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Permit (91) CITY OF TIGARD SEWER CONNECTION PERMIT '•44 COMMUNITY DEVELOPMENT Permit#: SWR2015-00227 Date Issued: 06/23/2016 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S 23/201 2800 Jurisdiction: TIGARD Site address: 14075 SW 118TH CT Project: Medallion Meadows,Lot 21 Subdivision: MEDALLION MEADOWS Lot: 21 Project Description: New SF. Contractor: Owner: JT ROTH CONSTRUCTION INC FOUR D CONSTRUCTION CO 12600 SW 72ND AVE#200 TIGARD,OR 97223 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 06/23/2016 $5,100.00 Sewer Inspection-Residential 06/23/2016 $35.00 Type of Use: SF Class of Work: NEW Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $5,135.00 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: ,/f _„ Q r. Permittee Signature: � �u _ Call 50 .6 .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 o e project. Approved plans are required on the job site at the time of each inspect'.n. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT,... ECEIVED Request for Permit Action AUG c� 2 2016 A f I) 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 •www.tigard-or.gc�v OM'OF TIMARD BUILDING DIVISION TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: X❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: J.T. Roth Construction Inc. INVOICE TO: (Business or Individual) Mailing Address: 12600 SW 72nd Ave City/State/Zip: Tigard, OR 97223 Phone No.: (503)639-2639 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ❑ CANCEL/VOID PERMIT APPLICATION. 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 CONTRACTOR ON PERMIT (do not cancel .ermit . Permit#: MST 2015-00298 _s'!C1A 02-0/5—QO ?c . 7 ) Site Address or Parcel#: 14075 SW 118th Court Project Name: Subdivision Name: Medallion Meadows Lot#: 21 EXPLANATION: After applying for the building permit it was discovered that the plan submitted for permits did not conform well to the site. The applicant has elected to construct a different house plan that will work better with the site Signature: Date: 08/19/2016 Print Name: David Jensen Refund Policy 1. The city's Community Develop ent 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. Route to Sys Admin: Date Q" 94. / y Route to Records: Date 4 7 /,o By — Refund Processed: Date / 7//i, Invoice Processed: Date By Permit Canceled: Date l c//6 By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 2314.doc TIGARD City of Tigard September 23, 2016 J.T. Roth Construction Attn: David Jensen 12600 SW 72nd Ave., #200 Tigard, OR 97223 Re: Permit No. MST2015-00298 6 WR2015-00227 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 14075 SW 118th Ct. Project Name: Medallion Meadows,Lot 21 Job No.: N/A Refund Method: ® Check#222422 in the amount of$28,786.68. 0 Credit card "return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. 0 Trust account"deposit"receipt in the amount of$ Comment(s): Per applicant's request as building plans did not fit on lot and plans were resubmitted under MST2016-00306/SWR2016-00269. Refund 100%of permit fees except for plan review that was already completed when request to cancel permit was received. If you have any questions please contact me at 503.718.2430. Sincerely, 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 II 11 City of Tigard T r c n v 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: J.T. Roth Construction DATE: 8/18/2016 Attn: David Jensen 12600 SW 72nd Ave., #200 REQUESTED BY: Dianna Howse Tigard,OR 97223 TRANSACTION INFORMATION: Receipt#: 404637&404638 Case#: MST2015-00298& SWR2015-00227 Date: 6/23/2016 Address/Parcel: 14075 SW 118th Ct Pay Method: Credit Card Project Name: Medallion Meadows,Lot 21 EXPLANATION: Building plans were not a good fit for this lot and new plans were submitted under MST2016-00306/SWR2016-00269. Refund 100%of permit fees except plan review. :$111g!',1-,:i011:,..01,12 a ® . 12 a... ''�t 74 i irt: .r 3,� . +iLf: F ':::7::' 'rte'),."'14:'.1.4, 4.f."&: ;` " �' a i .x ' ° F� •,,.�� -a� e ens s '"f 4 i Yr-4Z , � � „;�a .',�t;, �u�� � 3s�� � �'� 1 t � ! "4. .$: a 4a y .' A,t »4r -"' :' o *ua tai l',4gi �� �! � 2' '"', .�.R .,, .v„' Building Permit 230-0000-43104 $2,206.80 ,i _Mechanical Permit 230-0000-43102 300.99 ✓ Electrical Permit 220-0000-43103 447.06 Plumbing Permit 230-0000-43101 500.32 'V 12%State Surcharge 100-0000-24001 414.63 Erosion Control 100-0000-43134 461.40 Metro Construction Excise Tax 230-0000-24010 483.48 Tig-Tual School CET 230-0000-24102 3,900.00 ✓ Washington County TDT 405-0000-43320 8,113.00 Parks SDC Improvement 425-0000-43300 4,248.00 Parks SDC Reimbursement 425-0000-43301 1,001.00 Parks SDC Neighborhood 425-0000-43300 1,575.00 Sewer Connection Fee 500-0000-25500 5,100.00 Sewer Inspection 230-0000-43118 35.00 TOTAL REFUND: $28,786.68 APPROVALS: SIGNATURES/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 ��, &f,iX4 . If over$50,000 Local Contract Review Board `FOR TIDLMARB SYSTEM AQMINISTRATION:USE:0 Y- . Case Refund Processed: Date: /0/7//42 BY I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT i2 ; • 13125 SW Hall Blvd.,Tigard OR 97223 iiii 503.639.4171 TIGAR.D LeriGfJ� Receipt Number: 406695 - 10/07/2016 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2015-00227 S EGt/E7. C4/v,v oAj X00 -0000 -�-S.SOT° S 4O7! ' ? $-5,135.00 56-74) -71- 1"15, -e.."