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Permit roR ,,OFrI r s F ONL : � Building Permit Application �R „ ,.. � � < �. , � _ �; ° g r ' Received N A CI OL �I `d r� e ss ��1 Permit \o pr � City g E C DDate/By S � /�� �.� � /1J ' ODD 9 ) ' v 13125 SW Flail Blvd., Tigard. OR. KA 3 2 8 2010 EffliiiMMIIIIIM Other Pernnrs V .,d0, 76 = 1., Phone: 503.639.4171 Fax. 503.598.1960 Date Reativ /ny © See Page 2 For Inspection Line: 503.639.4175 CITY OF TIGARD Notified/Method iliffa Supplemental Information lirliGfIkPa weogramow Internet: www.tigard-or.gov i r g t BUILDING DIVISION ;, h: - ? -'''',4"'"'''' , TYPE OF . WORK =:REQUIRED:DATA: 1 "AND`2- :FAMILY DWELLING °zi s� - - = •.:,gyp _ [i 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 - =i1 ' CATEGORY OF= CONSTRUCTION-" 3 . "'k' 3' - work indicated on this application 11- and 2- family dwelling ❑ Commercial /industrial Valuation ❑ Accessory building ❑ Multi- family Number of bedrooms: 2 ,-^ 4 . Master builder - ,• ,• ❑ ❑ Other: Number of bathrooms -'�"5 is -,'- -:��. - : -> ,5 ;, "�' "� ' -' ' ' ' ''' 71' ''' ;'- 4 '`''`JOB SITE :iNFORMATION AND LOCATION;r'E:. e ' _''°' t * Total number of floors 2 lob site address 113336:SW "UZEiI7ANE ..:. 1 k " New dwelling area: 'j739� square feet City /State /LIP: TIGARD, OR. 97224 Garage /carport area: 41 —' " square feet • Suite /bldg. /apt. no.: i Project name: Covered porch area: square feet Cross street /directions to job site: Deck area: square feet Other structure area: square feet 7y' REQUIREDDATA: COMMERCIAL=USE Plan No r1739 .; Permit fees me based on the value of the work performed Subdivision: ALPINE VIEW I Lot no.: 1112110 ind () all equipme n the t mate rials rounded , labor, overhead and the dollar profi t for the Tax map /parcel no.: work indicated on this application . -, ,_ 4. ; DESCRIPTION, WORK �hq.'. V aluation NEW CONSTRUCTION Existing building area: square feet New dwelling area: square feet Number of stories: W `-P,ROPERTY OWNER:•,` 'TENANT `i` . ;, E Type of construction: Name: WEST HILLS DEVELOPMENT Occupancy groups: Address: 735 SW 158th AVE Existing: City /State /ZIP: BEAVERTON, OR. 974006 New: Phone: ( 503) 641 -7342 Fax: ( 503) 641 -7661 - _:,>;'o:` .-° 1 ' " NOTICE ° ; , = =F[' APPLICANT - - ' a `CONTACT PERSONi' . All contractors and subcontractors are required to be licensed with the Oregon Construction Contractors Board Business name• WEST HILLS DEVELOPMENT under ORS 701 and may be required to he licensed in the Contact name: STEVE POLLARD Jurisdiction in which work is being performed If the applicant is exempt from licensing, the following reasons q Address: 735 SW 158th AVE apply City /State /ZIP: BEAVERTON, OR. 974006 Phone: ( 503 ) 726 -7041 Fax: ( 503 ) 641 -7661 E -mail: spollard @arborhomes.com 'CONTRACTO ` °• . = BUILDING PERMIT FEES' Business name: WEST HILLS DEVELOPMENT Please refer to fee schedule Address: 735 SW 158th AVE Structural plan review fee (or deposit): City /State /ZIP: BEAVERTON, OR. 974006 FLS plan review fee (if applicable): Phone: ( 503 ) 641 lFax: ( 503 ) 641 -7661 Total fees due upon application: CCB lie: 1048 Amount Received: Authorized This permit application expires if a permit is not obtained signature' / 0 within 180 days after it has been accepted as complete. 