Permit (69) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
rI1
Request for Permit Action
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: ❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: "¢7-j .2,31- 4 �1W/2,946'
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INVOICE TO: (Business or Individual) %/6 . — 771,9 i y.%7 e(hi°/.3/J x1c
Mailing Address: 6 ?6, 0 Sct) --5�-.446 e
City/State/Zip: /7G41, 9
Phone No.: --Co "3 y3/ - 90 9_3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
111 CANCJL/VOID PERMIT APPLICATION.
CREFUN9 PERMIT FEES (attach copy of original receipt and provide explanation below).
�j 1 INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: /7 20,., (o L,
Site Address or Parcel #: Fi yo J& 761 -.y /j
Project Name: - { j1 6Zi—I (9-j/C2A J (7e71/77-C-72—
Subdivision Name: Lot#:
EXPLANATION:,7C 9- 6-6;7 ,gin/ /°e S� �`// (Al 6 /,k ref t" 6-1(
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Signature: Date:
Print Name:
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
C., 2 $ rG 5'. e'7) 1/9,/,2e-,17
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FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date 9/2./,p B�
Refund Processed: Date �� /fes By , Invoice Processed: Date By
Permit Canceled: Date /1/ By Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_09_314.doc
III . 11
TIGARD
City of Tigard
April 18,2018
Tigard-Tualatin School District 23J
Attn: Sarah Mehrabzadeh
6960 SW Sandburg St
Tigard, OR 97223
Re: Permit No. SWR2017-00366
Dear Applicant:
The City of Tigard has processed a refund for fees on the above referenced permit(s) as
follows:
Site Address: 8040 SW Durham Rd.
Project Name: Durham Education Center
Job No.: N/A
Refund: ® Check#228228 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$
Comments: Change in plumbing fixture scope of work resulted in a reduction of sanitary
sewer system development fees and refunded the difference.
If you have any questions please contact me at 503.718.2430.
Sincerely,
# 9 C x -
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
Accumulative Sewer Tally
= Tenant Name: DURHAM EDUCATION CENTER SWR# 2017-00366
T t G A K n Site Address: 8040 SW DURHAM RD PLM# 2017-00474
Parcel#: 2S1136000300
Fixture Value Previous Previous Credits Capped Fixture Fixture New 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 1 2 1 2
Drinking Fountain 1 0 0 2 2 2 2
Eye Wash 1 0 0 1 1 1 1
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3 inch 5 0 0 2 10 2 10
-4 inch 6 0 0 4 24 4 24
-Car Wash 6 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 0 0 0 0
Living Unit 16 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 0 0 0 0
-Stall 2 0 0 1 2 1 2
Sink:
-Lav/Bar-Non-Food Related 2 0 0 19 38 19 38
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 3 9 3 9
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 9 54 9 54
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 44 154 44 154
Current Fixture Value 154 divided by 16= 9.625 Current EDU 1 EDU= $5,500.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 154 divided by 16= 9.625 over (under) $ 52,965.00
Enter EDU Change Here 9.630 *
*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:
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 1/3/2018
Building Division
INote: 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
Accumulative Sewer Tally
i II
a Tenant Name: DURHAM EDUCATION CENTER SWR# 2017-00366 REVISED
T 1 G A R D Site Address: 8040 SW DURHAM RD PLM# 2017-00474
Parcel#: 2S 113B000300
Fixture Value Previous Previous Credits Capped Fixture Fixture New 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 1 2 1 2
Drinking Fountain 1 0 0 2 2 2 2
Eye Wash 1 0 0 1 1 1 1
Floor Drain/Sink: -2 inch 2 0 0 2 4 2 4
-3 inch 5 0 0 2 10 2 10
-4inch 6 0 0 2 12 2 12
-Car Wash 6 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 0 0 0 0
Living Unit 16 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 0 0 0 0
-Stall 2 0 0 1 2 1 2
Sink:
-Lay/Bar-Non-Food Related 2 0 0 21 42 21 42
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 9 54 9 54
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 44 144 44 144
Current Fixture Value 144 divided by 16= 9.000 Current EDU 1 EDU= $5,500.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 144 divided by 16= 9.000 over (under) $ 49,500.00
Enter EDU Change Here 9.000 *
*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:
Authorized Name/Signature: Dianna Howse Date: 3/14/2018
Building Division
IN
ote: 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
R
Dianna Howse
From: Dianna Howse
Sent: Thursday, March 15, 2018 4:36 PM
To: 'Sarah Mehrabzadeh'; Michael DiPasquale
Cc: Sarah Oaks; Debbie Pearson
Subject: RE: FW: Plumbing/Sewer for Durham Education Center- 8040 SW Durham Rd
Hi Sarah,
Unfortunately, we cannot credit a refund check back into a trust account.
