Permit //P77I RErcIVED
*I"
City of Tigard a COMMUNITY DEVELOPMENT DEPARTMENT U Cl19 2017
Request for Permit Action CITY OF TIGARD
BUILDING DIVISION
13125 SW Hall Blvd. •Tigard, Oregon 97223• 503-718-2439 •:sv
TIGARD
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: Ei Owner El Applicant ID Contractor City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) R.A. Warner Plumbing Co. Inc.
Mailing Address: PO Box 493
City/State/Zip: Camas,WA 98607
Phone No.: (360) 772-2490
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED(1):
CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
O INVOICE FOR FEES DUE(attach case fee schedule and provide explanation below).
0 REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: SWR2017-00242
Site Address or Parcel#: 9504 SW WASHINGTON SQUARE RD Parcel#1S1260000300
Project Name: TUMI-Revision 1
Subdivision Name: Lot#:
EXPLANATION: As a result of the plumbing fixture changes, and sewer EDU credit, the sewer
connection permit SWR2017-00242 is no longer required and must be voided.
00'4, If- S /417
Signature: Date: 10/19/2017
Print Name: ' onda Boehm
Refund Policy
I. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
O Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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. Al]refunds will be returned to the original paver in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFLCE USE ONLy
Route to Sys Admia: Date By Route to Records: Date Y 6 re- •••77-f
Refund Processed: Date ,7' By •`••• Invoice Processed: Date By
Permit Canceled: Date /7 By :,,r444-'Parcel Tag Added: Date By
l:\Budding\Fonns\Reqpejthcflqty34.doc
1111111
Ill
TI GARD
November 20,2017 City of Tigard
R.A. Warner Plumbing Co., Inc.
Attn: Rhonda Boehm
PO Box 493
Camas,WA 98607
Re: Permit No. SWR2017-00242
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9504 SW Washington Square Rd
Project Name: Tumi
Job No.: N/A
Refund Method: ® Check#226783 in the amount of$3,465.00.
❑ Credit card "return"receipt in the amount of$
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$ .
Comment(s): Change in scope of work for plumbing fixtures and prior sewer system
development credits applied from capped fixtures resulted in no sewer fees due.
If you have any questions please contact me at 503.718.2430.
Sincerely,
f VA
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
It NI
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: R.A.Warner Plumbing Co. Inc. DATE:
11/8/2017
Attn: Rhonda Boehm
PO Box 493 REQUESTED BY: Dianna Howse
Camas,WA 98607
TRANSACTION INFORMATION:
Receipt#: 412056 Case#: SWR2017-00242
Date: 7/31/2017 Address/Parcel: 9504 SW Washington Sq Rd
Pay Method: Check Project Name: Tunis
EXPLANATION: Per applicant's request as change in plumbing fixture scope of work and credits applied
from prior capped fixtures,resulted in no sewer EDU fees due.
yc `sd"7�3 a d `'_, q .:3 �A.r,,,''' 3 J.*n 4.5
,p� � 1
Sewer Connection Fee
500-0000-25500 $3,465.00
TOTAL REFUND: $3,465.00
APPROVALS: SI S/DATE:
If under$5,000 Professional Staff � Irk/
If under$12,500 Division Manager
If under$25,500 Department Manager
If under$50,000 City Manager
If over$50,000 Local Contract Review Board
:. FORTIDE
MARK,SYSTEM ADMINIS'TRATION X7$E
Case Refund Processed: I Date: I y 6 /,
I.\Building\Refunds\RefundRequest.doc x 09/01/2010
1111 CITY OF TIGARD RECEIPT
i 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Tumi
Site Address: 9504 SW WASHINGTON SQUARE RD J02
/4—A4 fi/v
I Receipt Number: 416570 - 04/06/2018 I
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER
PAID
S WR2017-00242
$-3,465.00
Total: $3,465.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 226783 DHOWSE
Payor: R.A.Warner Plumbing Co., Inc. 04/06/2018 $-3,465.00
Total Payments: $-3,465.00
Balance Due: $3,465.00
Page 1 of 1
CITY OF TIGARD
• RECEIPT
g13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Tumi
Site Address: 9504 SW WASHINGTON SQUARE RD J02
Receipt Number: 412056 - 07/31/2017
CASE NO. FEE DESCRIPTION
REVENUE ACCOUNT NUMBER PAID
SWR2017-00242 Sewer Connection Fee
500-0000-25500 $3,465.00 k-
Total: $3,465.00
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID
Check CASHIER ID RECEIPT DATE RECEIPT AMT
1060
Payor: Jerime Maloney/R.A. Warner Plumbing Co. BTAGGART 07/31/2017 $3,465.00
Total Payments: $3,465.00
Balance Due: $0.00
Page 1 of 1
Accumulative Sewer Tally
_ Tenant Name: TUMI-Revision 1
Site Address: 9504 SW WASHINGTON SQUARE RD SWR# 2017-00242 REVISED
T I G A R D PLM# 2017-00313
Parcel#: 1 S 1260000300
Fixture Value Previous Previous Credits Capped Fixture Fixture
ew 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
Eye Wash 1 0 0 0 0 0
0 0 1 2
Floor Drain/Sink: -2 inch 2 000
-3 inch 5 0 0 1 2 1 2
0 0 0 0
-4inch 6 0
0
-Car Wash 6 0 0 0 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
Living Unit 16 0 0 0 0 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
-Stall 2 0 0 0 0 0
0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0
-Bradley 5 0 0 1 2 2
0 0 0 0 0
-Com/Sery/Util-Food Related 3 0
0 0 0 0
Swimming Pool Filter 1 0
0 0 0 0
Washer-Clothes 6 0
0 0 0 0
Water Extractor 6 0
0 0 10 0
Water Closet-Toilet 6 0
