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Permit City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 • ..._.-- 6 . TIGARD October 14, 2008 Centex Construction 8250 SW Hunziker Rd. Tigard, OR 97223 Attn: Russ Langbehn Re: Permit No. PLM2008 -00380 & SWR2008 -00137 Dear Mr. Langbehn: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 14035 SW 125 Ave. Project Name: Reinhart Job No.: N/A Refund: ® Check #59838 in the amount of $3,192.80. ❑ Credit card "return" receipt in the amount of $ • ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as "process to connect to sewer is too long and too expensive and a lot of hassle ". Refund 80% of plumbing permit fees and sewer inspection fee, and 100% of sewer connection fee. • If you have any questions please contact me at 503.718.2430. Sincerely, "C_Ocga/Z-e__ Dianna Howse Building Division Services Supervisor Enc. \Building\ Refunds \Administra tion \LuRefund- CancelPemritdoc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 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 Refund 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: Centex Construction DATE: October 2, 2008 8250 SW Hunziker Rd Tigard, OR 97223 REQUESTED BY: Dianna Howse Attn: Russ Langbehn TRANSACTION INFORMATION: Receipt #: 2008 -3368 Case #: PLM2008 -00380 and SWR2008 -00137 Date: 9/26/08 Address /Parcel: 14035 SW 125th Ave. Pay Method: Check Project Name: Reinhart EXPLANATION: Per applicant's request as "process to connect to sewer is too long and too expensive and a lot of hassle ". Refund 80% of plumbing permit fees and sewer inspection fee, • and 100% of sewer connection fee. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount [PLUMB] Permit Fee 245- 0000 - 431000 $57.84 [TAX] 12% State Surcharge 100- 0000 - 207020 6.96 [SWUSA] Sewer Connection Fee 500 - 0000 - 207000 3,100.00 [SWINSP] Sewer Inspection Fee 245 - 0000 - 441001 28.00 TOTAL REFUND: $3,192.80 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY LH Case Refund Processed: I Date: I /6/6/0, 1 By: I I: \Building \Refunds \RefundRequest.doc 05/23/07 _ - CITY OF TIGARD 9;26„- • 3 13125 _; d �� 1 1 : 4 1 I t i , . I I : , I : ;; A \'I Tigard, OR 97223 503.619.4171 . Receipt #: 27200800000000003368 Date: 09/26/2008 Case No 'Fran Code Description Revenue Account No Amount Paid PLM200$ -00380 [TAX] 12% State Surcharge 100- 0000 - 207020 8.70 PLM200S- 00380 t [PLUMB] Permit Fee 245-0000-43 1000 72.30 SWR2008-00137 [SWUSA] Sewer Connection Fee 500- 0000 - 20700(1 3,100.00 SWR200S- 00137 / [S1•VINSP] Sewer Inspection Fee 245- 0000 - 441001 35.00 Line Item "Total: $3,216.0( Payments: ------ Ii\Iethod Paver User ID Acct. /Check I o. Approval No. How Received Amount Paid Check CENTREX CONSTRUCTION DEB 46830 In Person 3,216.00 Payment Total: $3,216.00 ;Rc,•: Paps I .ii' 1 1 Ph " Building Division OCT o : " _ _,i Request for Permit Action IIGARD 'l ,. c.l uC !r. ' n• TO: CITY OF TIGARD . Permit System Administrator • 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503398.1960 www.tigazd- or.gov FROM: ❑ Owner IN Applicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: ( of individual) (, �. \ ti —� `1t 0Sj fcL1Q i i 0 � OCsst.Pt. '1 Mailing Address: ' R Sc 1�t 3 K-� fig: City /State /Zip: l kclAr; 1 0 � 1 Phone No.: .:(---• c Lk 0( 4 4 + l• a/Vot PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ►�4 CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if availabl ). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do n 3t cancel permit). Permit #: �L.) O �--"' ©C3 l --t 7 Site Address or Parcel #: I > O ' SiZ & ; • 5\i) Project Name: Subdivision Name: Lot #: EXPLANATION: OCrc-s.s. t5b UNIFSLT 'TO S �� 1'S (c o - .FiSkv A US" 'CR kkiXv...-re.".. s 111111LVMSt Signature: ".. � Date: \.0 IIT O 00 — Print Name: \ , • F1.) Refund Polig 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 with irawn or canceled before any review effort has been expended, c) not more than 80' /o of the land use application fee for issued permits. e) nor more than 80a /o of the building plan review fee when an application is canceled before any plan re iew effort has been expended. d) not more than 80% of the building permit Fee for issued permits prior to any i lapectian 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 (. Rte to Sys Admin: Date By Rtc to alit Admin: Date A /9 O,& By OP Refund Processed: Date /d /(/p,P' By r'l. Invoice Processed: Data By Permit Canceled: Date / bA B • , z'' Parcel Tt R Added: Date By Recei.t -4, - ' Data - Method _ Amount $ I: \Building \Forms \RegPermitAetion.: oc . • 05/24/06 L S' 44) tam.. ` Plumbing Permit Applica - 1,1 0 ei✓6 -lcver - oo., fA : 1 Building Fixtures G FOR OFFICE USE ONLY City of Tigard ���� / o , •�" Date/By: q 2..6, D 3 Permit No.: I ^00 ?j8'O q 13125 SW Hall Blvd., Tigard, OR 97 ��� Plan Review 17 Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit NoL / Inspection Line: 503.639.4175 Date Read /B K El See Page 2 for T 1 G A R D Intemet: www.tigard -or.gov Notified/Method: 6 it j Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ 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) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 E. I- 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: I 035 5 u/ (Z 5 7 'r - 9 a r ( Catch basin or area drain 16.60 City /State /ZIP: Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: It th M l v , r d t" %eV,c to WO 5f w Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 t' Qu L( Mt Gadl 4- 1 Z 5 T b pt),..e - Rain drain connector / 0 / 16.60 Sanitary sewer (no. linear ft.; , r Page 2 63; Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2 Tax map /parcel no.: ZOO Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 e4e e v vei i : r off II VC 5 fen, 7 �.) / • Backwater valve 16.60 o it / 4 i t7 C , + 56 w c l 6.ti d (0 i4,a.CL}- - Clothes washer 16.60 Dishwasher 1 6.60 ®, PROPERTY OWNER 1 ❑ TENANT Drinking fountain .16.60 p / Ejectors /sump 16.60. Name: Steve fi 1. i aoty i .e'i it rd I Expansion tank 16.60 Address: (1.-1 b 3 5 5 Lt.) (Z 5 -t h Fixture /sewer cap 16.60 City /State/ZIP: ' ,3 u r A Dtr ✓1 1 Z Z if Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: (503 ) 215 ZZ S 3 Garbage disposal 16.60 ES APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: Ce. v,, 4 , { v, Co n h -- r V- C 4 Interceptor /grease trap 16.60 Contact name: 5 i Lea 5u re Medical gas (value: $ ) Page 2 Address: $Z50 5 W f) u n? i k r Rai Primer 16.60 City /State /ZIP: j t c O. 1 2 z 3 Roof drain (commercial) 16.60 9 Sink/basin/lavatory 16.60 Phone: (SO 3) b ' ti 0493 Fax:: (So)) 6 20 679'2_ Tub /shower /shower pan 1 6.60 E -mail: 7 +eve C -eytk rer.