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Permit Support Document (18) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 97,y/' 14 Request for Permit Action T 1 c A R[) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.1garclo' v TO: CITY OF TIGARD Ct` _ lr Building Division 1. ' S10 qtltDiNtl 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor M City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) N / � Mailing Address: I City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): MCANCEL/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 permit). Permit#: EG..-2 020/7-001 gS Site Address or Parcel#: //53/ §1.4D 1-hai e 141-0Y Project Name: P2,r./ c , T'i4L h 46 £ Subdivision Name: Lot#: EXPLANATION: C ��-r t-r, -1.012.x,,0 d, Pe_,21•,1 ,-r TYNE., g E FI...0 az./ 7-466 /.5 Signature: C _472.1 Date: be, /17 Print Name: (De-A/5 r e_ /4-b.91451-.-,1 Refund Policy 1. The 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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 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 cs 14 r 7 By Route to Records: Date 7/y /) Refund Processed: Date A1/4- By Invoice Processed: Date By Permit Canceled: Date 9//0 7 By 17r7 Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 2314.doc City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT VOIn li ..it yq� F „ifr W� ir Request for Permit Action 9//V17 °4(1-- T IGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov 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: ❑ Owner Q Applicant Q Contractor [] City Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) Beaverton Plumbing,Inc Mailing Address: 13980 SW Tualatin Valley Hwy City/State/Zip: Beaverton,Oregon 97005 Phone No.: 503-6434619 x106 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): C CANCEL/VOID PERMIT APPLICATION. , 1Jt REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). U INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). El REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: PLM2097-00306 Site Address or Parcel#: 10865 SW Walnut Street Project Name: Reynolds Middle School Subdivision Name: Lot#: EXPLANATION: We were provided with inaccurate address on our Letter of Intent/Contract for this ro ect.Actual protect is in Fairview,Ore on Signature: - , _ 1 4 , , ., Date: 08/22/2017 Print Name: Jacqueline Stewart Refund Policy 1. The 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 requests. 2. AU 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. FOR OFFICE USE ONLY Route to S s Admin Date '�/a7--? 1 B Route to Records: Date y /Y /7 B- i� r Refund Processed: Date N/ , By, • Invoice Processed: Date By Permit Canceled: Date i f y /7 if Parcel T Added: Date _23y I:\Building\Forms\RegPennitAction_® �14. oc From:Beaverton Plumbing 5036437620 07/27/2077 15:14 #343 P.001/002 Plumbing Permit Applic� V C.) i u 9/07 "tit"- Building FixturesVEFOR OFFICE USE ONLY INCity of Tigard JUL 2 7 2017 RCM ed w 13125 SW Hall Blvd.,Tigard,OR 97223 Date;By, j'% Permit irLM / �L?�� Phone: 503.718.2439 Fax 5 $rt Platz Retic 9 i 1 t� C� Dateilly Other Permit, r j7 ?Jd/O. TIGARD Inspection incL . 503.63941r73t '1L�1A1n Internet. www tigard-orgov 'VVIR DIVISION Ril DatcRe/Metbo: 1 lu:is j ®tiee Supplemental e HJpVt Notthed,:Method: t Supplemental Information TYPL OF WORK • FEE* SCHEDULE' • . 0 New construction 0 Demolition For special information use checklist. ( Description I Qty. Ea. j Total ®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for cach utility connection)� CATEGOR.Y OF CONSTRUCTION •••; SFR(1)bath 312.70 0 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78 0 Accessory building j 0 Multi-family SFR(3)bath 500.32 ❑Master builder _ ❑Other Each additional bath/kitchen 25.02 Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION • Site utilities: Job site address:10865 SW WALNUT STREET Catch basin or area drain 18.76 City/State/I.IP:TIGARD/OREGON/97223 Dryweil,leach line,or trends drain 18.76 FOlvLt�- Footing drain(no.linear ft.:_) Page 2 Suite/bldgJapt.no.: Project name:RE ' ' MIDDLE SCHOOL 1) Manufactured home utilities 50.03 Cross street/directions to job site: _ Manholes l 18.76 f --- Rain drain connector 18 76 Sanitary sewer(no.linear ft.: 1 Page 2 it R• y Stonn sewer(no.linear ft.:100) 2 Page 2 _.1-23'1 1 - - - Water service(no.linear if.: ) Page 2 Subdivision: -�- Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK • Backwater valve 12.51 INSTALL ROOF DRAINS,,:OFF ANI)REINSTALL SINK Clothes washer 25 02 Dishwasher - 25.02 64-0, - -- --- -- Drinking fountain _ 25.02 Ejectors/sump 25.02 1 0•PROPERTY''OWNED:::f •0 :TENANT 1 xpansion tank - 12.51 Name: Fixture/sewer cap / 25.02 A 51D Address: Floor drain/floor sink/hub 25.02 1 Garbage disposal 2 City/State/ZIP: I g p 5.02 I 1 Hose bib 25 02 Phone:( ) Fax:( ) li i Ice maker 12.51 0 APPLICANT ►* CONTACT-PERSON. Interceptor/grease trap 25.02 Business name:BEAVERTON PLUMBING,INC 4 Medical gas(value:$_) Page 2 Contact name:JACKIE SiEW'AR7 _ Primer 12 51 Roof drain(commercial) 12.51 Address:13980 SW'TUALATIN VALLEY HWY Sink/basin/lavatory 1 1 25.02 25.02 City/State/"ZIP:BEAVERTON,OREGON 97005 Solar units(potable water) 62.54 Phone:(503)643-7619 X106 Fax::(503-)643-7620 Tub/shower/shower pan - 12.51 E-mail:jackie!a beavertonplumbing.com - - Urinal 25.02 CONTRACTOR. Water closet 25.02 Business name:BEAVERTON PLUMBING,INC Water heater 37.52 Water piping/DW V 56.29 Address:13980 SW TUALATIN VALLEY HWY Other: .