor: Receipt Date Receipt Amount
183274 Credit Card Shelley Lemieux / 07/15/2011 $246.78
Siemens
183413 Credit Card Shelley Lemieux / 07/26/2011 $201.60
Siemens
183428 Credit Card Shelley Lemieux - 07/27/2011 $136.52
Siemens Industry
Building Technologies
Total Payments: $584.90
Balance Due: $0.00
R' jS og?
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c.
-d4 L£my"e ,
.l�rK�?- i��•1�4%��f. �.
City of Tigard
August 11, 2011
Siemens
Attn: Shelley Lemieux
15201 NW Greenbriar Pkwy A -4
Beaverton, OR 97006
Re: Permit No. FPS2011 -00091
Dear Ms. Lemieux:
The City of Tigard has processed a refund for fees on the above referenced permit(s) as
follows:
Site Address: 9502 SW Washington Square Rd.
Project Name: Wetzel's Pretzels
Job No.: N/A
Refund: n Check # in the amount of $
® Credit card "return" receipt in the amount of $403.20.
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
n Trust account "deposit" receipt in the amount of $
Comments: Per bulding official's request as customer was double charged in error for •
after hours alarm inspection and inspection meeting was not scheduled due to staff error.
If you have any questions please contact me at 503.718.2430.
Sincerely,
77)4;7,,,,;r: /
d
✓"mil %� - ��t� '� ..,..,._. _
Dianna Howse
Building Division Services Supervisor
Enc.
1: \Buildin r 2, I ia1k131hd nli ad,(itt gan 97223 ® 503.639.4171
TTY Relay: 503.684.2772 ® www.tigard- or.gov
11
; 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 . fir 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: Siemens DATE: 08/01/2011
Shelley Lemieux
15201 NW Greenbriar Pkwy A -4 REQUESTED BY: Dianna Howse
Beaverton, OR 97006 Debbie Adamski
TRANSACTION INFORMATION:
Receipt #: 183274 & 183413 Case #: FPS2011 -00091
Date: 7/15/2011 & 7/26/2011 Address /Parcel: 9502 SW Washington Sq Rd
Pay Method: CreditCard Project Name: Wetzel's Pretzels
EXPLANATION: Per building official's request as customer was double charged in error for after hours
alarm inspection and inspection meeting was not scheduled due to staff error.
v� 7��7 ink'-: - a�?d= ';�`4,3';itt:sn'�7_^-,,.'.., " -i - t.R"xii; _ _ :' m..vS °.im,+,�� - ,.,�..,; „�. _.�:a�;, _ -- `"x.^._ _:,"C' -. C°.,' xx -���
"1 lOCIJ` c ; �; ;sY..f«,'i },'� a"-.�-�,, .,,, '. ` :4:C "£ i'e:• t . 'fi�.� ^ ` ; 'k.. .', "Y , -y`
1VD NF,.,O'RMATI.O.N. � ;� °' � •,�� =;, �...,�-.: �.,.
_:s. -., : x?,. .,�L.. °`�.�` +, .s.,�. ' - ;= k�Si?�: �'�':.3 v,,:,,i;�it �;c�a4; °��;;r;rs..:� � - �" ;3�'�Z� � �',�`” " �,�°
..�:- d "4 !"t,,^ kx�; r�; eiF.s,:a„;.,. sue .
,: .geiY q.;_b�x-N .. '?N,Bu u"' r•,U ; un „-r`�• ^;a°t � _ - �*�s,.. p.