- Cove +f v.c4 - cvw,ylt • Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: Pr; , _ x C - C i rr` -r Water heater 16.60 vN ru � xta ✓or. -1 ,'0.1 Address: 1,0 21 6E_ L 0 r5 -t". Other: City /State/ZIP: 1, 12e7rO Oic° on 71 I z3 - Subtotal • Phone: (50 ) 519 19,31 5 Fax: (50 6`10 HO/Z. Minimum permit fee: $72.50 �Jn 0 Residential backflow minimum permit fee: $36.25 CCB Lic.: ` 2.2. H f .4a3I od Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (12% of permit fee) IT. Authorized signature: �"__ TOTAL PERMIT FEE C1, P' J Print name: 5-re,.tG «s u r r Date: q'( L5 log 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. t:' Building \Permits\PLMF- PennitApp.doc 12/27/06 440- 4616T(10 /02/COM/WEB) • • Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. - Fee (ea) - Total Square Footage: Permit Fee: Footing drain - lA 100' 55.00 0 to 2,000 $115.00 • Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1 st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: • Permit Fee: Storrs & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Commercial Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" - 4" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) • Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet Urinal . Other Fixtures: is\ Building \Permits\PLM- PermiiApp.doc 12/27/06 111 „ ” Building Division OCT C T. 2008 Request for Permit Action TIGARD 'I1 -‘ ., , • .i ;: :.dl:•j 'Pi 1 1111 1,; I -- ._ , ' `a TO: CITY OF TIGARD . Permit System Administrator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigatd- or.gov FROM: ❑ Owner 1 ► ■'1 Applicant ❑ Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business orindivitlttal) (, �,\ (ia..9t C0S "iR u�'r�i i ON 63 C.S\tc l i,c Mailing Address: St.A 1�� K` ` � .1 0 ✓ City /State /Zip: ' j . • ( 0/b/ r Phone No.: -• LRtk"C (f PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ►.� CANCEL PERMIT APPLICATION. t►� REFUND PERMIT FEES (attach receipt, if availabl ). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: "\ (0 8 - M80 Site Address or Parcel #: l O . "3 SL 1, -P\\) • Project Name: Subdivision Name: Lot #: EXPLANATION: S S HE TO @IOP i szes&,R le ts , % ■ ■ .1 Signature: ‘1114111.....,.......... - Date: 4a g Print Name: --,... • A FVCn'i')C. kit. N • R ^ P i I. 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 fcc 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, c) not more than 80 of the building plan review fee when an application is canceled before any plan review effort has been expended. d) not more than 80% of the building permit fee for issued permits prior to any i lspcetion requests. 2. Refunds will be returned to the original Payee in the same method in which payment was received. Please allow 1.2 weeks For processing refunds. - l:0 K. OFFICE USE c)NI.Y Rte to S • s Admin: Date Ell=11. Rte to Bi : Admin: Date /# l o .. B :. Refund Processed: Date /O 0/0f-- By ,.�� Invoice Processed: Date By Permit Canceled: Date /21/4/0P By ; %; Parcel Ti g Added: Date By Receipt # 0r - 3.Ct'Datc 9/24 /F,f' Method of ° ek Amount $ I: \Building \ Forms \RegPcmtitAction, c R6 D5/24/06 • City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 • • TIGARD October 14, 2008 Centex Construction 8250 SW Hunziker Rd. Tigard, OR 97223 Attn: Russ Langbehn Re: Permit No. PLM2008 -00380 & SWR2008 -00137 Dear Mr. Langbehn: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 14035 SW 125 Ave. Project Name: Reinhart Job No.: N/A Refund: ® Check #59838 in the amount of $3,192.80. ❑ Credit card "return" receipt in the amount of $ ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as "process to connect to sewer is too long and too expensive and a lot of hassle ". Refund 80% of plumbing permit fees and sewer inspection fee, and 100% of sewer connection fee. If you have any questions please contact me at 503.718.2430. • Sincerely, Dianna Howse Building Division Services Supervisor Enc. I:\ Building\ Refunds\ Administration \LtrRefund- CancelPermitdoc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 