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Permit 1gi CITY OF TIGARD SEWER CONNECTION PERMIT 11112 : COMMUNITY DEVELOPMENT Permit#: SWR2016 00125 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �.E1513 Date Issued: 2016 Parcel: 1 S135BA00102 Jurisdiction: Tigard Site address: 10140 SW WASHINGTON SQUARE RD Project: Zoup! Subdivision: OAKBURG Lot: 9 Project Description: 1.69 EDU increase. 6/3/2016: REPRINT permit to reduce EDU per change in scope of work on plumbing permit. Contractor: Owner: PPR SQUARE TOO LLC PO BOX 847 CARLSBAD, CA 92018 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 04/28/2016 $8,619.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: 2.06 Total $8,619.00 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 by calling 503.232.1987 or 1.800.332.2344. / Issued By: AZ;gic2V Permittee Signature: e� �p��Cej' / Call 503.639.4175 by 7:00 a.m.for the next available inspection date. ���lllfff 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. 1 Accumulative Sewer Tally ,� . Tenant Name: ZOUP! SWR# 2016-00125 REVISED Site Address: 10140 SW WASHINGTON SQUARE RD PLM# 2016-00232 TIGARD Parcel#: 1 S 135BA00102 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values Baptisery/Font 4 0 0 0 0 0 Bath: -Tub/Shower 4 0 0 0 _ 0 0 -Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash: -Each Stall 6 0 0 0 0 0 -Drive through 16 0 0 0 0 0 Cuspidor/Water Aspirator 1 0 0 0 0 0 Dishwasher: -Commercial 4 0 0 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 5 10 5 10 -3 inch 5 0 0 0 0 0 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 HP) 16 0 0 0 0 0 -Commercial(to 5 HP) 32 0 0 0 0 0 -Industrial(over 5 HP) 42 0 0 0 0 0 Ice Machine/Refrigerator Drain 1 0 0 1 1 1 1 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Station) 6 0 0 0 0 0 Rec.Vehicle Dump station 16 0 0 0 0 0 Shower: -Gang(per head) 1 0 0 0 0 0 -Stall 2 0 0 0 0 0 Sink: -Lav/Bar-Non-Food Related 2 0 2 4 4 8 2 4 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-Food Related 3 0 0 2 6 2 6 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 1 6 2 12 1 6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 3 10 14 37 11 27 Current Fixture Value 27 divided by 16= 1.688 Current EDU 1 EDU= $5,100.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 27 divided by 16= 1.688 over (under) $ 8,619.00 Enter EDU Change Here 1.690 * *Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01. Notes: (1)3-compartment sink is not included in the calculation as it drains into a floor sink. Authorized Name/Signature: Dianna Howse Date: 5/26/2016 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be submitted to the City of"Tigard Building,Division to redeem credits towards future system development charges. I:ABuilding\Sewer Tally\Sewer I'allySheet_510)_0701I5.xlsx ■ TIGARD City of Tigard June 3,2016 Tom Whitaker 28955 S Dalmation Rd Mulino, OR 97042 Re: Permit No. SWR2016-00125 Dear Applicant: • The City of Tigard has processed a refund for fees on the above referenced permit(s) as follows: Site Address: 10140 SW Washington Square Rd Project Name: Zoup Job No.: N/A Refund: ® Check#221231 in the amount of$1,887.00. ❑ Credit card"return" receipt in the amount of$ 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$ Comments: Plumbing fixtures reduced resulting in a reduction of sewer connection fees. If you have any questions please contact me at 503.718.2430. Sincerely, '61"9eleY1-€-- 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 „,„ , . 