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Permit RECEIVEP City of Tigard * commuN!Ty DEVELOPNfliNT 1)EPARTMENT JUL. 1 o ..?,.- ., ' -1: Request for Permit Action CITY OF TIGARb 13125 SW Hall Blvd. •Tigard,Oregon 97223 a 503-718-2439 •www.tritilloalft DW s* I lort TO: 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: D Owner E3 Applicant Di Contractor El City Staff ch.a(si)oric REFUND OR Name: , ,-- INVOICE TO: i 1., I/ fl ti," (-,,,rti ---, (liunnes or Indtvidual) I V CI(10,1le,v/i"."". LL,,, ,I V -.4,t.'V 1 ' ' C) 1 .,-.) ,„,--'-`,,‘ f " ,.i i, gr-), Mailing Address: .-:? 0 r- ) u;YN t„ ...,‘'/I I 14.1 . .. City/State/Zip: C2) .C', CIe..... ''‘.-- i CC)(...6- Phone No.: t- C;`5"" ? -, — '''') ( -..)) PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): N CANCEL/VOID PERMIT APPLICATION, 0 0 REFUND PERMIT IT:ES (attach copy of original receipt and provide explanation below). INVOICE FOR FEES DUE(attach case fee schedttic and provide explanation below). El REMOVE/REPI.ACE CONTRACTOR ON PERMIT(do not cancel permit). Perrnit#: \--) \WV-724A L-P„ — . .)‘--- cc'S.--1 • • 6 30 .... 1 * ' Site Address or Parcel#: 95,C.,; (:,„,.,) '<:&--,v,„j '', C„.11/4,1"Ntl,,,VV\6 K Project Name: „,,i Subdivision Name: \ AiNA i: ci (....,,A 4 I/7-)1,v 10 Lot#: . ILC)1 Iv EXPLANATION: .,/, \ ,---, ,,,„ ' .--',‘ 9 A. ' - Signature: 6X kkit,./- ( 'AAADA41, '.., Date: Print Name: LAVL\d/t\,C,‘ \ (4.2„. Refund Policy 1. The city's Community Development 1)irmtor,Building Official or City P.tigmeer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan teview fce when an application is withdrawn or canceled before review effort has been expended.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. AU refunds will be returned to the original payer m the form of a cheek via US postal service 3. Please allow 3-4 weeks for processing refund requests. -7Z_ .S0 ''s-f--. ,,,,-; -,, Pt, so ey2ci -- - 1. 72/ ?A -2e) 6't,/, <, /6 . u()R,()FFIct,, USE()NLY Route to Sys Admin: Date 7 ksmipsLiosiono, Route to Records: _Date,37,23 41-- By .lif r Refund Processed: Date jnalle'Zi-,F Invoice Processed: Date B Permit Canceled: Date ' 2 By ...:5",— Parcel Tag Added: Date B' 1,\Building\Forms\RegrermitAetioit. 2314 or ,1111. . TIGARD City of Tigard September 21, 2017 DR Horton, Inc. Attn: Emerald Weeks 4380 SW Macadam Ave.,Ste 100 Portland, OR 97239 Re: Permit No. PLM2016-00630 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 8535 SW Schmidt Lp Project Name: Heritage Crossing,Lot 61 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, da971/7°_,_<, 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 1,1 H • . 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&quest 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#: 409603 Case#: PLM2016-00630 Date: 3/24/2017 Address/Parcel: 8535 SW Schmidt Lp Pay Method: CreditCard Project Name: Heritage Crossing,Lot 61 EXPLANATION: Per applicant's request as work was not completed. Refund 80%of permit fees. eai ell �s�'l e�Y��.,i�.� -� ,t �,�,,,. sr - ..� ��"`� '� ,�-, t. ''. "rs..tz'�.`x. ,*�'�� ` Z.0 Plumbin. Permit 230-0000-43101 $58.00 12%State Surchar.a 100-0000-24001 6.96 TOTAL REFUND: $64.96 APPROVALS: SIGN U /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 Fob^'T ]umm y A RATI+hi i7 Q.y�.aiJ I 1! Case Refund Processed: I Date: I 31 `3,//e I:\Building\Refunds\RefundRequest.doc x 09/01/2010 jpiCITY OF TIGARD '" "I RECEIPT g 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Heritage Crossing, Lot 61 Site Address: 8535 SW SCHMIDT LOOP O—&—,-u A/6 Receipt Number: 416290 - 03/23/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2016-00630 $-64.96 Total: $-64.96 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID Check CASHIER ID RECEIPT DATE RECEIPT AMT 226146 Payor: D R Horton, Inc. DROWSE 03/23/2018 $-64.96 Total Payments: $-64.96 Balance Due: $64.96 Page 1 of 1 R 11,,,_ .. 