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Correspondence x rti c. 1mom f ,-,tw, City of Tigard October 20, 2011 West Hills Development Attn: Dan Grimberg 735 SW 158 Ave. Beaverton, OR 97224 Re: Permit No. PLM2010 -00169 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 13336 SW Ouzel Ln. „ Project Name: Alpine View, Lot 24 Job No.: N/A Refund Method: n Check # in the amount of $ . ® Credit card "return" receipt in the amount of $64.96. 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 $ . Comment(s): Per applicant's request as building plan was changed for this lot. Refund 80% of deposit, less fees due for development code review. If you have any questions please contact me at 503.718.2430. Sincerely, „...60 -- / -- ,e - V....) -7 ---c____ Dianna Howse Building Division Services Supervisor Enc. I \Bwld,n \Refunds1 8sSA , iifBilvaLcS amdp 97223 0 503.639.4171 TTY Relay: 503.684.2772 © www.tigard- or.gov City ®f 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 _o 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: West Hills Development DATE: 10/20/2011 Attn: Dan Grimberg 735 SW 158 Ave. REQUESTED BY: Dianna Howse Beaverton, OR 97224 Applicant TRANSACTION INFORMATION: Receipt #: 178118 Case #: PLM2010 -00169 Date: 5/28/2010 Address /Parcel: 13336 SW Ouzel Ln. Pay Method: CreditCard Project Name: Alpine View, Lot 24 EXPLANATION: Per applicant's request as building plan was changed for this lot. Refund 80% of permit fees. .•U_ }_i' - —y.-- - ;n`sd'i''`.'` ''m'o-v > -"�:. i�.�,`.�i?- -z pmt• -'?' !t- .r. ° q ,M- r , - -a, r .ItEFUND,INFORMATI'ON` < g .� `;,,. �N ?, r '_,=, }z y _ .H,, A ,.�.,•a M4 �N _ .., a�.. _ , a..,! ���# �-..,; ,_<,,.;�,xt':e.„t,<ti.:- .��?91r sb�:�."gm.- d::��D_�x:- ��_c^;�::�'»'�a: �3r a.:w`"�w.t; �-- ��''�� 3"e?�?: s;�`��.��`.�1�.c3�P.�a. ;� ~�'.:.3::�.xr,� �+;�±NL�:�# s ai,` r ';'�e -ii" . - °z�'..«,,,5 ,; ,t.- -• °, r - s - s • _ Feea escrl' tlonx'F•rom Recei tv; . � 'u :„ , . �: �. ., 1. f` � , t � . ' °, � :rs'� , _ =- x + . ; Reveriie AccountIVo ,, ¢.� ,R e'fund, :, .ba: y }'� . ' =F a�`u ¢% �i:N• �:3. � y . :x . >; �.� w- : ` is ; r.�� : k3` `�? sr_ � ... fir`- 'y! ".-• t' s ^ '�.a =:,, {� ". "��" 's".L..�....Y.r; �. � C,w,'s�= �,:,;,,; ui r i- ti,`�p.:t,•�kya �3?£•.,m....++x�'4' -•xA, , • e$: airi `= P,ermife e, �r a=adh f'i- e 23,000.0.0'" :, :I ;' r - p "<- .g � � .n_.. �;r � o� �w;',��:��,�;,:�.�,: ��Ex ,�� .U.. -.,•, ,. , "..43:10.4_`,t£�•�.� �,. $�A Plumbing Permit Fee 230- 0000 -43101 $58.00 12% State Surcharge 100 -0000 -24001 6.96 TOTAL REFUND: $64.96 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager 1 0 41 If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board ,,. rw,"i,.Yj;ra �'ci == 'k �._,� f .... ,._ .. _ - _.. fs'. ;�� £.�P " '�.�o-ss r, r .. } , , ..- : F O TAI k iVI'A�R^K.SI'STE1�AT MIN. 3 N ,�.�- .�.;,:: � ., r� ' _r,,.._; .� .��, -..... > .,_. -..M. m��,... ...... .... ..... .�_,.- _.r,,." . _�.. ._ .. ,. IS,TRAT�I_�O �...�- �.���;�:�.�;,. �n�r4; Case Refund Processed: Date: /(/ /V/ B ,. / - I \ Building \ Refunds \RcfundRcquut doe x 09/01/2010 IN Community Development TIGARD Request for Permit Action .---_) /` TO: CITY OF TIGARD , Iilt. Building Division Services Coordinator ' .'6 r, 13125 SW Hall Blvd., Tigard, OR 97223 ,, l' V -,.,i 1! Phone- 503 718.2430 Fax 503 598 1960 www ttgard -or gov ,, ,; pl FROM: fl Owner [1 Applicant I I Contractor fl City Staff (check one) REFUND OR Name: , INVOICE TO: (Business or Individual) '1‘‘V I, .r l / d ; r r � y ;d r, ) t_.1' r 1 Matting Address: (� 6- �!�i { ` ` ,,y 0 �= M ,( City/State /Zip: 101 �/.,� � , j "i w � ( ,�' Vii_ C, ' , ; % � � s Phone No.: / /.�° �, A ,.r /' A `I �/ 7 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ( - � '� Y CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). i INVOICE I' FOR FEES DUE (attach case fee schedule and explain belo '" -- ' 6 n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). t//(2c/f/ Permit #: l ( , G AGE JI. i' ��- � � Site Address or Parcel #: („ ( n t r ! /1 --190/4 Pro)ect Name: �1"I, 0( f/ t t , � / l.1_'�1-' Subdivision Name. r-) L " Lot #• ,r6 EXPLANATION: �� !