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Permit CITY OF TIGARD SEWER CONNECTION PERMIT 1111 COMMUNITY DEVELOPMENT Permit#: SWR2014-00118 T f G AR.U 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/06/2014 Parcel: 25111 BC00300 Jurisdiction: Tigard Site address: 14415 SW 100TH AVE Project: Howse/Ornelas Subdivision: TIGARDVILLE HEIGHTS Lot: 18 Project Description: 1 EDU to connect existing house to sewer service. Contractor: Owner: HOWSE, DIANNA L ORNELAS, STEVE F 14415 SW 100TH AVE TIGARD, OR 97224 PHONE: PHONE: 503-840-0309 FAX: FEES Description Date Amount Specifics: Sewer Inspection-Residential 11/06/2014 $35.00 Type of Use: SF Class of Work: ALT Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $35.00 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 b 503.232.1987 or 1.800.332.2344. Issu By: Permittee Signature: 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. A T I GARD City of Tigard December 11, 2014 Dianna Howse 14415 SW 100th Ave. Tigard, OR 97224 Re: Permit No. SWR2014-00118 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 14415 SW 100th Ave. Project Name: Howse/Ornelas Job No.: N/A Refund: ® Check #215841 in the amount of$35.00. ❑ Credit card"return" receipt in the amount of$ . ❑ Trust account"deposit" receipt in the amount of$ . Notes: Refund overpayment of sewer connection inspection fee that was part of the sewer connection loan. If you have any questions please contact me at 503.718.2430. Sincerely, 7 , , - Dianna Howse Building Division Services Coordinator Enc. I:\Building\RefundAA3irn3tY'rigai 1Ep gAni Q gon 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 fir 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: Dianna Howse DATE: 12/4/2014 14415 SW 100th Ave. Tigard, OR 97224 REQUESTED BY: Debbie Adamski TRANSACTION INFORMATION: Receipt#: 198313 Case#: SWR2014-00118 Date: 11/6/2014 Address/Parcel: 14415 SW 100th Ave. Pay Method: Check Project Name: Howse/Ornelas EXPLANATION: Refund$35.00 sewer inspection fee that was incorporated into loan package. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Sewer inspection fee 230-0000-43118 533.05 TOTAL REFUND: $35.00 APPROVALS: ,,---SIG-NATURES/DATE: 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 ONL Case Refund Processed: I Date: /%/ ,y 14-: 'C I:\Building\Refunds\RefundRequesudoc x 09/01/2010 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Er" Request for Permit Action T I G A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov 7'O: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerrnits @tigard-or.gov FROM: ❑ Owner ❑ Applicant El Contractor City Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) Zj/ � S r Mailing Address: Y yi 5' S i.) City/State/Zip: 77 4/L[� , 9/L 9 7.2,2 V Phone No.: 3 6FW 03.09 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL/VOID PERMIT APPLICATION. pler REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONI RR�ACTOR ON PERMIT (do not cancel permit). o� Permit#: Gv/C �1/� `O0//F Site Address or Parcel #: / 17/4// S i.t) /OO !/- Project Name: /90 i4..L.0 C/o " j�S Subdivision Name: Lot#: EXPLANATION: 2r�-�cA/^ /,fSP"--e.-77O,J " /'fly& 67 ,47°/'L/ C-417V — 77/1T 14)6 S' /4/e 0 2.PDf-7- zs //I/7v V Signature: Date: /.114/// Print Name: e[c_en-s 14%, Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. IOR OFFICE USE ONI.1 Route to S s Admin: Date l;©®ErEW7_J Route to Records: Date _Awnsriprgifiam Refund Processed: Date /.2`/i / 1 By .CF1ra Invoice Processed: Date By Permit Canceled: Date /(/ 't— By .• Parcel Tag Added: Date By l:\Building\Forms\Req PermitAction_092 14.doc