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Permit II -• N TIGARD City of Tigard August 6, 2015 Lovett Excavating Inc. Attn: Richard Hicks 6920 NE 42nd Ave. Portland, OR 97218 Re: Permit No. PLM2015-00237 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: 10205 SW Murdock St. Project Name: Phou Job No.: N/A Refund: ® Check#218204 in the amount of$19.09. ❑ Credit card "return"receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ Notes: Refund 80% of 40'water service only as this item was a duplicate under permit PLM2015-00232. See attached fee and payment history for refund explanation. If you have any questions please contact me at 503.718.2430. Sincerely, do Dianna Howse Building Division Services Coordinator Enc. I:\Building\Refunds\1,rya ,r nMALA'Ckerpay.'Hdg Otpregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov CITY OF TIGARD FEE AND PAYMENT HISTORY 11111 I 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD PLM2015-00237 - 10205 SW MURDOCK ST, TIGARD, OR 97224 Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Water Service 230-0000-43101 $62.54 $62.54 $62.54 7/23/15 Credit Card 201791 $0.00 Backflow Preventer 230-0000-43101 $31.27 $31.27 $31.27 7/23/15 Credit Card 201791 $0.00 12%State Surcharge-Plumbing 100-0000-24001 $11.26 $11.26 $11.26 7/23/15 Credit Card 201791 $0.00 Totals for Fees $105.07 $105.07 $105.07 $0.00 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount 201791 Credit Card lovett excavating inc 07/23/2015 $105.07 Total Payments: $105.07 Balance Due: $0.00 Ag-C/e_r=urzJ 37' g3 : ii //, ,26 /PIA/ . i°6-72...-77 r- - 7 , s"o ,P. 7o S ✓. /9-ry,✓T. d-4/6 �/, 20 -/- 02_ , 5.6 - v.3 . 1-', ErCity 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 Reqaestfiir 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: Lovett Excavating Inc. DATE: 8/3/2015 Attn: chard Flicks ` 90 ..0 NE 42'Ave. REQUESTED BY: Dianna Howse �P Portland, OR 97218 TRANSACTION INFORMATION: Receipt#: 201791 Case#: PL■ 2O15-00237 Date: 7/23/2015 Address/Parcel: 10205 SW Murdock St. Pay Method: CreditCard Project Name: Phou EXPLANATION: Per applicant's request as they paid twice for 40'water service(PLM2015-00232). Refund 80% of overpayment. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Plumbing Permit 230-0000-43101 $17.04 12%State Surcharge 100-0000-24001 2.05 TOTAL REFUND: $19.09 APPROVALS: I NATU' DATE: If under$5,000 Professional Staff r' 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 0 Y Case Refund Processed: I Date: I ff/' //f I By: 1:\Building\Refunds\RefundRequestdoe x 09/01/2010 Jul. 29. 2015 1 : 10PM Lovett Excavat i ng No. 5865 P. 1 RECEIVED City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT r Request for Permit Action JUL 2 9 2015 q CITY OF-rIcA I o I t;A 1 r) 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 •wunu.tigar o�'f a U!Vlt.S,®N TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@dgard-or.gov FROM: ❑ Owner [Applicant '' Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) L-6 V E T C�Y� f��v� I C Mailing Address: 6 920 N . C 142nd 14v( City/State/Zip: Po r7 4 AAi D EqoA) Phone No.: 2 I g PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): r;�'`�...-4:._. OID PERMIT APPLICATION. V 4 REFUND 'RMIT FEES (attach copy of original receipt and provide explanation below). Olv fin • '• E FOR FEES DUE(attach case fee schedule and provide explanation below). jtt ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: FLAN 2O15 ` UC.. 37 Site Address or Parcel#: A S 1 1 1 "BC 0 y r 0 0 /00205- sSJ /7 u2.)o(fe- j-7 Project Name: Su n Cl- &4 , ?Flo V Subdivision Name. Lot#: EXPLANATION: ft l D (o J t(p m-r6 r 6rfu ICf s Pt/1,2-0/s Signature: `� • Date: T— 2 Q— Print Name: 'Z l,cNa 1- 01S 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. 19"P/0-19"P/0-0 u�b!✓e72- /Q Ai, 3o - /?1OV ,s� s.9'• /q. o9 y. 77 FOR OFFICE USE ONLY Route to S s Adminu Date By Route to Records: BEM�v�i 1i%. Refund Processed: Date , /s r 71 7 Invoice Processed: Date By Permit Canceled: Date N By i, Parcel Tag Added: Date By i\Building\Forms RegPcumirAcrion_092314.dor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10205 SW MURDOCK ST, TIGARD, OR, 97224 Residential - Plumbing 399 Plumbing ﬁnal FAIL PLM2015-00237 George Heimos 1. Corrections from previous inspection not completed. Recall Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10205 SW MURDOCK ST, TIGARD, OR, 97224 Residential - Plumbing 399 Plumbing ﬁnal FAIL PLM2015-00237 George Heimos 1. Back ﬂow device requires a minimum 12” clear space with box (prevents inﬁll) to ground below device. 603.3.3 2. Back ﬂow device: provide lawn irrigation device backﬂow test results. 310.3/407.2 3. Recall inspection when corrections have been completed. Re-inspection required. 103.5.6.1 NOTE OK to backﬁll patricia.s@lovettservices.com Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10205 SW MURDOCK ST, TIGARD, OR, 97224 Residential - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2015-00237 George Heimos Backﬂow test results. 1" Watts model LF007M1QT Serial number 029947 Violation Summary: Inspector Contractor Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 10205 SW MURDOCK ST, TIGARD, OR, 97224 Residential - Plumbing 399 Plumbing ﬁnal PASS - No C of O PLM2015-00237 George Heimos Backﬂow test results. 1" Watts model LF007M1QT Serial number 029947 Violation Summary: Inspector Contractor