�,� " �,� (.'A ' (2,A7(' �' �' � l- ,��, 7 Signature: ( i(,, f. ��� D 1 l A fl i ' l 1 Print Name. 71 /4,G' j L (T /( Refund Policy 1 The Director or Building Official may authonze 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 pnor to any inspection requests 2 Refunds will be returned to the onginal Payer m the same method in which payment was received Please allow 1 -2 weeks for processing refunds FO OFFIC USE O T 7.i Rte to S s Adm Date MU= B A V Rte to Bld• Admin Date /fit ( B rn ap - Refund Processed Date 76/ j/ B - i Invoice Processed B • Permit Canceled Date - v2_,, ; , - By c 21,-; - Parcel Ta. Added B Receipt # Date Metho. Amount $ I \ Building \ Forms \RegpennuAction doe Rev 07/26/07 Plumbing Permit Applica> C,Cp1 1 ,] 7�� - l �t,4 A r a Building Fixtures 1 �� ' ,I F OR O FF I C E : USE °ONL ` MAY 2 8 2010 Received � is �r permit No . City of Tigard Date/By: �.� /0 + /) of /Q ° dd /�r IN y 13125 SW Hnll'Blvd., Tigard, OR 97223 Plan Review ti Phone: 503.639.417,1 Fax: 503 �d�F TIGARD Date/13y: Other Permit No sh p / 7 -- 420 57„„ Ins ection.Line. 503.639:4175 p p r Date Ready/By., tuns ®Sec Page 2 for TIGARD p BUILDING DIVISION ' Supplemental Information S u lc age 2 nform Internet: \vwsv tlgard -orgov Notified/Method: 77 -r� mrr,an ; �� �r x4 ..fix t ' ', 11 . :7, b` tt.,5 ,04 Os+r t,k'F'�,.,. 4:141::;':g/7 '§ a F INEMF IT * 6_D11 i " a ; "''+ E ❑ De molition For,special lnforntarion use checklist ® New construction Description I Qty I Ea. I Total — ❑ Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection) 'L t5 .. t �a a� fl - Sci a.. -�wi Os � 4 ... 1 _ S FR (1) bath 312.70 ❑ Commercial/industrial SFR (2) bath 437.78 ® 1 -and 2-family dwelling SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq ft.) Page 2 T4 4 i` ' 3'- a„3, ri. r n ■ 4 0.00 rs Site utilities: Catch basin or area drain 18 76 Job site address: 13336 SW Ouzel Lane Drywcll, leach line, or trench drain 18.76 City / State/ZIP: Tigard OR 97224 Footing drain (no linear ft : ) Page 2 Sutte /bldg. /apt. no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.. ) Page 2 _ Storm sewer (no. linear ft.: ) Page 2 Water scrvice.(no. linear ft.: ) Page 2 Subdivision: Alpine View I Lot no.: 24 Fixture or item: Backfloi preventer I 31.27 Tax map /parcel no.: 12 51 y • -� «eu �,-•.s.,,.o �3'�:r ', r -', i'�'- ".:'?' ( Backwater valve 4,.--,3i.:2 µs atY. r .�- { re a ts1.. ,.. m-, r " . v Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 f ,. ,. i� , ^. ... ! °r , t Exp ansiont ank 1251 %it'( ;'�ER ° ...: ° .t .otg y 't5> k_ �e- .:,,. :. D 5 4 - Fixture/sewer cap 25.02 Name: West Hills Development Floor drain/floor sink/hub 25.02 Address: 735 SW 158 Ave Garbage disposal 25.02 City / State/ZIP: Beaverton OR 97006 Hose bib 25.02 Phone: (503)641 -7342 Fax: (503)641 -7661 Ice maker 12.51 .a ,n�.K c< 2502 :K r t � I 1 r ' Interceptor /grease trap '� � 4�r��N` "�,Frll ;. "' ��^.;.x� ,�'-� : ®� Q � e� i� ' RS 'O wr lca.sc. Medical gas (value $ ) Page 2 Business name: West Hills Development 12 5l Primer Contact name. Angie Cook Roof drain (commercial) 12.51 Address: 735 SW 158 Ave. Sink/basin/lavatory 25.02 City / State/ZIP: Beaverton OR 97006 Solar units (potable water) 62.54 Phone: (503) 641 -7342 Fax: : (503) 641 -7661 Tub /shower /shower pan 12.51 Urinal 25 02 E -mail acook @arborhomcs.com 25.02 � Water closet Ac a k *r€a�m17c > .. 'gONRA. tpxR rest aa..:r €; �. Water heater 37 52 Business name: Trademark Landscape Water piping/DWV 56.29 Address: 19088 S. Redland Rd. Other: 25,02 City /State/ZIP: Oregon City, OR 97045 Subtotal ( ) Phone: (503) 631-3893 F ax: 503 631-4'737 Minimum permit fee: $72.50 ✓9 ,5 Plan review (25% of permit (cc) CCB Lic.: 11353 Plumbing Lic. no.: State surcharge (12% of pennit fee) 5- r i7 v Authorized signature: 4, </k . - a:4 TTOTAL PERMIT FEE ,SI`/ , AO ,/ Date: 5/27/10 This permit application expires If a permit Is not obtained within 180 days Print name: Steve Ellis after it has been accepted as complete. "Fee methodology set by Tn -Co utty Building Industry Service Board 1 \nuddmgWermas\PLMU- PcrmitApp doe ID/01/09 440 - 16167(10 /01/COMAYLa)