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Permit (119) RECEIVED City of Tigard • commuNtry DEVELOPMENT DEPARTMENT ...rn AIL, ' N" Request for Permit Action 10 2017 11 •wwwalWiakiriGAR f I-. T,, ,,.„i;1 i 13125 SW Hall Blvd. * Tigard, Oregon 97223• 503-718-2439 MUM%DrVISIOIN TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPerinits@tigard-or.gor FROM: 0 Owner Ej Applicant rij Contractor Li City Staff (heck(V.)one REFUND OR Name: , .. INVOICE TO: ,,, ,- 1 , ,. ; ,./i ,... , 04,,,,,,,,,or Individual) 1 y C IC,(1,I 1 irlii,/ t It 1 -.1 1 't 5 Mailing Address: ,:r? o k...:-..) c) :. , 1 Q Li I(J 0‘. .N r PA 0 6 \--1 -co(1) City/State/Zip: kal •i,_„' t../ F--... c::::::>C,)%).-.) Phone No.: m PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED(1): in CANCEL/VOID PERMIT APPLICATION. 0 REFUND PERMIT FEES(attach copy of original receipt and provide explanation below). 0 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ID REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: V) \\AA ,LLA Le — .)(:)( --- C p e o „...._ _...... . Site Address or Parcel#: Apo 7:..-•--) \--1 cf 5.)...2) \i-v4r\kk o -± ,, . ' Project Name: , A . "_ , Subdiv \v\i ision Name: \A/[ 1,1 , _ VIC' i of#: EXPLANATION: ' 4,10 fac... itio/ Co/-1,0 .• Signature: MAS AA v Oa C— V- Date: 1 I —7I 1 7 Print Name: &fund Polity 1. '11e 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was erroneously paid or collected, • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended, • Not more than 80%of the application or permit fee for issued permits prior to any inspection ret esti. 2. All refunds will be returned to the original payer in the form of a check via I,,!S postal service. 3, Please allow 3-4 weeks for processing refund requests. 7c2. .5 0 — 5:4 er-D "1-'' /-%-Ca 20 -- FOR OFFICE 1.1SE ONLY Route to S,s Admin: Date minimay. Route to Records: Date 29//.....- B C'"7— Refund Processed: Date ' /4' i 13 ig ---nvoice Processed: Date ___By ..e Permit Canceled: Date 1.1q i 7 By w. arcel Tag Added: Dare By 4 x IABLulding\Forms\ReVcrmitAction_012.31 V TIGARD September 21, 2017 City of Tigard DR Horton, Inc. Attn: Emerald Weeks 4380 SW Macadam Ave.,Ste 100 Portland, OR 97239 Re: Permit No. PLM2016-00610 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 8517 SW Schmidt Lp Project Name: Heritage Crossing,Lot 60 Job No.: N/A Refund Method: ® Check#226146 in the amount of$64.96. ❑ Credit card "return"receipt in the amount of$ 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$ Comment(s): Per applicant's request as work was not completed. Refund 80%of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 151171-0i€71- 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 w _ 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 Bequest 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: DR Horton,Inc. DATE: 9/18/2017 Attn: Emerald Weeks 4380 SW Macadam Ave.,Ste 100 REQUESTED BY: Dianna Howse Portland, OR 97239 TRANSACTION INFORMATION: Receipt#: 408733 Case#: PLM2016-00610 Date: 2/6/2017 Address/Parcel: 8517 SW Schmidt Lp Pay Method: CreditCard Project Name: Heritage Crossing,Lot 60 EXPLANATION: Per applicant's request as work was not completed. Refund 80%of permit fees. r �,. ,7rs6,04.t.;,.4.atif4 •�� , t �� q° w4a FPlumbin. Permit _rei `stn 230-0000-43101 $58.00 F5 12%State Surchar•e 100-0000-24001 6.96 TOTAL REFUND: $64.96 APPROVALS: SIGN T RES/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 A' TO `- 4f T.I I,.I`ION 1 Date: By: 1 r Case Refund Processed: I 44).0.z- \ '�2 � \Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT u c jig'. 13125 SW HaII Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Heritage Crossing, Lot 60 Site Address: 8517 SW SCHMIDT LOOP IReceipt Number: 416293 - 03/23/2018 I CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2016-00610 $-64.96 Total: $-64.96 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 226146 DHOWSE 03/23/2018 Payor: D R Horton, Inc. $-64.96 Total Payments: $-64.96 Balance Due: $64.96 Page 1 of 1 CITY OF TIGARD r- RECEIPT ! 