Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2009 -00094
T t G A R n 13125 SW Hall Blvd.. Tigard OR 97223 503.639.4171 Date Issued: 04/21/2009
Parcel: 2S 104AB02100
Jurisdiction: Tigard
Site address: 12184 SW MORNING HILL DR
Subdivision: Lot: 0
Project: spring
Project Description: Install backflow preventer.
Owner: FEES
SPRING, ROGER J Quantity Description Date Amount
SPRING, DEBORAH E, 12184 SW MORNING 1 ea Backflow Prevention - RES 04/21/2009 $27.55
HILL DR 1 12% State Surcharge - 04/21/2009 $4.35
PHONE:
Plumbing
9 ea Minimum Fee Adjustment 04 /21/2009 $8.70
Contractor: - Plumbing
DENNIS' SEVEN DEES LANDSCAPING INC
7355 SE JOHNSON CK BLVD •
PORTLAND, OR 97206 -9329 •
PHONE: 503 - 777 -7777
FAX: 503 - 777 -2399
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $40.60
Required Items and Reports (Conditions)
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
Issued By: qM l .,� U4d O / Permittee Signature: 2 f2j2 _ t p \ r1 n i
Lx Y v( 1(1( J! 777���111 pp 1 S�:fc
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.
PI>tImbin Permit A licatio (}d351- 6g c.
Site Utilities C E71/ FOR OFFICE USE ONLY
Cl of Tigard APR O 2 009
/ ., f Received
Date/By. Permit No.: / /Q OA
u 131 ll
SW Hall �
l Blvd., Tigard, OR 97223 r/` � r.�e • 3Q
III
Phone: 503.639.4171 Fax: 503.56/1ld Plan Review
C
Date/By: Other Permit No.:
B(
TIGARD Inspection Line: 503.639.4175 OF Date Ready /By: is: E1 See Page 2 for
Internet: www.tigard- or.gov /�� OI GARD „kris:
` 1 C. Supplemental Information
TYPE OF WORK � /S / ON FEE* SC EDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ® Other: LANDSCAPE New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /gay Y Sw A7„h/0' p ,e„ o Catch basin or area drain 16.60
City /State /ZIP: TIGARD, OR 972 ZJ Drywell, teach line, or trench drain 16.60
Q�K Footing drain (no. linear ft.: _) Page 2
Suite /bldg. /apt. no.: Project name: ( VP/
Manufactured home utilities 1 10.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer 1 Page 2 36.25
INSTALL BACKFLOW DEVICE Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
-/ Ejectors /sump 16.60
�G� Name: ce- ce / ie__ I7 Expansion tank 16.60
Address: SAME AS ABOVE Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
50$ ) 5 ^a� -7 0 7 3? Garbage disposal 16.60
Phone: e .. Fax: ( )
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 1 6.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: DENNIS' SEVEN DEES LANDSCAPING, INC. Water heater 16.60
Address: 7355 SE JOHNSON CREEK BOULEVARD Other:
Subtotal
City /State /ZIP: I'ORTLAND, OR 97206
Minimum permit fee: $72.50
36.25
Phone: (503) 777 - 7777 Fax: (503) 777 - 2399 Residential backflow minimum permit fee: $36.25
CCB Lic.: 5009 ,\ V\ ,mbing Lic. no.: 5LIBDI Plan review (25% of permit fee)
State surcharge (12% of permit fee) 4.35
Authorized signature: " - j
TOTAL PERMIT FEE 40.60
r
Print name: DEAN SNODGRASS/I'B Date: y45 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:t Building \Permits1PLMU- PcrmitApp.doc 12/27/06 440- 4616T(I 0 /02/COMIWEB)
•
CITY OF TIGARD RECEIPT
• �I
is . , 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
11 WARD
Receipt Number: 173297 - 04/21/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2009 -00094 Backflow Prevention - RES 245 0000 - 431000 ='.:% $27.55
PLM2009 - 00094 12% State Surcharge - Plumbing 100 - 0000 - 207020 3 • �.•/,;" $4.35 )
PLM2009 -00094 Minimum Fee Adjustment - Plumbing 245- 0000 - 431000 $8.70
Total: $40.60
•
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 12797 LSELLERS 04/21/2009 . $40.60
Payor: DENNIS' SEVEN DEES LANDSCAPING INC
Total Payments: $40.60
Balance Due: $0.00
Page 1 of 1
•
c p CITY OF TIGARD RECEIPT
8 _ I 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
i`
.r y
Ae—:- ..t d".'
Receipt Number: 175179 - 09/11/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2009 - 00094 $ - 32.48
Total: $ -32.48
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 100524 DHOWSE 09/11/2009 $ -32.48
Payor: Dennis' Seven Dees Landscaping Inc.
Total Payments: $ -32.48
Balance Due: $32.48
Page 1 of 1
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
•
u®
TIGARD
September 11, 2009
Dennis' Seven Dees Landscaping Inc
7355 SE Johnson Creek Blvd.
Portland, OR 97206
Attn: Tiffany Bright
Re: Permit No. PLM2009 -00094
Dear Ms. Bright:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12184 SW Morning Hill Dr.
Project Name: Spring
Job No.: N/A
Refund: ® Check #100524 in the amount of $32.48.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as backflow device already exists on site. Refund 80% of
permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
l
Dianna Howse
Building Division Services Supervisor
Enc.
1: \ Building \ Refunds \ Administration \1..trRcfund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
4
L
c . City of Tigard
TIGARD Accela 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 Refund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Dennis' Seven Dees Landscaping Inc DATE: 7/16/09
7355 SE Johnson Creek Blvd.
Portland, OR 97206 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 173297 Case #: PLM2009 -00094
Date: 4/21/09 Address /Parcel: 12184 SW Morning Hill Dr.
Pay Method: Check Project Name: Spring
EXPLANATION: Per applicant's request as backflow device already exists on this site address. Request
refund of 80% of permit fees.
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.le:, :0 �`Pefx4ii4trl 'ee • „ _, +;., - - .ii.6: Exaxri' e:= 245=.05. - 4320Q0= �'� t .,
Backflow Prevention - RES 245- 0000 - 431000 $29.00
12% State Surcharge - Plumbing 100- 0000 - 207020 3.48
TOTAL REFUND: $32.48
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager i✓ 1 1 6 4 �� -
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
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Refund Request Reviewed: Date: 1/ 6 €.?,,• By: el
Case Refund Processed: Date: � 7 0' o By: 46
I:\ Building \Refunds \RefundRequest.doc 04/13/09
RECEIVED
DENNIS' MAY 0 7 2009
SEVEN DEES
landscaping & garden centers CITY OF TIGARD
BUILDING DIVISION
May 6, 2009
City of Tigard
Community Development
13125 SW Hall Boulevard
Tigard, OR 97223
Re: Plumbing Permit # PLM2009 -00094 12184 SW Morning Hill Dr
I am writing to request the cancellation and refund for the above permit number. Site
has an existing backflow device.
Thank you for your time regarding this request. If you have any questions, please contact
me at 503.777.7777 ext 322 or at tiffanyb
Sincerely,
Tiffany Bright
Administrative Assistant
Copy of permit located on the backside of this letter
•
7355 SE Johnson Creek Blvd. 503.777.7777
Portland, OR 97206 LCBr5D09 360.737.3755 tel.WA
dennis7dces.com 503.777.2399 fax