13125CITY SWOF Hall Blvd.TIGA,Tigard ODR 97223 RECEIPT 503.639.4171 Project Name: Heritage Crossing, Lot 61 Site Address: 8535 SW SCHMIDT LOOP Receipt Number: 409603 - 03/24/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2016-00630 Backflow Preventer PLM2016-00630 12%State Surcharge-Plumbing 230-0000-431010 $$8.20 PLM2016-00630 Minimum Fee Adjustment-Plumbing 10-0000- 70 230-0000-4310101 $8$41.23 Total: $81.20 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID Credit Card 058881 CASHIER ID RECEIPT DATE RECEIPT AMT Payor: dr horton inc PUBLICUSERO 03/24/2017 $81.20 Total Payments: $81.20 Balance Due: $0.00 • Page 1 of 1 CITY OF TIGARD. 2. .71 PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2016 00630 FtGAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/27/2017 Parcel: 2S 111 DA24200 Jurisdiction: Tigard Site address: 8535 SW SCHMIDT LP Project: Heritage Crossing,Lot 61 Subdivision: HERITAGE CROSSING Lot: 61 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 03/24/2017 $31.27 Specifics: 1 12%State Surcharge- 03/24/2017 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 03/24/2017 $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: /4/ Permittee Signature: cr / ice. ,e,,2-.,�__, 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. PIumbina Permit Application Building Fixtures 1 t►u 0, t It . t ,l t►\l City of Tigard Received 71 . 13125 SW Hall Blvd,Tigard OR 97223 Date%By L //7 7 IV p B Phone: 503 718 2439 Fax 503 398 2 Q Plan Review / Other Permit`y* , )`( , .inspection Line: 303.639.4175 Due Ready/B+ rocs ee 2 for tie.A ;t) Internet. www tigard-or gov CITYOF • t 'f, Notified/Method: Supplemental information TYPE OFr g9i It°1(7 nIVISIO 1 s�<-• -� ' FEE* SCHEDULE *New construction 0 Demolition For special information use checklist Description I Qty. 1 Ea. I Total 0 Addition/alteration/replacement 0 Other. New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORI' OF CONSTRUCTION SFR(1)bath 312.70 >� 1-and 2-family dwelling 0 Commercial'industnal SFR(2)bath 437 78 ❑Accessory building 0 Multi-famil+ SFR(3)bath 500.32 ❑Master builder Criher Each additional bath,kitchen 25.02 Fire sprinkler( sq.11.1 Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: ir��3� Std cj_ � + /f/C11/v Catch basin orarea drain 18 76 City/State/ZIP: Tigard, OR 97223 �'ClYl •i` U Dn'++ell,leach line.or trench drain 18.76 Footing drain(no.linear ft: Suite/bldg./apt.no.. 1 Project name' c —) Page 2 le,�� +1'3a Manufactured home utilities 50.03 Cross street/directions to job site: Manholes "i 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft:. 1 Page 2 Storm sewer(no.linear ft.: t Page 2 Subdivision: Water service(no linear ft. ) Page 2 Lot no.: (9( Fixture or item: Tax map/parcel no.: Backflow preventer 1 31.27 DESCRIPTION OF WORK Backwater valve 12.51 New SFR Clothes washer 25 02 / Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25 02 PROPERTY OWNER i 0 TENANT Expansion tank 12.51 Name: DR Horton Inc. Fixture/sewer cap 25 02 Address;4380 SW Macadam Ave Suite 100 Floor drain/floor sink:hub 25 02 Cit}/State/ZIP: Portland,OR 97239 Garbage disposal 25,02 Hose bib 25.02 Phone:(503)222-4151 Fax.( ) Ice maker ❑ APPLICANT CONTACT PERSON Interco tori 12 0 1 p trap 25.02 Business name: DR Horton Inc. Medical gas(value 5 ) Page, Contact name:Emerald'Weeks Primer 12.51 Address:4380 SW Macadam Ave Suite 100 Roof drain(commercial) 12.51 Sink/basin/lavatory 25 02 City/State/ZIP: Portland,OR 97239 Solar units(potable water) 62.54 Phone.(503 )222-4151 x1107 I Fax :( ) Tub/shower/shower pan 12.51 E-mail. esweeks@drhorton.com Urinal 25 02 CONTRACTOR Water closet 25.02 . Rater heater 37.52 Business name Trademark Landscapes Inc Water piping DV+v Address: PO Box 2410 . 56.29 Other: 25 02 CitysState/ZIPOregon City, OR 97045 Subtotal Phone:(503) 631-3893 Fax'1, 1 63,_973? Minimum permit fee: 572.50 CCB Lic.: j l3.S3 "' Plumbin�Lio.no.: '.(.21-1 4,-,:, review 125%of permit fee)_ Ii i f State surcharge(12%of permit fee) Authorized signature: ,,/, ,( ti.r - TOTAL PER-MIT FEE Print name: „5/2_,,L. 1/Ai I Date:2016 1 This permit application expires If a permit is not obtained within 180 days ' after it ties been accepted as complete. 'Fee methodolog}set b}Tri•Count)Building Industry Service Board. 1 Buuding PermitsPltn:-PetnitApp.isu 100109 44046161110 02COM WEB1