71 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: Tom Whitaker DATE: 5/26/2016 28955 S. Dalmation Rd Mulino, OR 97042 REQUESTED BY: Dianna Howse DA TRANSACTION INFORMATION: Receipt#: 403560 Case#: SWR2016-00125 Date: 4/28/2016 Address/Parcel: 10140 SW Washington Sq Rd Pay Method: CreditCard Project Name: Zoup EXPLANATION: Refund difference of sewer EDU after reduction in the number of plumbing fixtures added. 1 FONto INFORMATION," ,: / Fee Description From Recei'Pt Revet ue Aceounf Nay 7: Example: Building Permit Fee` Exaa ple.• 2300000:-43104 `$-Ani t Sewer Connection Fee 500-0000-25500 $1,887.00 TOTAL REFUND: $1,887.00 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff •'& 5:2)207.0.2'C— 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: 4, j06,, By: , I:\Building\Refunds\RefundRequest.doc x 09/01/2010 Dianna Howse From: Tom Whitaker <twhitaker@zoup.com> Sent: Wednesday, May 11, 2016 12:53 PM To: Dianna Howse Cc: #Building Permit Technicians Subject: Re:Zoup! Washington Square Too Plumbing Credit Thank you Dianna! Please mail check to 28955 S. Dalmatian Rd. Mulino, OR 97042 Regards, Tom Whitaker Franchise Owner "`;4 AWARD-WINNING SOUP, SALAD AND SANDWICHES 10140 S.W.Washington Square Rd.Tigard,OR 97223 503.505.2400 direct twhitaker@zoup.com 00 .@i x IOU IRAN<HHI Inters , On Wed, May 11, 2016 at 12:46 PM, Dianna Howse <Dianna@tigard-or.gov> wrote: Hello Tom, Debbie is on vacation this week. The plumbing contractor submitted the permit application today to reduce the 2" floor drains from 8 to 5. I have reprinted the plumbing permit and will be adjusting the sewer tally sheet for utility billing to adjust the amount of the service charge. I will email you a copy of the revised sewer tally sheet when it is done. I will be processing the refund for both the plumbing and sewer permits, however please allow 3-4 weeks for the check to be cut. Can you please provide the mailing address where you would like the check sent? Thank you. 1 * Dianna Howse From: Dianna Howse Sent: Wednesday, May 11, 2016 12:47 PM To: 'Tom Whitaker' Cc: #Building Permit Technicians Subject: RE:Zoup! Washington Square Too Plumbing Credit Hello Tom, Debbie is on vacation this week. The plumbing contractor submitted the permit application today to reduce the 2"floor drains from 8 to 5. I have reprinted the plumbing permit and will be adjusting the sewer tally sheet for utility billing to adjust the amount of the service charge. I will email you a copy of the revised sewer tally sheet when it is done. I will be processing the refund for both the plumbing and sewer permits, however please allow 3-4 weeks for the check to be cut. Can you please provide the mailing address where you would like the check sent? Thank you. Dianna Howse Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd.,Tigard, OR 97223 503-718-2430 From: Tom Whitaker [mailto:twhitaker@zoup.com] Sent: Wednesday, May 11, 2016 12:29 PM To: #Building Permit Technicians Subject: Fwd: Zoup! Washington Square Too Plumbing Credit see below Tom Whitaker Franchise Owner >td, AWARD-WINNING SOUP, SALAD AND SANDWICHES 10140 S.W.Washington Square Rd.Tigard,OR 97223 503.505.2400 direct twhitaker@zoup.com /Si Wu', (RA$CHNL nom Forwarded message From: Tom Whitaker<twhitaker@zoup.com> Date: Wed, May 11, 2016 at 11:39 AM Subject: Re: Zoup! Washington Square Too Plumbing Credit To: Debbie Adamski <DEBBIE@tigard-or.gov> Hi Debbie, 1 Do you have everything to process my credit of$1,938? Thank you, Tom Tom Whitaker Franchise Owner AWARD-WINNING 1,-7 SOUP, SALAD AND SANDWICHES 10140 S.W.Washington Square Rd.Tigard,OR 97223 503.505.2400 direct twhitaker@zoup.com tour tRAHCMNL _ " ", .. On Tue, May 3, 2016 at 5:35 PM, Debbie Adamski <DEBBIE@tigard-or.gov> wrote: Tom, Yes. But to make this happen,the contractor needs to submit a revised plumbing application requesting