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 Refund 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: Centex Construction DATE: October 2, 2008 8250 SW Hunziker Rd Tigard, OR 97223 REQUESTED BY: Dianna Howse Attn: Russ Langbehn TRANSACTION INFORMATION: Receipt #: 2008 -3368 Case #: PLM2008 -00380 and SWR2008 -00137 Date: 9/26/08 Address /Parcel: 14035 SW 125th Ave. Pay Method: Check Project Name: Reinhart EXPLANATION: Per applicant's request as "process to connect to sewer is too long and too expensive and a lot of hassle ". Refund 80% of plumbing permit fees and sewer inspection fee, and 100% of sewer connection fee. REFUND INFORMATION: Fee. Description. From Receipt' • Revenue AccountNo:: " Refund Example:.' [BUILID] Permit Feb. • ,'Ex 245 - 0000 - 432000 • • . $ Amount . [PLUMB] Permit Fee 245- 0000 - 431000 $57.84 (TAX] 12% State Surcharge 100- 0000 - 207020 6.96 [SWUSA] Sewer Connection Fee 500 - 0000 - 207000 3,100.00 [SWINSP] Sewer Inspection Fee 245- 0000 - 441001 28.00 • TOTAL REFUND: $3,192.80 APPROVALS: If under $500 Professional Staff 9‘g If under $7,500 Division Manager If under $22,500 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 /6/62/06F By: . I:\ Building \Refunds \RefundRequest.doc 05/23/07 ...' Y: CITY OF TIGARD 9,.2.0.2u08 ' 131 5 i�� Hall Blvd. I I : 31: 35 A \m1 a Tigard, OR 97223 5113.639.4171 i l o Receipt #: 27200800000000003368 Date: 09/26/2008 / �i irt�f i .. , / Case No "fr Code Description Revenue Account NO Amount Paid I'LM2005 -00380 [TAX] 12% State Surcharge 100 -0000- 207020 8.70 PLM200S- 0038( [PLUM L3] Permit Fee 245- 0000 - 431000 72.30 SWR200S -001 37 ) [SWUSA] Sewer Connection Fee 500- 0000- 207000 3,100.00 SWR200S -001 37 / [SW INSP] Sewer Inspection Fee 2 45- 0000 - _441001 35.00 • — Line Item Total: $3,216.00 Payments: (Method Payer User ID Acct. /Check I o. Approval No. liuw Received .amount Paid Check CLNTREX CONSTRUCTION DEB 4683U In Person 3,216.00 Payment Total: $3,2I6.0(1 :Rr,.ri I'.i_. I of I ' PI I Building Division OCT 0 _ ntiJ Request for Permit Action _ . _ � T TO: CITY OF TIGARD . • Permit System Administrator . 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov FROM: ❑ Owner .TI Applicant ❑ Contractor ❑ City Staff (cheek one) REFUND OR Name: INVOICE TO: (Business or Individual) `Vi 1� Q )tvs tA�1 i 01 oc T(..c�. z n Mailing Address: Sri. \t -1AK D V ® D City/State/Zip: \ �; C)\ ----- � - A � � /P /01' ! Phone No.: .:C L PLEASE TAKE AC'T'ION FOR THE ITEM(S) CHECKED (✓): ►•:e CANCEL PERMIT APPLICATION. y * REFUND PERMIT FEES (attach receipt, if avai]abl ). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Pezrnit #: ' U1 ` � W - 'Ma 01 Site Address or Parcel #: N G SA ' �E fAij� Project Name: Subdivision Name: Lot #: EXPLANATION: CiNkZ Q- 1% �1C14 ii' TO 7 -fa ,It 1 4 Mi lk Signature: >`, Date: O i I Print Name: • ANC,,I,k(\t • Re nd rill 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 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. c) not more than 80 /e of the building plan review fee when an application is canceled before any plan review effort has been expended. d) not more than 80% of the building permit fee for Issued permits prior to any i lspection 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 Rtc to Bldg Adrnin: Date /e /fy c dr B • "* Refund Processed: Date /V Vol- By Invoice Processed: Date • By Permit Canceled: Date /�'n/, /op By Parcel Tag Added: Date By _Receipt # of - 33c�'Datc 7 /zi0f Method Cv� Amount $ I:\ Building \Forms \RegPcrmi Action.di c Rt4 05/24/04