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Permit
City of Tigard, Oregon ® 13125 SW Hall Blvd. O Tigard, OR 97223 F '� December 31, 2007 Larry Durham 2131 Goodall Ct. Lake Oswego, OR 97034 Re: Permit No. BUP2007 -00641 Dear Mr. Durham: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 7540 SW Hermoso Way Project Name: Luby Job No.: N/A Refund: ❑ Check # in the am ount of $ M Credit card "return" receipt in the amount of $374.95. n Trust account "deposit" receipt in the amount of $ . Notes: Land use application was not yet approved, therefore building building application should not have been accepted. Refund 100% of building permit application fees. If you have any questions please contact me at 503.718.2430. Sincerely, ; r '`ems Dianna Howse Building Division Services Coordinator Enc. I: \Building\ Refunds\ Administration \LtrRefund- CancelPerrnit.doc 01/16/07 Phone: 503.639.4171 ® Fax: 503.684.7297 © www.tigard or.gov ® TTY Relay: 503.684.2772 Community Development Request for Permit Action TIGARD 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 a City Staff (check one) REFUND OR Name: n , INVOICE TO: (Business or Individual) L ,4 /�2 U 1) U ! ` r /91-1 Mailing Address: 2/3/ -00P ,it 00/z; V 0 1 ® City /State /Zip: 1A,k_C ®swZ6 ,, /1 7- 03 2 AV, Phone No.: SO 3 " 6 ? 7- 8 7 8 / PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): M CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). n INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: 13 0P200 -- OG (/ / Site Address or Parcel #: - 7S ' d D SCE W 4 v Project Name: 4- 06Y /Z es/Pz Name: N Lot #: EXPLANATION: PC /T S /lee} L/) N O r } � PPS- C1 7i "- AID 7" APP / Signature: ` Date: / Z - M t Print Name: /,6/Q /4 /0/9411toc !G— 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 b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.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 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 BT Rte to Bld. Admin: Date ,?/ Q By off Refund Processed: Date /dt , 4 2 By Sc. Invoice Processed: Date By Permit Canceled: Date /'a2 p Parcel Tag Added: 7 By i '�• Par Date By Receipt #67 — S7'/ Date /0 7 Method �°� Amount $ 3 7 '. �s 1:\ Building \ Forms \RegPemvtAction.doc Rev '67/26/07 U • City of Tigard TIGARD Tidemark Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or R fund form (if applicable) must be attached to this form. Refund requests are due to Tidemark System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Larry Durham DATE: 12/26/07 2131 Goodall Ct. Lake Oswego, OR 97034 REQUESTED BY: Dianna Howse BSB TRANSACTION INFORMATION: Receipt #: 2007 -5471 Case #: BUP2007 -00641 Date: 12/17/07 Address /Parcel: 7540 SW Hermoso Way Pay Method: CreditCard Project Name: Luby EXPLANATION: Permit application should not have been accepted as land use application was not yet approved. Refund 100% per Building Official. ?: ;'• '.r' •.i ="� - Sup ;;.�: ,, } -. EEiJND I ORMA= °�:�: _ %`- • - . IVF T•I 1V sg cA ; 'be s From Receipt, ,• Revenue Account No f Refui d Example ,.[BUILD] Permit Fee = zEx i m • 1 e == 245 0000 432000 $ Amount V [BUPPLN] Pln Rv 245 -0000- 433000 $374.95 TOTAL REFUND: $374.95 APPROVALS: If under $500 Professional Staff - - -� �� 1 If under $7,500 Division Manager u "` If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TI D EMARK: SYSTEM'ADIVI,INOTWtONV$7''`O1VIY,- ' Case Refund Processed: Date: ,/° "%6 B • L \ Building \ Refunds \RcfundRequcst.doc 05 /23/07 CITY OF TIGARD 5Ii . >0 12/18/2007 e 1 3125 SW flan Blvd. 12:07:06PM ,: Ti gard, OR 97223 503.639.4171 TI Receipt #: 27200700000000005471 tr',!? /F ;z rA-`- {% Date: 12/17/2007 Line Items: Case No Tran Code Description Revenue Account No Amount Paid BUP2007 - 00641 [BUPPL1\1] Pln Rv 