--70/1/41 .A70 *MeV - y.3,/, 35% ere Total: $-5,135.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 222422 DHOWSE 10/07/2016 $-5,135.00 Payor: J.T. Roth Construction Total Payments: $-5,135.00 Balance Due: $5,135.00 i Page 1 of 1 CITY OF TIGARD RECEIPT q s * 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD 0,/�rfAJ/tt---- Receipt Number: 404638 - 06/23/2016 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2015-00227 Sewer Inspection-Residential 230-0000-43118 $35.00 — SWR2015-00227 Sewer Connection Fee 500-0000-25500 $5,100.00 — Total: $5,135.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 85600P BTAGGART 06/23/2016 $5,135.00 Payor: JT Roth Construction Total Payments: $5,135.00 Balance Due: $0.00 Page 1 of 1 Dianna Howse From: Dianna Howse Sent: Thursday,August 18, 2016 5:28 PM To: davidj@jtrothinc.com Cc: #Building Permit Technicians; Mark VanDomelen Subject: RE: Medallion Meadows Lot 21: MST2016-00306, SWR2016-00269& MST2015-00298, SWR2015-00227 Attachments: Req PermitAction_082014.doc Hello David, Due to the differences in the building permit plans, and the fact that the fees cross two fee schedule increases(1/1/2016 and 7/1/2016), I am unable to just"credit"the permit fees from one permit to another on the building and sewer permits for lot 21 of Medallion Meadows. You will need to submit a request to void the first permit and process a refund for MST2015-00298. I have attached the request form for you to complete and return to us. We will refund all permit and SDC fees paid on this permit,with the exception of plan review and archiving fees as plan review was already completed on this permit prior to cancellation. Please allow 3-4 weeks for processing the refund check which will be mailed to you. Thank you and please let me know if you have any questions. Dianna Howse Building Division Services Supervisor City of Tigard I Community Development 13125 SW Hall Blvd.,Tigard, OR 97223 503-718-2430 From: Branden Taggart Sent: Thursday, August 18, 2016 2:45 PM To: davidj@ jtrothinc.com Cc: #Building Permit Technicians Subject: RE: Medallion Meadows Permit: MST2016-00306, SWR2016-00269 David, Dianna is working on the credit/refund details. This process is complicated with the changes in SDC fees between the two permits,so it will take a little more time. We will get back to you as soon as we know more. In the meantime, if you can submit the form to get the process started,that would be great. Thank you, 1 e Branden Taggart111114 City of Tigard a p Permit Technician TOGARD Community Development 13125 SW Hall Blvd Tigard. OR 97223 (503)718-2449 ( brandent@tgard-or.gov From: Branden Taggart Sent: Thursday, August 18, 2016 2:24 PM To: 'David Jensen' Cc: #Building Permit Technicians Subject: RE: Medallion Meadows Permit: MST2016-00306, SWR2016-00269 Hi David, If you submit a Request for Permit Action form to us requesting to void permit MST2015-00298,we will credit MST2016- 00306. You can follow the link below to complete the Request for Permit Action: http://www.tigard-or.gov/document center/Building/ReoPermitAction.pdf Once we receive the completed form from you,we will let you know what the balance due is. Let us know if you have any questions. Thanks, Branden Taggart , s City of Tigard i a .. Permit Technician Community Development TIGARD 13125 SW Hall Blvd Tigard, OR 97223 (503)718-2449 brandent©tgard-or.gov From: David Jensen [mailto:davidj@ jtrothinc.com] Sent: Thursday, August 18, 2016 1:22 PM To: Branden Taggart Subject: RE: Medallion Meadows Permit: MST2016-00306, SWR2016-00269 Branden: Thanks for the notification. However, I am wondering about the fees due. As you can see in your records I have already purchased permits for this house. As we began the formwork on the plans submitted we realized that the plans we originally submitted would not work on the lot. We then resubmitted a new plan that better fit the site conditions. I 2 understand that we have incurred costs for the additional plan review but all other fees that have been previously paid for should be credited to the new plan. Please let me know what the revised amount due is for Medallion Meadows lot 21. Thank you DAVID JENSEN J.T. ROTH CONSTRUCTION,INC. 503.639.2639 davidj@jtrothinc.com www.jtrothinc.com From: Branden Taggart [mailto:brandent6tigard-or.gov] Sent: Wednesday, August 17, 2016 9:32 AM To: davidjCTjtrothinc.com Cc: #Building Permit Technicians Subject: Medallion Meadows Permit: MST2016-00306, SWR2016-00269 Hi David, Your permit for lot 21 of Medallion Meadows is ready to issue. The balance due is$34,615.06,and you can pay the permit fees online at https://aca.accela.com/tigard/or in person when you pick up the permit between the hours of 8:00 a.m.and 4:30 p.m., Monday through Thursday. We are closed on Fridays. If you have any questions, please let me know. Thanks, Branden Taggart * City of Tigard $ t: Permit Technician Community Development 13125 SW Hall Blvd Tigard. OR 97223 (503) 718-2449 brandentOtigard-or.gov DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained by the City of Tigard in compliance with the Oregon Administrative Rules"City General Records Retention Schedule." 3