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 1503-718-2439 Permits
From:Sarah Mehrabzadeh [mailto:smehrabzadeh@ttsd.k12.or.us]
Sent:Thursday, March 15, 2018 4:33 PM
To: Michael DiPasquale<mdipasquale@daycpm.com>
Cc: Dianna Howse<Dianna@tigard-or.gov>; Sarah Oaks<sarah@daycpm.com>; Debbie Pearson
<dpearson@daycpm.com>
Subject: Re: FW: Plumbing/Sewer for Durham Education Center-8040 SW Durham Rd
Dianna
Is it possible to credit our trust account instead? I am not sure how much the refund is?
Thanks
On Thu, Mar 15, 2018 at 3:59 PM, Michael DiPasquale <mdipasquale@daycpm.com>wrote:
Hi Dianna
Your email made its way to me and I can help you out. Please contact-
Sarah Mehrabzadeh
Bond Accountant
Tigard-Tualatin School District 23J
6960 SW Sandburg Street
Tigard, OR 97223
1
Phone: (503)431-4093 Fax: (503)431-4037
smehrabzadeh@ttsd.kl2.or.us
Thank you.
DAY Mike DiPasquale PE
Sr. Project Manager
.41
Ax'"`'"3" DAYCPM,An Otak
Division
Cell:971.284.1907
From: Dianna Howse [mailto:Dianna a,tigard-or.gov]
Sent: Thursday, March 15, 2018 10:36 AM
To: Heather Hardie-Hill <hhardie-hill@glumac.com>
Cc: #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Plumbing/Sewer for Durham Education Center- 8040 SW Durham Rd
Hello Heather,
I am reaching out to you as the applicant listed on the plumbing permit for this project.
Due to a change in the fixture count of the permit, this resulted in an overpayment for the sewer SDC fees paid
by the Tigard-Tualatin School District.
Can you please provide me with a contact name at the school district so that I can explain about our refund
process and where to send the refund check?
Thank you.
2
CITY OF TIGARD SEWER CONNECTION PERMIT
cri
2 Y '.
COMMUNITY DEVELOPMENT Permit#: SWR2017-00366
T E G.A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2018
Parcel: 2S 113B000300
Site address: 8040 SW DURHAM RD Jurisdiction: Tigard
Project: Durham Education Center Subdivision: None
Project Description: 9.0 EDU increase for sewer connection of new 17,828 sq.ft.alternative high school. dot: None
Contractor:
Owner: TIGARD-TUALATIN SCHOOL DISTRICT
6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee
02/26/2018 $52,965.00
Type of Use: COM Sewer Inspection-Commercial 02/26/2018
$45.00
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 9.0
Total $53,010.00
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 obtain a copy of the rules or direct questions
to OUNC by calling 50 32.1987 or 1.800.332.2344.
Issued By:
Permittee Signature: Q r /7,G i 6,9...7---(0,1
--- ",/,47
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. �I
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.
Accumulative Sewer Tally
•
s Tenant Name: DURHAM EDUCATION CENTER SWR# 2017-00366 REVISED
TI G A R D Site Address: 8040 SW DURHAM RD PLM# 2017-00474
Parcel#: 2S 113B000300
Fixture Value Previous Previous Credits Capped Fixture Fixture New 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 1 2 1 2
Drinking Fountain 1 0 0 2 2 2 2
Eye Wash 1 0 0 1 1 1 1
Floor Drain/Sink: -2 inch 2 0 0 2 4 2 4
-3 inch 5 0 0 2 10 2 10
-4inch 6 0 0 2 12 2 12
-Car Wash 6 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 0 0 0 0
Living Unit 16 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 0 0 0 0
-Stall 2 0 0 1 2 1 2
Sink:
-Lay/Bar-Non-Food Related 2 0 0 21 42 21 42
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 9 54 9 54
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 44 144 44 144
Current Fixture Value 144 divided by 16= 9.000 Current EDU 1 EDU= $5,500.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 144 divided by 16= 9.000 over (under) $ 49,500.00
Enter EDU Change Here 9.000 *
*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:
Authorized Name/Signature: Dianna Howse Date: 3/14/2018
Building Division
INote: 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