1 Print name: STEVE POLL • D I Date: 4/29/2010 * Fee methodology set by Tri- County Building Industry Service Board. i \Building\pernuts \BUP -RES PermitApp doe 1 116/07 440- 4613T(1 I /02 /COM /WEB1 Plumbing Permit A licatio F Building Fixtures p8t AECF\ FOR OFFICE USE O NLY . °'' ' a '' City of Tigard Eiew Permit No --40096Z., /4/57;20/0 13125 SW Hall Bd ,Tigard, OR 9722 AY 2 8 2010 Other Permit No C Phone 503 639 4171 Fax. 503 598 1960 Other Inspection Ltne 503 639 4175 TIGARD CITY OF TIGARD Date Ready /By turn I H See Page 2 for Internet wwwti and or ov 1 Il Ptr' g g Notified/Method Supplemen r 1 ` K ;;,. r ?s ,Tit E OF W R „ell, ( nit in np , 5 P n .e � t 'u - tTF, E SC DUDE - .-, ,r,:- ® New construction ❑ Demolition For special information use checklist. Description I Qty I Ea I Total ❑ Addition/alteration /replacement ❑ Other New 1- 2- family dwellings (includes 100 ft for each utility connection) e T r * _ ,xCAtEGORY,;OF CONSTR i CT1QN ^ti ftij: SFR (1) bath 312 70 ® 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 437 78 SFR (3) bath 500 32 ❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25 02 ❑ Master builder ['Other Fire sprinkler ( sq ft) Page 2 4 � € z , ` 4 ' x SITE INNORMA I AN .4,, ° a ° " 4„ Sit • ut ilitie s : Job site address 13336 SW Ouzel Lane Catch basin or area drain 18 76 Drywell, leach line, or trench dram 18 76 City /State /ZIP Tigard OR 97224 Footing drain (no linear ft _) Page 2 Suite /bldg /apt no I 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 service (no linear ft ) Page 2 Subdivision. Alpine View I Lot no 24 Fixture or item: Tax map /parcel no Backflow preventer 31 27 r Backwater valve 12 51 it 0 � a ” 1' ;, 1 V ESCRiPTIONi OF as -- '14 ; -„rt Clothes washer 25 02 New Construction Dishwasher 25.02 Drinking fountain 25 02 Ejectors /sump 25 02 tit ' s' ®9 OW NER' e I ®' r'E T , Expansion tank 12 51 hit, ,. „at, . .._. Name West Hills Development Fixture /sewer cap 25 02 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�ICANir $ ; `-.£ � q ® MO1VT�AC PE SO 3 1 Interceptor /grease trap 25 02 d Business name West Hills Development Medical gas (value $ ) Page 2 Primer 12 51 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 E -mail acook @arborhomes.com Urinal 25 02 _ P t t Water closet 25 02 i s oCl 1sr' ego.: ? cz ' 1 r , i.11 - T"CONT A GT- : bk ; t n t~ - t `> `� Water heater 37 52 Business name Development Northwest (Wolcott Plumbing) Water piping/DWV 56 29 Address 1075 W Historic Columbia River Hwy Other 25 02 City /State /ZIP Troutdale, OR 97060 Subtotal Phone (503) 667 -1781 Fax. (503) 667 -9891 Minimum permit fee $72 50 CCB Lic . 112220 Plumbing Lic no 26 -824PB Plan review (25% of permit tee) State surcharge (12% of permit fee) Authorized signature /.3e TOTAL PERMIT FEE Piint name Cliff Bowman Date 5/27/10 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tn -County Building Industry Service Board 1 \Budding \Permus\PLMU- PermuApp doc 10/01/09 440- 4616T(10/02 /COM/WEB) Electrical Permit Applicati + r � ° +• `.,,F OFFICE USE ONLY , City of Received •T f Ti and g Date/B : Permit No.: /15' �7 /r III - 13,125 SW Hull, Blvd Tigard Tigard, OR 972 2 8 2010 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: TIGARD Inspection Line: 503.639.4175 CiTY OF TIGARD Date'ReadyBy: lung. H Sec Paget for Internet. www,tigard- ir.gov I Notified/Method: Supplemental Information D 1 nimr.s. nivicl'°li a .. "1'c A;f ,ta1 L12t°1+.a"Mf:t ,. •• -' 2• a 4 f: -,.:ti .iJ �4.,rl ..4. as) ❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans.w /items checked below) ❑ Service or feeder 400 amps or more ❑ Building over three stones ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards a ; t f • t 0 • - d +' ar t e < <i;*+ � . " ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings. 1 w" �' + "" I _ � less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings. ❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or z ❑ Emergency system. larger separately derived system S *S g :: 4 {f (ob i till j 1 P1'�6:0i S(o)tj(i01? 11 t f 0) r s SkeetP a ❑ Addition of new motor load of ❑ "A • 'E "1 - "1 -3 100HPormore. occupancy. Job no.: Job site address: 13336 SW Ouzel Lane ❑ Six or more residential units. ❑ Recreational vchicle,parks. City/SIAte/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than Tigard, OR 97224 ❑Hazardous locations, G00 volts nominal Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more. Cross street/directions to job site: ncseripdan I Otv, I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Alpine View I Lot no.: 24 1,000 sq ft. or less 168.54 4 Ea. add 500 sq ft_ or portion 33 92 1 Tax map /parcel no.: Limited energy, residential h _ r f "r t wlffi aboves R. 67.84 2 Limited energy, multi -family 67.84 2 New Construction residential (with above sq. fl ) Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 „ m : 1a `at it a i , 0 7 j v x 1 . 1" '1 i t t" ' 201 am to 400 amps 133.56 i.n �����t �..�t . . .+.'sL,.a •�w?�' �:� -nxr� , �. t� : � '' ' # 401 amps to 600 amps 200 34 2 Name: West Hills Development 601 amps to 1,000 amps 30104 2 Address: 735 SW 158th Ave Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City/State /ZIP: Beaverton, OR 97006 relocation Phone: ( 503 ) 641 -7342 I Fax: -( 503 ) 641 -7661 200 amps or less 59 36 I 201 amps to 400 amps 125.08 2 Owner installation:'This installation is being made on property that I own °which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to:599 amps 168 54 2 Branch circuits- new,-alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits tvttli .e. , ,• x _ a, ,�.� ' 1; --;, ., above service or feeder ce, 742 2 • e 0 la1• 0 �.��I" ©t�i.�� � I � .... , .,+ ���' 0741'7 �. �, ��;1...,,�. each branch circuit Business name: West Hills Development B Fee for branch circuits without p service or feeder fee, first 56 18 2 Contact name: Angie Cook branch circuit Each udd'I branch circuit 7.42 2 Address: 735 SW 158th Ave Miscellaneous (service or feeder not included) Each Ci /State/Z1P: dwelling, service and/or feeder 67 84 2 ty Beaverton OR 97006 g. servi Phone: ( 503 ) 726 -7042 I Fax: : ( 503) 641 -7661 Reconnect only 67 84 2 Pump or irrigation circle 67 84 2 E a n n, c Sign or outline lighting 67 84 2 ar? , . Y te.t' rh m- c C (6 "tit CItl i ,.: , t>,. err' rrt�v.' � � � *- �� ..�.'w- It +.;� ` +�>cf� � �. ;.s�;. � - -•�' ° �xi Signal circuit(s) or limited-energy Business name: Garner Electric panel, alteration, or extension Page 2 2 Each additional inspection over allowable in any of the above Address: 2920 SE Brookwood Ave Additional inspection (1 hr min) 66 25/ hr Investigation (1 hr min) 66.25/ hr City/State /Z1P: Hillsboro, OR 97123 Industrial plant (1 hr min) 7818/ lir Phone: ( 503 ) 648 -4552 I Fax: ( 503 ) 642-7925 ons no Inspections for which fee i s 90.00 / hr specifically listed (% hr min) CCB Lit.: 121159 Electrical • .: ' 4- :5' Suprv. Lie.: 3707S i-:: ' t ; ut n titlii _ ) CU14 r1w � 44 .'