___. 25.02 City/State/ZIP:BEAVERTON,OREGON 97005 T _ Subtotal 150.10 Phone:(503)643-7619 X106 Fax:(503)643-7620 Minimum permit fee: $72.50 CC'B Lie.:12889 Plumbing Lie.no.:34-4PB 7/// _ - Plan review (25%ofpermit fee) State surcharge(l2%of permit fee) 18.01 Authorized signator . 1-4- 4--(.-.-G... TOTAL PERMIT FEE 168,11 I I This permit application expires if a permit is not obtained within 180 days Print name.JACQUELINE STEWART Date:07/24/2017 __ll after it has been accepted as complete. "Fee methodology set by Tri-County Building industry Service Board f:'1 '•.P Idi naernu tsiPLMt1-PermitApp.dec 10;01/09 440-4616T(IO/02/COMJWEB) ©I From:Beaverton Plumbing 5036437620 07/27/2017 15:14 #343 P.002/002 Plumbing Permit Application - City of Tigard Page 2 -Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site'Utilities .. . Qtr Fee(ea) total :Square Footage : Permit Fee. Footing drain-1"100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,001 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1st 100' 62.54 7,201 and greater 1 $327.54 Sewer-each additional 100' 37.52 Water Service- 1st 100' 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 Valuation. Permit:Fee: Storm&Rain Drain-1st 100' 2 62.54 $1.00 to$5,000.00 Minimum fee$72.50 Storm&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for Other inspeetions;or Fees qtr dee(ea) 7otat each additional$100.00 or fraction thereof,to and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/hr each additional$100.00 or fraction thereof,to (minimum charge-1/2 hour) and including$25,000.00. Inspections outside of normal business 90.00/hr $25,001.00 to$50,000.00 $379.50 for the first$25.000.00 and$1.45 for hours(minimum charge-2 hours) each additional$I00.00 or fraction thereof,to Reinspection Fees 90.00/hr and including$50,000.00. Additional plan review for revisions 90.00/hr . 55(1,001.00 and up $742.00 for the first$50,000.00 and$1.20 for _(minimum charge-1/2 hour) i each additional$100.00 or fraction thereof. Subtotal- - Commercial Fixture Work: Are you capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees*. Quantity by Fixture Type Plan Review..for Plumbing Installations..`: Fixture Typr for: Replace) Work Performed: Capped .Added Relocate Plan review is required for any of the following. ' Baptistry/Font Please check all that apply. Bath -Tub/Shower D Any new commercial building with water service 2"and -Jacuzzi/Whirlpoolgreater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive Thru 0 New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OAR918-780-0040. Dishwasher -Commercial 0 Medical gas and vacuum systems for health care facilities. -Domestic 0 Any multipurpose fire sprinkler system. Drinking Fountain 0 Any complex structure as defined in OAR918-780-0040. Eye Wash Floor Drain/sink -2" Submit 1 sets of plans with any of the above. -3" 4 Isometric or Riser Dia ram Car Wash Drain g Garbage Domestic-non-food 0 Isometric or riser diagram is required for new buildings Disposal -Domestic-food related that meet the qualifications above. -Commercial-food related -Industrial-food related Ice MachiRefria.Drains Oil Separator(Gas Station) Comments regarding fixture work: Rec.Vehicle Dump Station Shower -Gang -Stall Sink/Lav -Non-food related 1 �--�� -SLA e 4¢7-E" 67c1 -Bradley -Commercial-food related -Service Sw Washering Pool Filter *Note: If the fixture work under this permit results in an Washer-Clothes Water Extractor increase of sewer EDUs,a sewer permit will be issued and WaterCloset-Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. Other Fixtures: http://www.ti gard-or.gov/document_center/Au i l d i ng/PL M F_Perm i to pp.dbx CITY OF TIGARD FEE AND PAYMENT HISTORY 11114 s„ 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD PLM2017-00306 - 10865 SW WALNUT ST, TIGARD, OR 97223 Fowler Middle School Revenue Payment Fee Description Account Number Fee Amount Invoiced Paid Date Paid Method Receipt# Due Storm Sewer 230-0000-43101 $62.54 $62.54 $62.54 Fixture/Sewer Cap 230-0000-43101 $25.02 $25.02 $25.02 Sink 230-0000-43101 $25.02 $25.02 $25.02 12%State Surcharge-Plumbing 100-0000-24001 $13.51 $13.51 $13.51 Totals for Fees $126.09 $126.09 $0.00 $126.09 Receipt# Payment Method Check# Payor: Receipt Date Receipt Amount Total Payments: $0.00 Balance Due: $126.09 Debbie Adamski From: Debbie Adamski Sent: Tuesday, August 22, 2017 7:25 AM To: jackie@beavertonplumbing.com Cc: #Building Permit Technicians Subject: PLM2017-00306, Fowler Middle School, 10865 SW Walnut Jackie, This is a second notice that this permit has been ready to issue since 7/31/17. The balance due is$126.09. You can pay the fees online at https://aca.accela.com/tigard/by searching for the permit number, or in person if you come in to pick up the permit, Monday-Thursday, 8:00 am to 4:30 pm. We are closed on Fridays. Debbie Adamski Senior Building Permit Technician City of Tigard I Community Development 13125 SW Hall Blvd.,Tigard, OR 97223 503-718-2450 1