13125 SW Hall Blvd.,Tigard OR 97223 q 503.639.4171 TI6AIJ) Project Name: Heritage Crossing, Lot 60 Site Address: 8517 SW SCHMIDT LOOP Receipt Number: 408733 - 02/06/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PLM2016-00610 Backflow Preventer PAID PLM2016-00610 12%State Surcharge-Plumbing 230-000043101 $31.27 PLM2016-00610 Minimum Fee Adjustment-Plumbing 2330-0000-0000-4..431101 $8 70 3101 $41.23 Total: $81.20 PAYMENT METHOD CHECK# CC RUTH.CODE ACCT ID Credit Card CASHIER ID RECEIPT DATE RECEIPT AMT 047367 PUBLICUSERO Payor: dr horton inc 02/06/2017 $81.20 Total Payments: $81.20 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD PLUMBING PERMIT 71COMMUNITY DEVELOPMENT Permit#: PLM2016 00610 13125 SW Hall Blvd.,Ti Date Issued: 02/06/2017 fCCr11?. and OR 97223 503.718.2439 9 Parcel: 2S 111 DA24100 Jurisdiction: Tigard Site address: 8517 SW SCHMIDT LP Project: Heritage Crossing, Lot 60 Subdivision: HERITAGE CROSSING Lot: 60 Project Description: Backflow preventer for irrigation. Contractor: TRADEMARK LANDSCAPES INC Owner: DR HORTON INC. PO BOX 2410 4380 SW MACADAM AVE STE 100 OREGON CITY, OR 97006 PORTLAND, OR 97239 PHONE: 503-631-3893 PHONE: 503-222-4151 FAX: 503-631-4737 FEES Quantity Description Date Amount 1 ea Backflow Preventer 02/06/2017 $31.27 Specifics: 1 12%State Surcharge- 02/06/2017 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment 02/06/2017 $41.23 Class of Work: OTR Plumbing 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: 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. . . '111' Plumbing Permit Applieati t .ECEIVEP , Building Fixtures 11 I:1 '2 5 ?016 Reett%ed * ' ' - . City of Tigard Dateq3 /A//Snle "21— .,' P—ssfAi i t 2ac-vc, !./ 13125 SW Hall Blvd,Tigard.OR 97223 ' I Phone: 503 718 2439 Fax 5035ntit, IOF TIGplanARD Date 8. i Other Perms-Nort4<,-}v/co:rr)s:T4s--- , 5 1 ., Internet NW:t%ttgard-or go DING DIVISIOonfiedAtedSupp l'ad' Inspection Line 503439.417BUILpate Reads./3v ions I 10 fee Page 2 for lements!Worn:a:ion TITE OF WORK FEE* SCHEDI LE Ness construction 1 0 Demolition For special information use checklist Description 1, P. _,1 Ea 1 Total 0 Additionialterationireplacement 0 Other New 1.2-fsmity dwellings(includes 100 tifor each unlit)connection) CATEGORY OF CONSTRE'CTION SFR(1)bath 312 70 1 .4 SFR(2)bath 437 78 1 e 1-and 2-family dwelling 0 Commercial industrial .._.. SFR(3)bath 500.32 1 0 Accessory building 0 Multi-famils ...„,,„ , Each additional bath-kitchen 25.02 0 Master builder I 0 Other Fire sprinkler t s ft; Page 2 _4 ..._...... JOB SITE INFORMATION AM tOCATIO.' Site utilities: Job site address:Cil 0 C91;ki CII 0 AkitA0 Catch basin or area drain I 18 76 Dry well,leach Inc.or trench drain 1 18 76 City/State/21P, Tigard,OR 97223 3,,, Footing dram(no.linear ft ? Page 2 Suite/1)1dg/apt no. Project name sis *, All Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 1576 i Rain drain connector 18 76 1 Sanitary sewer(no linear ft' ) Page 2 I Storm sewer Mo.linear ft i Page 2 . . Water service(no linear 11„ i Page 2 i ----1 Subdivision- [ Lot no.:\DO Fixture Or Rent: Tax map/parcel no.: Backflow presenter 1 1 31 27 ; Backwater valve 12 51 DESCRIPTION OF WORK Clothes washer 25 02 r New SFR 1 1 Dishwasher 25 02 i ItDrinking fountain 2502 1 i* PROPERTY OWNR E 0 TENANT Ejectors sump Expansion tank 25 02 12 51 ; I Name: DR Horton Inc. Fixture/sewer cap - 25 02 Floor dramlloor sinkihub 25 02 Address,4380 SW Macadam Ave Suite 100 . Garbage disposal 25.02 City/State/Z1P' Portland,OR 97239 Hose bib 25.02 Phone:(503) 222-4151 Fax t ) Ice maker 12 51 0 APPLICANT CONTACT PERSON Interceptor grease trap 25.02 Medical gas(value 5 ) Page 2 Business name: DR Horton Inc. Primer 12 51 11 Contact name Emerald Weeks . Roof drain(Commercial) 12.51 Address4380 SW Macadam Ave Suite 100 Sinichasmiavaton 241 02 City/State/ZIP' Portland,OR 97239 Solar units(potable water) 62.54 1 Phone (503 /222-4151 x1107 i Fax'.( ) 1 Tubishowershower pan 12.5i Urinal 25 02 E-mail esweeks@clrhorton.corn, Water closet , 25 02 CONTRACTOR Water heater [ 37 52' Business nameTradernark Landscapes Inc Water pipingIDWV 56 29 Address- PO Box 2410 Other: 2502 CityState/ZIPOre,gon City,OR 97045 ,.. Subtotal Phone'(503) 631-3893 i Fax 16.031 e,,3/ q737 Minimum permit fee: $7250 CCB Lie.: i /3 5-3 ,..„, Plumbin(Lre.,,Ito1: , ,, '.--, Plan res Jew (25%of permit feet . i , State surcharge(12%of permit fee) ' Authorized signature: ,,,e.„..." ' TOTAL PERMIT FEE I Print name: L511//0 :' i Date.2016 1 This permit opplicatioti expires ire permit is not obtained wIthin 1.80 da” Ow it hits been incepted as complete. *Fee tnedlodologt,en ti Tri-Court,Boildtog IndustrySemott Board I aukdolg PeroutsPOTC-PertrotApp doz toe:so 40-46162t to 02 COM WE13). 11==1M11111M,'