-. a Subtotal: Suprv. Electrician signature, require i y /-_-,-, Plan review (25% of permit fee): Print name: Chuck Garner Date: 5/20/10 State surcharge (12% of permit fee): TOTAL PERMIT FEE: Authorized signature: This permit application expires if n permit is not obtained within 180 days after It has been accepted as complete. Print name: Angie Cook Date: • Number of inspections allowed per peril 11DUdmg\PcrntitskELC- PernutApp doe 10/01/09 440- 1615T(11 /05 /COM/WEt Mechanical Permit Application ; ' FOR OFFICE USE ONLY , . City of Tigard I UU tltl N TI Received Permit No�S�ao�O --- D�� /� =�a Pi WE v a 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review " •_ = Phone 503 639 4171 Fax 503 598 19 IQAY 2 2010 Date/By Permit D ate /By T 1 C;A It D Inspection Line 503 639 4175 Date Ready /By ions See Page 2 for Internet www tigard - gov CITY OF TIGARD Notified/Method Supplemental Information nI" i ■c'Iro,m k m,w m. nror,,,,owt -inn m. m.^eF +� "i e n ' ° 4 ' = 4 �' s " TYPE %O � ORf ' s a . y ,r':" , , ' COMMERCI FEE* SCHEDULE -W USE CHECKLIST i �: . 1 �, z ..°a� +, ,�. - 5 . � *,€ ;t. 8 . � .,. ,,,,,xs:�. °- °. _ .,.�r.;r, am. � w,�- �.r..n •,a.n�: »�w.�a Mechanical permit fees* are based on the value of the work ® New construction ❑ Addition/alteration/replacement performed Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit , . , ' /. , I Ss�a4° , CAa M eoN STRU@TIO ' a a,; t ,, e V toil .:: Values �� h 7 4 12 5ID EN TIAI EQUIPNIEi /ISY,S,T+EMSFEES 44, ® I- and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist ❑ Multi family ❑ Master builder ❑ Other Description Qty Ea Total Y JB SITE INFORMATION AND LOCA p[ON ' t ee I t o] ; Heating/cooling � t �? ate_ ;? -, s :sO .. -.m -�_�, ,...... ". -.. �. �,..t,��. „_.,; ��` . -" s , l g ); Air conditioning Job site address 13336 SW Ouzel Lane (requires site e plan plan showing placement) 46 75 City /State /ZIP Tigard OR 97224 Furnace 100,000 BTU (ducts /vents) 46 75 Furnace 100,000+ BTU (ducts /vents) 54 91 Suite/bldg /apt no Project name Heat pump 61 06 Cross street/directions to job site Duct work 23 32 Hydronic hot water system 23 32 Residential boiler (radiator or hydronic) 23 32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc 46 75 Subdivision Flue /vent for any of above 23 32 ubdivision Alpine View Lot no 24 Other 23 32 Tax map /parcel no Other fuel appliances ' 1* 4 ' DESCR1P 70N rWORK,:" `">` e 4 Viii: X38 Water heater 23 32 Gas fireplace 33 39 New Construction Flue vent for water heater or gas fireplace 23 32 Log lighter (gas) 23 32 Wood /pellet stove 33 39 Wood fireplace /insert 23 32 23 32 ' MP,RO° IrV :(18 ; ;" . 3 ' rr tilf#, rTENAN+T . t £Il , = �µ other 23 23 32 Name West Hills Development Environmental exhaust and ventilation Address' 735 SW 158 Ave Range hood /other kitchen equipment 33 39 City/State /ZIP Beaverton OR 97006 Clothes dryer exhaust 33 39 Single - duct exhaust (bathrooms, Phone (503)641 -7342 Fax. (503)641 -7661 toilet compartments, utility rooms) 23 32 04 gy ' s ' ,® AliOie;0.: ": uF -.V- "CONTACT PERSON ■ , " Attic /crawlspace fans 23 ° Other 23 32 Business name West Hills Development Fuel piping Contact name Angie Cook S14.15 for first four; $4.03 for each additional Address 735 SW 158 Ave Furnace, etc Gas heat pump City /State /ZIP Beaverton OR 97006 Wall /suspended /unit heater Phone (503) 726 -7042 Fax (503) 641 -7661 Water heater Fireplace E -mail acook @arborhomes.com Range Ze. A erns ,t ' ., eC.ONTR 'R ice;; r, .IJ 40 ,,.h. ti.