us to remove the 3 floor drains from the scope of work. We will charge $45.00 to process the revision to the issued permit. We will also process a request for a refund to the contractor of 80%of the fees for the fixtures being removed from the permit. We will also revise the sewer tally worksheet, removing the 3 fixtures from the Sewer System Development Charges. The 3 fixtures are worth 6 value points total,or$1,938. Which we will process a refund for this amount. Let me know if you have any questions. I will be out of the office on Wednesday, 5/4/16,so direct any email correspondence to TigardBuildingPermits@tigard- or.gov. This way you will get a quicker response. Debbie Adamski Senior Building Permit Technician City of Tigard I Community Development 13125 SW Hall Blvd.,Tigard, OR 97223 503-718-2450 2 From: Tom Whitaker [mailto:twhitaker@zoup.com] Sent: Tuesday, May 03, 2016 3:29 PM To: Debbie Adamski Subject: Zoup! Washington Square Too Plumbing Credit Hi Debbie, If we remove three floor drains, (1 in each bathroom and the one in front of the freezer) would I receive a refund from the city for these 3 drains? As you may recall, I have already paid $10,506. The architect, contractor and inspector are discussing removing these from the design. Once again thank you for your assistance! Tom Whitaker Franchise Owner AWARD-WINNING SOUP, SALAD AND SANDWICHES 10140 S.W.Washington Square Rd.Tigard,OR 97223 503.505.2400 direct thitaker@zoup.com f ,4 , Ny X sou►! iRANGNNC �. non. DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail rE-mails are retained may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." 3 CITY OF TIGARD SEWER CONNECTION PERMIT s COMMUNITY DEVELOPMENT Permit#: SWR2016-00125 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/02/2016 T r 1?17 g Parcel: 1S135BA00102 Jurisdiction: Tigard Site address: 10140 SW WASHINGTON SQUARE RD Project: Zoup! Subdivision: OAKBURG Lot: 9 Project Description: 2.06 EDU increase. Contractor: Owner: PPR SQUARE TOO LLC PO BOX 847 CARLSBAD, CA 92018 PHONE: PHONE: FAX: FEES Description Date Amount Specifics:, Sewer Connection Fee 04/28/2016 $10,506.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: 2.06 Total $10,506.00 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 by cal••• 83.232.1987 o 1.800.332.2344. Issued c. : � ��J 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. lig 111il Accumulative Sewer Tally Tenant Name: 'COUP! SWR# 2016-00125 Site Address: 10140 SW WASHINGTON SQUARE RD PLM# 2016-00232 TIGARD Parcel#: 1S 135BA00102 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value total#s total values Baptisery/Font 4 0 0 0 0 0 Bath: -Tub/Shower 4 0 0 0 0 0 -Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash: -Each Stall 6 0 0 0 0 0 -Drive through 16 0 0 0 0 0 Cuspidor/Water Aspirator 1 0 0 0 0 0 Dishwasher: -Commercial 4 0 0 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 8 16 8 16 -3inch 5 0 0 0 0 0 -4 inch 6 0 0 0 0 0 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 IIP) 16 0 0 0 0 0 -Commercial(to 5 HP) 32 0 0 0 0 0 -Industrial(over 5 HP) 42 0 0 0 0 0 Ice Machine/Refrigerator Drain 1 0 0 1 1 1 1 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Station) 6 0 0 0 0 0 Rec.Vehicle Dump station 16 0 0 0 0 0 Shower: -Gang(per head) 1 0 0 0 0 0 -Stall 2 0 0 0 0 0 Sink: -Lav/Bar-Non-Food Related 2 0 2 4 4 8 2 4 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-Food Related 3 0 0 2 6 2 6 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 1 6 2 12 1 6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 IOTAI,S 0 0 3 10 17 43 14 33 Current Fixture Value 33 divided by 16= 2.063 Current EDU 1 EDU= $5,100.