Urinal 6 0 0 1 6 1 6
0 0 0 0
Previous EDU Count 0
Capped EDU Credit 0.88 0
TOTALS 0 0 14.08
0 0 3 10 3 -4.08
Current Fixture Value -4.08 divided by 16= -0.255 Current EDU
1 EDU= $5,500.00
Previous Fixture Value 0
divided by 16= 0.000 Previous EDU
Change -4.08 divided by 16= -0.255
over (under) $ (1,430.00)
Enter EDU Change Here -0.260 *
*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: 9/6/17,.88 sewer credits from PLM2017-00248 applied,.26 credit balance remaining. Dadamski
Authorized Name/Signature: BRANDEN TAGGART X2449
Date: 9/6/2017
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:\Building\Sewer Tally\SewerTallySheet_5500_070117.xlsx
Dianna Howse
,-7/E ) `✓/&f,/.6EAj
From: Dianna Howse
Sent: Thursday, October 19, 2017 1:53 PM
To: 'Rhonda Boehm'
Cc: Albert Shields;#Building Permit Technicians
Subject: RE:Case#SWR2017-00242 - 9504 SW Washington Square Rd - Tumi
g q Az6
Attachments:
Req PermitAction_092314.pdf; SWR2017-00242_REV1.pdf
C:sr Ail
Hello Rhonda,
There was a sewer connection credit of.88 EDU calculated due to the capped sewer fixtures under plumbing permit
PLM2017-00248. Under our policy,the property owner is responsible for retaining the original sewer EDU credit
document that can be submitted for credits when obtaining future plumbing permits.
When the interior plumbing permit PLM2017-00313 was applied for,the sewer EDU credit document was not
submitted, and page 2 of the plumbing permit application completed by the plumbing contractor R A Warner Plumbing
indicated that all plumbing fixtures were "added"to this space resulting in new and additional EDU charges for sewer.
After the$3,465.00 sewer EDU fees were paid, it appears that this information was corrected under the interior
plumbing permit PLM2017-00313, where the original sewer EDU credits of.88 was applied to the newly added fixtures,
resulting still in a remaining sewer EDU credit of.26 for this address. A revised sewer EDU tally was generated (see
attached)and this document is the responsibility of the property owner for future plumbing permit submittals.
As a result of the plumbing fixture changes, and sewer EDU credit,the sewer connection permit SWR2017-00242 is no
longer required and must be voided. Please complete the attached Request For Permit Action form and email it back to
me so that I can void the sewer connection permit and process a refund in the amount of$3,465.00. Please allow 3-4
weeks for a refund check to be mailed to your company.
Thank you and please let me know if you have any questions.
Dianna L. Howse
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct I 503-718-2439 Permits
From: Albert Shields
Sent: Wednesday, October 18, 2017 12:10 PM
To: Dianna Howse
Cc: 'Rhonda Boehm'
Subject: RE: Case #SWR2017-00242
Dianna, do you know anything about this sewer connection fee being waived? Thanks,Albert.
From: Rhonda Boehm [mailto:rhoodles@gmail.com]
Sent:Wednesday,October 18, 2017 12:05 PM
To:Albert Shields<albert@tigard-or.gov>
Subject:Case#SWR2017-00242
1
Good afternoon,
We (R.A. Warner Plumbing Co. Inc.) performed services as a subcontractor for Dugan Building Company several weeks
ago.We applied for and received a permit for the Sewer Connection Fee for work done at 9504 Washington Square-
Space#J02
Portland, OR 97223. We have since billed this cost to the General Contractor(Dugan) and have been notified by Dugan
that the permit fees were waived by the City of Tigard and that we should have received a reimbursement.
There was an original building permit issued for this project. I have attached a copy. I have also attached a copy of the
receipt for the Sewer Connection Fee,and included our contact information in the body of this email. I would appreciate
any help in getting this reimbursement processed.
R.A. Warner Plumbing Co. Inc.
Jerime Maloney—Owner
PO Box 493
Camas, WA 98607
Phone: (360) 772-2490
Email: rawarnerplumbing@gmail.com
Thank you again for any assistance you can provide. Please let me know if any additional information is needed. Enjoy
the rest of your day.
Rhonda Boehm
Office Manager
R.A. Warner Plumbing Co. Inc.
(360) 261-3157 mobile
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.`
2
CITY OF TIGARD SEWER CONNECTION PERMIT
:14 .. COMMUNITY DEVELOPMENT
Permit*: SWR2017-00242
T MARE) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/31/2017
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9504 SW WASHINGTON SQUARE RD J02
Project: Tumi Subdivision: None
Project Description: .63 EDU increase. Lot: None
Contractor: Owner: PPR WASHINGTON SQUARE LLC
PO BOX 847
CARLSBAD, CA 92018
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee
07/31/2017 $3,465.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .63
Total $3,465.00
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 .. .in a copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800. . ''--„„
Issued By: ermittee Signature: 1111 L
Call 503.639. y 7:00 a.m.for the next available inspection .a•nte
This permit card shall be kept in a conspicuous place on the job site until co .I. on of the pr. ect.
Approved plans are required on the job site at the time of each i section.