'.'� =Re'ce`ipt �� � a � �'x �: s � -;: �Reyenue �,"�, � � Refurid �'tl
: i z ,�': �," �.arftr. ''s',.5 =• ,� � �' �.r.,�" '° a °i�'ri::.� , k~° ?i `�',, , ��''°"y`. r ��ca.�.�' :,�,s �� ' - " ,�' �� ,2'� �;,K'
i1E: T1 le ` B>uldtn Permit1Feie t il*-rm ::, n , ; x, � , : . . ;�` x v � ,•
P ... . g . � .. _.� -� � ��v ,� <� ��Y.::�.� .��;P �E .�:=. �.:��; ,$`Amount;=
Hourly Building Rate 230 - 0000 -43104 $360.00
12% State Surcharge 100 - 0000 -24001 43.20
/ ,, ,T -O.TAL REFUND: $403.20
APPROVALS: / 1 Iii , ,,,,,--
If under $5,000 Professional Staff .1 , � ti� — y --
Pr ,- -
If under $12,500 Division Manager
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
s , rt- ; „A , FOR TID.gMARK SYSTE1VrADMI,N.ISTRATION USEgO ;,... NORA ,',
Case Refund Processed: Date: ;,>,r',, B 7--
/
I.A Building \ Refunds \RcfundRcqucstdoc x 09/01/2010
CITY OF TIGARD RECEIPT
f 13125 SW Hall Blvd., Tigard OR 97223
. 503.639.4171
T IIOARD
p
Receipt Number: 183274 - 07/15/2011 P . E r '
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
FPS2011 -00091 Plan Review - Fire Life Safety - COM 230 - 0000 -43108 $45.t8
FPS2011 -00091 Houlry Building Rate 230 - 0000 -43104
C180.00 ' D
FPS2011 -00091 Hourly Building 12% State Surcharge 100 - 0000 -24001 $21.60
Total: $246.78
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 084872 BTAGGART 07/15/2011 $246.78
Payor: enelleyienemens
Total Payments: $246.78
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD Mi RECEIPT
II
13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
1104
i
P a�p/
Receipt Number: 183413 - 07/26/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
FPS2011 -00091 Houlry Building Rate 230- 0000 -43104 $180.00
FPS2011 -00091 Hourly Building 12% State Surcharge 100 - 0000 -24001 $21.60
Total: $201.60
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 025891 BTAGGART 07/26/2011 $201.60
Payor: elley Lemieux / iemens
Total Payments: $201.60
Balance Due: $0.00
Page 1 of 1
L
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0 4- io
City of Tigard
August 11, 2011
Siemens
Attn: Shelley Lemieux
15201 NW Greenbriar Pkwy A -4
Beaverton, OR 97006
Re: Permit No. FPS2011 -00091
Dear Ms. Lemieux:
The City of Tigard has processed a refund for fees on the above referenced permit(s) as
follows:
Site Address: 9502 SW Washington Square Rd.
Project Name: Wetzel's Pretzels
Job No.: N/A
Refund: ❑ Check # in the amount of $ .
® Credit card "return" receipt in the amount of $403.20.
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 $ .
Comments: Per bulding official's request as customer was double charged in error for
after hours alarm inspection and inspection meeting was not scheduled due to staff error.
If you have any questions please contact me at 503.718.2430.
Sincerely,
,d . , , , , s , 4 .
l
, Dianna Howse
Building Division Services Supervisor
Enc.
I:\ Building \Re undo nSWo It,l uiercInTci ad,(Orregon 97223 0 503.639.4171
TTY Relay: 503.684.2772 0 www.tigard or.gov
•
CITY OF TIGARD RECEIPT
V
t a 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 183641 - 08/11/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
FPS2011 -00091 rz2/ 1. Li s i,vi C= 70-00 0 .. PC ` —g°'C" $- 403.20
_4 Cie' 5f• iL r cJ- ztrt.e/ /, 4:4 -z'. ler't't^L'l . -°441"
Tota I: $ 403.20
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 025891/084872 DHOWSE 08/11/2011 $- 403.20 •
Payor: Shelley Lemieux/Siemens
Total Payments: $403.20
Balance Due: $403.20
Accela
., . - System Administration
' ` - " "' Finance Department Request..
bate : .� / - -
•
To: Liz Lutz .
' . a/' _ 'Kathy Gende : - .
•
.
From ..Dianna Howse /
Re:. Receipt #: /�.3'% /,_":35i 77 /des 0 9/
r
Please process this request as follows:
,. Journal, Entry (route copy of JE to . . -
DiannaHowse). -
Reversal (fees have been reversed on
Revenue Account Report).
(.ice. Credit Card Return (fees have been
.reversed on Revenue Account Report).
Other/Explanation:
/ i` 1 /L /�'-. 2.rYr i—
Thank y
I:\ Building \Forms \Rteslip- FinanceReq.doc y
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