Permit 1 . ,.
TIGARD
City of Tigard
August 22, 2012
DTS Systems Inc.
Attn: Gary L Yake
7905 SW Nimbus Ave.
Beaverton, OR 97008
Re: Permit No. FPS2012 -00047
Dear Mr. Yake:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 6960 SW Sandburg St.
Project Name: Online Academy
Job No.: N/A
Refund Method: ❑ Check # in the amount of $ .
® Credit card "return" receipt in the amount of $137.36.
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 refund 80% of permit fees as they applied for
permit at the wrong site address.
If you have any questions please contact me at 503.718.2430.
Sincerely,
S,WtitYV
Dianna Howse
Building Division Services Supervisor
Enc.
I:\ Building \Rcfunds1, ,st,Wn cegkdr,ceinggalydPl3tgon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
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: DTS Systems Inc. DATE: 07/26/2012
Attn: Gary L Yake
7905 SW Nimbus Ave. REQUESTED BY: Dianna Howse
Beaverton, OR 97008
TRANSACTION INFORMATION:
Receipt #: 186105 Case #: FPS2012- 00047
Date: 03/28/2012 Address /Parcel: 6960 SW Sandburg St.
Pay Method: CreditCard Project Name: Online Academy
EXPLANATION: Refund 80% of permit fees per applicant's request as they applied for permit at the
wrong site address.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Permit Fee 230- 0000 -43104 $90.37 2 % '
12% State Surcharge 100- 0000 - 24001 10.85 T i
Plan Review - FLS 230- 0000 -43108 36.14 T , 0q
TOTAL REFUND: $137.36
APPROVALS:
If under $5,000 Professional Staff
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
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: I p /q //Z By: I- --
L:\ Building \Refunds \RefundReguest.doc x 09/01/2010
G �
1 1111 RECEIVED
,. Community Development
MAR 2 9 2012
TIGARD Request for Permit Action
CITY OF TIGARD
BUILDING DIVISION
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: ❑ Owner ® Applicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name: DTS Systems Inc.
INVOICE TO: (Business or Individual)
Mailing Address: 7905 SW Nimbus Ave.
City /State /Zip: Beaverton, Or. 97008
Phone No.: 503- 643 -3127
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
® CANCEL PERMIT APPLICATION.
® 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 #: FPS2012 -00047
Site Address or Parcel #: 6960 SW Sandburg Street
Project Name: Online Academy
Subdivision Name: Lot #:
EXPLANATION: Job Site has wrong Address
Signature: �� Date: 3/29/12 , / . . �y
Print Name:
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 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 Sys Admin: Date By Rte to Bldg Admin: Dated /22 Az_ By if -
Refund Processed: Dateef7AM4— By Invoice Processed: Date By
Permit Canceled: Date ,p rz./j,1___ By, Parcel Tag Added: Date _ By
Receipt # 4f6A95 Date (ap-�47_ Method GC.. Amount $
Building Permit Application
Fire Protection System 0 `1 FOR OFFICE IISF ONLY
City of Tigard e2z//v Date/B Received
C ° 1 3125 SW Hall Blvd., �d., Tigard, OR 97223 �/� �� Plan Review y Other Permit: •
7
hone: 503.7182 39 Fax: 503.598.1960 4 � � Date/B
T I G A R Inspection Line: 503.639.4175 a �, D. e Ready/By:
mil ® See Page 2 for
Internet: www.tigard or.gov Y V'. : fied/Method: Supplemental Information
TYPE OF WORK G�tk, )45 REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolitio%vy 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
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling ® Commercial industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 6960 S.W. Sandburg Street New dwelling area: square feet
City/ State/ZIP: Tigard, OR 97223 Garage/carport area: square feet
Suite/bldg. /apt. no.: 100 I Project name: O ademy'1 Q_,' Covered porch area: square feet
Cross sheet/directions to job site: S.W. 72 Avenue. See attached MAP. 50e —cal 611-3/1("2 � Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
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
DESCRIPTION OF WORK work indicated on this application.
Install Fire Detection and Alarm System. Valuation: $3,250.00
Building is NOT Sprinklered. Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( )
New:
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: DTS Systems, Inc All contractors and subcontractors are required to be
Contact name: Gary Yake licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 7905 S.W. Nimbus Avenue jurisdiction in which work is being performed. If the
City/ State/ZIP: Beaverton, OR 97008 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 643 -3127 l Fax: : (503) 643 -6194
E -mail: gyake @dtssystemsinc.com
CONTRACTOR BUILDING PERMIT FEES*
Business name: DTS Systems, Inc (Please refer to fee schedule)
Permit fee:
Address: 7905 S.W. Nimbus Avenue
City/State /ZIP: Beaverton, OR 97008 State surcharge (12% of permit fee):
FLS plan review (40% of permit fee):
Phone: (503) 643 -3127 I Fax: (503) 643-6194 (Due upon application)
CCB lic.: 134056 Total permit fees:
Authorizedsignattue: Amount received: pr 1 3
This permit application expires if a permit is not obtained
Print name: Gary Yake Date: 3 -28 -12 within 180 days after it has been accepted as complete.
• Fee methodology set by Tri -County Building Industry
Service Board.
1:1BuildingWermits \FPS- PamitApp.doo Rev 01/05/1012 440- 4613T(tl /02/COMnvEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
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:
Type of System (Complete A, B, C or D as applicable):
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ® Yes
include: Individual Component ® Yes
Cut Sheets
Fire Alarm Project Valuation: $ 3,250.00
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $ 3,250.00
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 three (3) sets of plans at submittal.
Plan review fees are required at submittal.
S: \Bud's Files \ Permits \ Tigard \ 2012\ Fire System Permit Application Form- Online Acadt2my.doc Rev 01/05/2012