__ Barbecue Business name Pyramid Heating & Cooling Clothes dryer (gas) Other Address 5699 SE International Way Suite 19 n ,4 vie �MECHA CALPERMIaTFEES* * s �. tom_., City/State /ZIP Milwaukie, OR 97222 Subtotal Minimum permit fee ($90 00) Phone (503) 786 - 9522 Fax (503) 786 - 3432 Plan review (25% of permit fee) CCB lic. 59382 State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized signature' aP ' This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name Greg Phillips Date 5/27/10 * Fee methodology set by Tn -County Building Industry Service Board I \Building \ Permits \MEC- PermitApp doc 10/01/09 440 -4617T (I I/02 /COM/WEB) y : s • ; • )%~' ,!- ., / ..., • Er P ', ' Fp 1 ., . �'�' . A WATE• MAY 2 8 2010 • I • �;PQ °1' ,f� —V N., , • _.. .,_.F. CITY OF TIGARD 580 ",./ ► ' _ _ c �Q� � � �, E . � -• . BUILDING DIVISION / �� :AS- `" o+. ./1-,,.. ; RIVE YTAY • covERED ENTR . - , t 1 ;1 , a: f V z • 325Q. FT I • , la.--- f .' .� / ' zed a. © 5 - -- ,i 580 io,o. I SEWER GARAG: _ if 1 STO :::::: ........-.....-:::::::. ,. LAT. .::•:4 r :: :::::: :::::.::.::: {: : ? T.O.S.= 579 : :.: ` .::: g in • , SAN, ' I •: : {;•.MAI F L O G ::.. F .. =79: 173r .. . I`; ` "IRVIN.1 TON" ; ?ii: }r � ? }`. _ • to . AME• SCAN : •'.' COVERED P•.. f0'-0' 48 SQ. FT I ® PATIO $ a �I �5os4.' p al I o I H II . 20 I 24 I 1 PE I — J ._.. L. 1 ; '-' •-• 4 . ! ,• . i i — — . — at, 4 579 . y ^ e 50.00' y ^ ta , 574 PM A.PP ,OVAL 1(// , , SITE PLAN DRAWN 04/28/10 WEJ ALPINE VIEW Contractor is responsible to check SITUATED IN THE N.E. 1/4 OF SECTION 9, TOWNSHIP site plans and notify designer of any 2- SOUTH, RANGE 1 -WEST OF THE WILLAMETTE MERIDIAN errors or omissions prior to start of , CITY OF TIGARD, WASHINGTON COUNTY, OREGON construction. Also plans and , specifications shall be approved by 13336 S.W. S OUZEL LN. local building authorities prior or 5 674 SQ. FT. start of construction. LOT 24 WEST HILLS. SETBACK REQUIREMENTS, �..... REAR YARD: 15' (FROM P.L.) DEVELOPMENT, INC. ' FRONT (HOUSE): 15' (FROM PL.) FRONT (PORCH): 15' (FROM PL.) 735 SW 158th Ave. FRONT (GARAGE): 20' (FROM PL.) SCALE - STREET SIDE: 10' (FROM PL.) BEAVERTON, OR 97006 SIDE: 5' (FROM PL.) 1 " =208 CITY OF TIGARD - SITE PLAN REVIEW BUILDING PERMIT NO.: /1Si o2Dr0 - Oao 92- PLANNING DIVISION: Required Setbacks: Er A, pproved ❑ Not Approved Side: __,?.__ Street Sire � v _ - Front. Gva::c:: .Q Rear: CJ Visual Clearance: Dr Aphr v :;.i 0 Not Approved Maximum Building Height• feet CWS Service Provider Letter Required: ❑ Yes ❑ No Q ftece�ved B : a / ... 0 d- Date: 3 /a / //) ENGINEERING - DEPARTMENT: Actual SI pe: % ®. Approved El Not Approved Site PI : Approved ❑ No.7 A proved 8 Date: Notes: Gr Q_,t U-Lc CITY OF TIGARD - SITE PLAN RtVLLr W BUILDING PERMIT NO: i"17 )/0 -- coo ?2. Street Trees: Approved 0 Not Approved Protected , AppIoved ❑ No Approved 8 Y• ! ° `MI a Date: 5/2 V /0 Notes: ' . ca ! .: i•wil•!..i.-7!ii:11 � �a , fit rr o c City of Tigard October 20, 2011 West Hills Development Attn: Dan Grimberg 735 SW 158 Ave. Beaverton, OR 97224 Re: Permit No. MST2010 -00092 . 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: ❑ Check # in the amount of $ . ® Credit card "return" receipt in the amount of $525.00. 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 $ . 