Permit . �
City of Tigard
June 5, 2013
Landscape Oregon Inc.
Attn: Ellen Sparrow
PO Box 2386
Tualatin, OR 97062
Re: Permit No. PLM2013 -00138
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15272 SW Greenridge Pl.
Project Name: Arlington Heights, Lot 73
Job No.: N/A
Refund Method: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $64.96.
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 this was a duplicate permit. Refund 80% of
permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
"d2)ff;47?...11-e— --
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 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 permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Landscape Oregon DATE: 6/5/2013
Attn: Ellen Sparrow
PO Box 2386 REQUESTED BY: Dianna Howse
Tualatin, OR 97062
TRANSACTION INFORMATION:
Receipt #: 191232 Case #: PLM2013 -00138
Date: 5/2/2013 Address /Parcel: 15272 SW Greenridge Pl.
Pay Method: CreditCard Project Name: Arlington Heights, Lot 73
EXPLANATION: Per applicant's request as this was a duplicate permit of PLM2012- 00360. Refund 80%
of permit fee.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Plumbing permit fee 230- 0000 -43101 $58.00
12% State Surcharge 100- 0000 -24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIGNAT R . S DA E:
If under $5,000 Professional Staff I / 11-W , .
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
Refund Processed: I Date: I �v,S` /3 By: I
1: \ Building \ Refunds \RefundRequest.doc x 09/0!/2010
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O EIVED 1 D
f 4A Y 2 0 2013
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CITY OF G
BUILD SION
Landscape Oregon, Inc.
P. 0. Box 2386
Tualatin OR 97062
(503) 692 -5945
LCB # 7804
Fax Cover Sheet
To: Building Permit Department
Company: City of Tigard
Fax: 503 -598 -1960
From: Ellen
May 17, 2013
Fax: (503) 692 -0768
• Phone: (503) 692 -5945
Number of pages including cover sheet: 1
Hi,
I applied for back flow plumbing permits on 12/11/2012 2A, 50 F. 70
Permit # PLM 2012 -00360 G c�O S 6 , F0 ?c ,(1'
Called it in on 2/7/2013 for inspections on 2/8/2013 they passed �� 1-4 t '4 _ y 9
Site address: 15272 SW Greenridge Place
/ rove
Then...not paying attention.... p y, S o / , .7
I applied for back flow plumbing permits on 5/2/2013 „20 °Ie
Permit # PLM 2013- 001397 PL' a/3 — 0p / - 3 ? 12E7M /66
Site address: 15272 SW's Greenridge Place
I DO NOT NEED THIS PERMIT. I NEED TO CANCEL PLEASE
I have attached the form that has out card number on it. I am aware there is a service fee
that will not be refunded.
Thanks! - Ellen
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CITY OF TIGARD PLUMBING PERMIT
a -' COMMUNITY DEVELOPMENT Permit #: PLM2013 -00138
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2013
Parcel: 2S109DA15400
Jurisdiction: Tigard
Site address: 15272 SW GREENRIDGE PL
Project: Arlington Heights, Lot 73 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 73
Project Description: (1) backflow preventer
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW LLC
PO BOX 2386 4230 GALEWOOD ST, STE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
PHONE: 503 - 692 -5945 PHONE:
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/02/2013 $31.27
Specifics: 1 12% State Surcharge - 05/02/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 05/02/2013 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 04 1 / 'c - 1 -7 v /j f .4
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
PIumbin2 Permit A :plicatif EIVED
Building Fixtures MAY 0 2 2013 FOR OFFICE USE ONLY
City of Tigard O TIGARD 1 Rxet 5 y- ia-� 13 ?mink No.: �LJ { j(z - 00( 3,:
• 13125 SW Hall Blvd., Tigard, CR 9 it FTIGARD
Phone: 503.7183439 Fax: 503. f �ING DIVISION I DatciB tom. I Other Pettit Iv o.