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 33 divided by 16= 2.063 over (under) $ 10,506.00 Enter EDU Change Here 2.060 * *Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01. Notes: (1)3-compartment sink is not included in the calculation as it drains into a floor sink. Authorized Name/Signature: Debbie Adamski Date: 4/28/2016 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be submitted to the City of"Tigard Building Division to redeem credits towards future system development charges. I:ABuilding\Sewer Tally\Sewer 1'allyShect_5100_070115.slsx City of Tigard • (:t)y1MuNITY DEVELOPyIENT DRP.vRTNENT 1111 r Request for Permit Action TIGARD 13125 SW I Tall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW I Tall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant -(%ontractor ❑ City Staff check(V)one REFUND OR Name: INVOICE TO: (Business or Individual) Vsc--)aryz, rp C`(16-„, c Mailing Address: D 5 :0ThV0L{ i \ I City/State/Zip: �f )u , C(Siog , Phone No.: StO0 — 9-1-9-- 1`-t PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): w ',k.k. - .L/VOID PERMIT APPLICATION. �", REEL' ERMIT FEES (attach copy of original receipt and provide explanation below). ■;I 1 TOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).n Permit #: PL-Ai ao/lei l e0A 3o2. �a),,ev /6 OQ�a,j Site Address or Parcel #: /0/V10 S'&) J 9/4JC7 -_CQ )2.,6 Subdivision Name: Lot #: EXPLANATION: ZZA& L� - e_ .,/s /� /M✓S g_6/y rP TO .S Signature: Ci ___)C---;--Oef2-44&- A: Date: V////(e, Print Name: ---Th e.P6i i.-- 2.-. Gaon-v-,IA,t Refund Policy 1. The city's Community Development Director,Building()fficial or City I?ngincer may authorize the refund of: • .Anv 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 800 0 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 VS postal service. 3. Please allow 3-4 weeks for processing refund requests. G 0 / — 75, o C• 'Ir. / 5• /O 74 , sk, _ • ?€0/ G r f • 0'7 / 9a • 47-5- FOR sI OR OITICE ICE LSE ONLY Route to Sys Admin: Date By Route to Records: Date 6 9 /, By Refund Processed: Date 443 /¢ By Ji',v Invoice Processed: Date By Permit Canceled: Date '� '1,, Parcel Tag Added: Date By I:A Building\Forms\Ro1Pcrmit.Action_U92314.doc : . il 1,,, . . TIGARD City of Tigard June 3, 2016 Manzco Plumbing PO Box 822964 Vancouver,WA 98682 Re: Permit No. PLM2016-00232 Dear Applicant: The City of Tigard has processed a refund for fees on the above referenced permit(s) as follows: Site Address: 10140 SW Washington Square Rd Project Name: Zoup Job No.: N/A Refund: ® Check#221203 in the amount of$84.07. ❑ Credit card"return" receipt in the amount of$ . 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$ . Comments: Plumbing fixtures reduced from 8 to 5 2-inch floor drains resulting in a refund. If you have any questions please contact me at 503.718.2430. Sincerely, <9,f,171ef-7/. > 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: Manzco Plumbing DATE: 5/26/2016 PO Box 822964 Vancouver,WA 98682 REQUESTED BY: Dianna Howse DA TRANSACTION INFORMATION: Receipt#: 403583 Case#: PLM2016-00232 Date: 5/2/2016 Address/Parcel: 10140 SW Washington Sq Rd Pay Method: CreditCard Project Name: Zoup EXPLANATION: Refund difference after reduction in the number of plumbing fixtures from 8 to 5 2" floor drains. REFUND INFORMATION: Fee Description From Receipt Reventie'Aceount No. Example: Building Permit Fee Example: 2300000-43104 $ t. Plumbing Permit Fees 230-0000-43101 $75.06 12%State Surcharge 100-0000-24001 9.01 TOTAL REFUND: $84.07 APPROVALS: SIGN TU t S D TE: If under$5,000 Professional Staff � A 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: /V/6 By: - I:\Building\Refunds\RefundRequest.doc x 09/01/2010