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, 41g4-74,77-Q_____ . Dianna Howse Building Division Services Supervisor Enc. . 1:\ Building \RefundsMo s&Wn`iQllfahlaicsanigausdpiDregon 97223 e 503.639.4171 TTY Relay: 503.684.2772 o www.tigard - or.gov III 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: 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 #: 178116 Case #: MST2010 -00092 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 building plan review fee and invoice for DC review fees. REFUND INFORMATION: Fee.Description From Receipt, • Revenue Account No. Refund' Example: Building Permit Fee . ' Example: 2300000 - 43104. . $ Amount • Building Plan Review 230- 0000 -43106 $525.00 TOTAL REFUND: $525.00 APPROVALS: If under $5,000 Professional Staff — If under $12,500 Division Manager >LL '. 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 • . .. • Case Refund Processed: I Date: I I By: I I:\ Building \Refunds\ RefundRcquest.doc x 09 /01/2010 : lig CITY OF TIGARD U RECEIPT g 131 25 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD 4Cu /k./'1 Receipt Number: 184291 - 10/20/2011 CASE NO. FEE DESCRIPTION l REVENUE ACCOUNT NUMBER PAID MST2010 -00092 &IAA //✓G A /#X+' Z'i�L/ ,S' ot'0 '..f/e) 6 $- 525.00 Total: $- 525.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 013823 DHOWSE 10/20/2011 $- 525.00 Payor: Dan Grimberg, West Hills Development Total Payments: $- 525.00 Balance Due: $525.00 • Page 1 of 1 b 111 1 CITY OF TIGARD RECEIPT t; 13125 SW Hall Blvd.. Tigard OR 97223 503.639.4171 TIGARD /Ci/J. /4- Receipt Number: 178116 - 05/28/2010 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MST2010 -00092 Plan Review 2300000 -43106 $750.00 Total: $750.00 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT • Credit Card 013823 DHOWSE 05/28/2010 $750.00 Payor: Dan Grimberg, West Hills Development Total Payments: $750.00 Balance Due: $1.34 • • Page 1 of 1 C (-- I N Community Development Request for Permit Action TIGARD z • - f TO: CITY OF TIGARD JUL Building Division Services Coordinator 2 7 2011 13125 SW Hall Blvd., Tigard, OR 97223 B I T YOGFTIGAD Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov DIV!s ION FROM: n Owner ❑ Applicant n Contractor n City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) f A Vcf f f i l (S be ( V ,t Mailing Address: 7' l '-11 L ' D ( tfti'� 74 l.-�! - 7 f City/State/Zip: Phone No.: (C, 2 '1) q M — 40g 3 6'17 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ( — (~� !�1 CANCEL PERMIT APPLICATION. J REFUND PERMIT FEES (attach receipt, if available). 1 111 INVOICE FOR FEES DUE (attach case fee schedule and explain below . 0 ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). l0 /2p /j/ Permit #: 1 2-0 04 -- Site Address or Parcel #: /3330 `'C YJ U2ZC-j L- vY .'L/r010/?J t'O / g Project Name: A-�� , c V�-U. { j Subdivision Name: Lot #: ..2-- J EXPLANATION: 0 N 10A4, , -r.-y --rit Signature: /' S AL bell Date: 1 17:7 Print Name: '141.J / r% (7 /C r 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 fec 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 ongmal 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 Admire: Date '7 2.1 0 By �WV% Rte to Bldg Admin- Date /D/Zd/ // By Refund Processed: Date /p /jd // B Invoice Processed: Date ! By Permit Canceled: Date j � / By - Parcel Tag Added: Date By Receipt # Date MethOei Amount $ • I \Building \ Forms \RegPenmtAction doe Rev 07/26/07