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Permit Support Document (18) r7, 4 CITY OF TIGARD PLUMBING PERMIT a, COMMUNITY DEVELOPMENT Permit#: PLM2017-00535 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/21/2017 Parcel: 2S 103AD00502 Jurisdiction: Tigard Site address: 11200 SW ERROL ST Project: Megan Hewitt Subdivision: ECHO HEIGHTS Lot: 10 Project Description: Replacing kitchen sink drain line only,laundry drain line and floor drain with primer. Contractor: 3 MOUNTAINS PLUMBING Owner: HEWITT, DUSTIN A&MEGAN K 524 N TILLAMOOK ST 11200 SW ERROL ST PORTLAND, OR 97227 TIGARD, OR 97223 PHONE: 503-670-1342 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Clothes Washer 12/21/2017 $25.02 Specifics: 1 ea Floor Drain/Floor Sink/Hub 12/21/2017 $25.02 1 ea Primer 12/21/2017 $12.51 Type of Use: SF 1 ea Sink 12/21/2017 $25.02 Class of Work: ALT 1 12%State Surcharge- 12/21/2017 $10.51 Type of Const: Plumbing Occupancy Grp: 21 Cash Over 12/21/2017 $21.01 Stories: Total $119.09 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 questios to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: �, ( //' } _ Permittee Signature: .7,7/Vz:/,./1,7 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. 71 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 z' 503.639.4171 TIGARD Project Name: Megan Hewitt Site Address: 11200 SW ERROL ST Receipt Number: 414704 - 12/21/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2017-00535 Clothes Washer 230-0000-43101 $25.02 PLM2017-00535 Floor Drain/Floor Sink/Hub 230-0000-43101 $25.02 PLM2017-00535 Primer 230-0000-43101 $12.51 PLM2017-00535 Sink 230-0000-43101 $25.02 PLM2017-00535 12%State Surcharge-Plumbing 100-0000-24001 $10.51 PLM2017-00535 Cash Over 100-0000-48001 $21.01 Total: $119.09 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 04674G PUBLICUSER107 12/21/2017 $119.09 Payor: william kerrigan Total Payments: $119.09 Balance Due: $0.00 Page 1 of 1 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT ` I al Request for P r ' q emit Action 7111 TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: E Owner ❑ Applicant ❑ Contractor ity Staff Check(1)one REFUND OR Name: INVOICE TO: (Business or Individual) 3 ,-„ /S ,A L,-,/I%, ,-/-1( i� ?Y Mailing Address: __$ Al 77 L �`�`lx- c�i City/State/Zip: A,e.f Lr,3-n/A ) 117'2_ G�'�2e2. 7 Phone No.: 'meq - C 70 --/;31/..2- PLEASE / 1jPLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ ANCEL/VOID PERMIT APPLICATION. i REFON 1 RMIT FEES (attach copy of original receipt and provide explanation below). CE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: PLS G / 7 Oa_5-3 5' Site Address or Parcel#: //4,2.00 Siz,1 ��/LO C.- S Project Name: /7.474.1/ /7 Subdivision Name: Lot#: EXPLANATION: / j,-J/ 572 f yt-2 E---A/7 /-`/ ,y C -71 c fn/ Scc-p d/— it- og4- Signature: d-.zs - Date: / �/2-(// 7 Print Name: . /;.9-,JAzT- 6 +J'rr 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 By Route to Records: Date y L, / Refund Processed: Date /212,f/,',7 By ...or, Invoice Processed: Date By Permit Canceled: Date Alier B /-.., Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_0 22314.doc -'I " TIGARD January 18, 2018 City of Tigard 3 Mountains Plumbing 524 N Tillamook St Portland, OR 97227 Re: Permit No. PLM2017-00535 Dear Applicant: The City of Tigard has processed a refund for fees on the above referenced permit(s) as follows: Site Address: 11200 SW Errol St Project Name: Hewitt Job No.: N/A Refund: ® Check#227166 in the amount of$21.01. 0 Credit card "return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be ❑ credited to your account by the company that issued your card. Trust account "deposit"receipt in the amount of$ Comments: Refund overpayment of permit fees resulting from change in scope of work. If you have any questions please contact me at 503.718.2430. Sincerely, 4110 t ' .." 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 INV TigAccela City Refund Request TIGARD This form is used for refund requests of land use, development engineering andpermit 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: 3 Mountains Plumbing 524 N Tillamook St. DATE: 12/28/2017 Portland, OR 97227 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 414704 Date: 12/21/2017 Case#: PLM2017-00535 Pay Method: 2/21Card Address/Parcel: 11200 SW Errol St. Project Name: Hewitt EXPLANATION Refund overpayment erp yment of permit fees from change in scope of work e ®u ' � W 3 �3 �It ,� pia'Vifi .V.1''-- , t v 89 5� = � ,� l rnit A � ,,,'',$ rCash Over 100-0000-48001 $21.01 TOTAL REFUND: $21.01 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 If over$50,000 Local Contract Review Board Case Refund Processed: '4°7"- "MAW -4', .� Ifll11T S 0014 ',4 =,-2-,':,'" :3.1.4* : Date: �� B : IABui(ding\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD $' 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT - 503.639.4171 TIGA Project Name: Megan Hewitt Site Address: 11200 SW ERROL ST Receipt Number: 416600 - 04/06/2018 CASE NO. FEE DESCRIPTION PLM2017-00535 REVENUE ACCOUNT NUMBER PAID $-21.01 Total: $-21.01 PAYMENT METHOD CHECK# CC AUTH.CODE Check ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT 227166 Payor: 3 Mountains Plumbing DHOWSE 04/06/2018 $-21.01 Total Payments: $-21.01 Balance Due: $21.01 Page 1 of 1 IN CITY OF TIGARD i • 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT 503.639.4171 TIGARD Project Name: Megan Hewitt Site Address: 11200 SW ERROL ST o2/cr�rA0,}—i.,, I Receipt Number: 414704 - 12/21/2017 I CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2017-00535 Clothes Washer PLM2017-00535 Floor Drain/Floor Sink/Hub 230-0000-43101 $25.02 PLM2017-00535 Primer 230-0000-43101 $25.02 PLM2017-00535 Sink 230-0000-43101 $12.51 PLM2017-00535 12%State Surcharge-Plumbing 230-0000-43101 $25.02 100-0000-24001 $10.51 PLM2017-00535 Cash Over 100-000048001 $21.01 ,c--, Total: $119.09 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID Credit Card CASHIER ID RECEIPT DATE RECEIPT AMT 04674G PUBLICUSER107 12/21/2017 Payor: william kerrigan $119.09 Total Payments: $119.09 Balance Due: $0.00 Page 1 of 1 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 11200 SW ERROL ST, TIGARD, OR, 97223 Record Type: Record ID: Residential - Plumbing PLM2017-00535 Inspection Type: Inspector: 399 Plumbing final Don Sylvester Result: PASS - NoCofO Comments: 1 . Plumbing underslab,rough in,and final- approved for drain repair. Violation Summary: Inspector Contractor