245 - 0000 - 433000 374.95 Line Item Total: $374.95 Payments: Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid CreditCard LARRY DURHAM DEB 01541 B In Person 374 95 Payment Total: $374.95 eRcccipt.rpl Page I or 1 - .a CITY OF TIGARD 12/31/2007 M a 13121 S \ \' (tall 131cd. 11 :46:38AM I m . < fi =a rd, OR 97223 503.639.4171 PT A S Refund Receipt #: 27200700000000005622 , ' °Ya `'.5:>- Date: 12/31/2007 Line Items: Case No Tran Code Description Revenue Account No Amount Paid BUP2007 -00641 Reversal - [BUPPLN] Pln Rv 245 -0000 - 433000 (374.95) Line Item Total: ($374.95) Refund: Method Payer User ID Acct. /Check No. Approval No. H 011 Received Amount Paid Credit Reversal LARRY DURHAM 01541 B In Person (374.95) Refund Total: ($374.95) • • eRcceipi ipt Page I of I Building Permit Application, y 1 E FOR OFFICE. USE ONLY City of Tigard DEC 1 7 Date /B /A A7D / Mil Permit No.: / ..QO III 13125 SW HaII Blvd., Tigard, OR 97223 200 Plan Review Phone: 503.639.4171 Fax: 503.598.9 6 TYOF rIQf Date/By: Other Permit: T I G n RD Inspection Line: 503.639.4175 UB f Dj , 1 � �+ p� p Date Ready/By: to - ® See Attached Checklist for Internet: www.tigard - or.gov '� ®IN /SION Notified/Method: ( C i Supplemental Information ,, ' d ..9 3t { i Irv, , ie ` - . " - ? -* � . << � TYPE QF „Rr_(9RI� ,, - _ & . ,, ,RLQ ' ! b: � ± ' fi 1 ` F ' II . 624 , tzL ❑ 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 111 � a` c a 4; work indicated on this application. � I' t :_ � , 1 )GC)NSTRt?CTT, s ” �; � PP ® 1- and 2 -family dwelling ❑ Commercial /industrial Valuation: $ (Q4 O ❑ Accessory building ❑ Multi - family Number of bedrooms: 2 ❑ Master builder ❑ Other: Number of bathrooms: 2 4 -JUB %SF) NP ' ` TI 1 L "' •`4 . `� Total number of floors: 2 . s F . 4 ,, Job site address: 7540 SW Hermoso Way New dwelling area: square feet City /State/ZIP: Tigard, OR 97223 Garage /carport area: square feet Suite/bldg. /apt. no.: I Project name: Luby Residence Covered porch area: square feet Cross street /directions to job site: 72nd Deck area: square feet 72 north to Hermoso West Other structure area: square feet Subdivision: Tigard Triangle I Lot no.: 1607 Permit fees* are based on the value of the work performed. Tax map/parcel no.: 25101AB Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the 4 g' £ � ' 4 D R ilia t5 Ea - Y , 1 ;' work indicated on this application. Residential Upgrade Valuation: S Existing building area: square feet New building area: square feet NMI PRt3 „) ' ' - c *TF�� " Number "stories: - • . � sn. �,�. 't Name: Kevin Luby and Jane Luby Type of construction: Address: 7360 SW Hunziker St., Suite 206 Occupancy groups: City /State /ZIP: Tigard, Or 97223 Existing: Phone: (503)620-3 Fax: Fax: (503)620 -3356 v2 (( y r � { �� New: " <in try; . „, 7 . z ,�§� ,.4 � k, €, ,' Business name: Hatteras Construction, Inc. All contractors and subcontractors are required to be Contact name: Larry Durham licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 2131 Goodall Ct. jurisdiction in which work is being performed. If the City /State /ZIP: Lake Oswego, OR 97034 applicant is exempt from licensing, the following reasons apply: Phone: (503 ) 699 -8758 Fax: : (503) 697 -6935 E -mail: larry@hatterasconstruction.com ti , 444744 , ,. * * colVTl e,,ioR ', Business name: Same �, � �BD1]V PE' .� FEW; 4,;, Z Address: .. .6=i% erro p` schedul , Structural plan review fee (or deposit): City /State /ZIP: Phone: ( ) F es: ( ) FLS plan review fee (if applicable): CCB tic.: 116793 Total fees due upon application: 57% 401116 Amount received: Authorized signs diri "_=110i`� This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete - Print name: Larry W Date: • Fee methodology set by Tri -County Building Industry Service Board.