Inspection Lin_: 503.639.4175 D ate Ready/ Sy: /"_ 0 Sec Page 2 for
Interne i
T i ! ; -� R D t: www.tigard-or.gov ov
2
gard g Notified - Method: . tP Supplemenial lnfarrnat[on
� r C
._
� £ : set .� = 1 sr. i - 3;7PEUF W.OEK i .31t-'1 CS '� I' � P, S HEDLYi3E -'
For special rrrfo rntiox use checklist New construction ❑ Demolition
Description I Qty. Ea. i Total
Q Addition /alteration/replacement ❑ Other: New 1- 2 - family dwellings (includes 100 ft. for :sch utility connection)
Vi _r t ,a : ; . E „" _ AT G OF cfJN rRuc - . ,,�,� .. d g SF R (t) bath 312.70
CI 1- and 2- family dwelling ; E3 Commercial/industrial SFR (2) bath j 437.78
SFR (3) bath 500.32
Accessory building ❑ Multi- family I
. Faeh additional bath /kitchen 25.02
Master builder ❑ Other: , 'Fire sprinkler ( sq. ft.) I Page 2
r t ? igN. , JOB - ;S ITE jfp0121►' C1" oN 5 II T.O A71p E, ..' - ' - Site utiitier
Catch basin or area drain 1 18.76
r 1
Job site address: J -- -a. '7 Q ,,(.„) tr- rr e r"; et C. PL c" t_ , Dryw leach line, or trench drain 18.76
City /State/ZIP: j .1_ CL-- �
IC '2 -2 ��cf Footing drain (no, linear ft.: _) Page 2
Suite/bldg./apt no.: 'l Project name:4 // / fe - t ? 3 Manufaotured home utilities 50.03
Cross street/directions to job site: Manholes I8.76
S tJ /3 e f' iU net •=, 07-9 Rakich-air. conne;tor 18.76
_ _ Lm m 1^ 1 & _
L) Sanitary sewer (no. linmr ft.: 1 1 : Page 2
� � Storm sewer (no. linear ft.: ) Page 2
G r - e, i- 4. �- Water service (no. linear ft.: _) Page 2
Subdivision: ifityl / rt epitcl i H e_,.q /'t., Lot no.: r]3 Future or item:
soap /parcel no.: &
,� ,� ! Backflow preventer x f 31.27 31.27
Tax
ai ,_$i mat E * .: Bac kwater valve 1 12.51
t1 �.., ? a 1 DES ; ji p
, . -..� r �31i l6 . X511 ,.. -.. ? . u ° 1 ; .,. Clothes washer 25.02
. Landscape Irrigation Back Flow Device
Dishwasher 25.02
Drinking fountain 25.02
, Ejectors /sump 25.02
1 I " } sj9g t Rl)1RT O %% d. ik t a I 4 r r r TEN91 T i , it'�e it r l l ' Expansion tank I2.51
Name: Stone Bridge Romes 1CW LLC Fixture(sewer rap 25.02 -
Floor drain/floor sink/hub 25.02
Address: 4230 Galewood Street Suite 100
Garbage disposal , 25.02
City /State/ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: ( ) Fax: ( ) . Ice maker 12.51
3t'e; . is: ' ; r •t � ...�. 6 3.t :j : k !� CQ F4 ,P. a s imer epmr/gtease trap 25.02
. 1
Business name: Landscape Oregon, Inc. Medical gas (value: 5 ) Page 2
Primer ' 12.51
Contact name: Ellen Sparrow
Roof drain (comenciat) 12.51
Address: P.Q. Box 2386 [ ae Sink/basinlavatory 25.02
I City/State/ZIP: Tualatin, OR. 97062 • ! Solar units (potable water) 62.54
Phone: (503) 692 -5945 I Fax: : (503 -) 692 -0768 Tub/showtr/showerpan t 12.51 .
E -mail: ellenea�landscapeoregon.com it final 25.02
W
IP, ,il. 6 ` n sr h n a. ii.s i ! r q co 25.02
water sec
l
,t „i rc ^ .,,a._.._: .:tkEi :,llfr 1Pll!+ __a SGTOIt ._ 8.., .,... *.. . i.i 7. - a. : ` Water heater I ' 37.52
• Business name: Landscape Oregon, Inc. Waterpiping,DWV 1 . 56.29
es i I t
Address: P.O. Box 2386 Other 25.02
CityiState'ZIP: Tualatin, OR 97062 I Subtotal 3127
Phone: (503) 692 -5945 I Fax: (503) 692.0768 Minimum permit fee: S "2 50 j 72.50 I.
CCB Lie.: LCB 7804 Plumbing Lie. no.: Plan review (25% of permit fee) •
State surcharge (12% of permit fee) 8.70
Authorized signature ,` :i 4..1/./L OT_ - TOTAL PERMIT FEE 8120
Print name: Ellen Sparrow Dat / This permit ap expires.if apermit is not obtained within 180 days
F ° ) 43 after it bas been accepted as complete.
*Fee methodology set by Tri- County Building industry Service Board.
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