Permit (192) "
TIGARD
City of Tigard
August 9, 2019
PMSI LLC
8295 NE Evergreen Pkwy, Ste 204
Hillsboro, OR 97124
Re: Permit No. PLM2019-00188
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9777 SW Washington Square Rd
Project Name: Hollister Co.
Job No.: N/A
Refund Method: lz Check#232939 in the amount of$67.26.
❑ Credit card "return" receipt in the amount of$
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 scope of work was changed and permit was not
required. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
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
1,111
III
0 City of Tigard
T I G A R U 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: PMSI LLC DATE: 8/2/2019
8295 NE Evergreen Pkwy., Ste 204
Hillsboro, OR 97124 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 423253 Case#: PLM2019-00188
Date: 5/3/2019 Address/Parcel: 9777 SW Wash Square Rd
Pay Method: CreditCard Project Name: Hollister Co.
EXPLANATION: Per applicant's request as scope of work changed and permit was not required. Refund
80%of permit fees.
REFUND INFORMATION: f . ${. as µs rf « '' ' - 7
fne..a> . �e "moo
Fee Description From Receipt Revenue Account No. Refund
.
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plumbing Permit 230-0000-43101 $60.05
12%State Surcharge 100-0000-24001 7.21
TOTAL REFUND: $67.26
APPROVALS: SIGNATU / ATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY '.' ' t,
Case Refund Processed: Date: 1--/)--z/5._, By: j< e.)
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
q
CITY OF TIGARD RECEIPT
t I13125 SW Hall Blvd.,Tigard OR 97223
P
503.639.4171
TIGARD
Project Name: Hollister Co.
Site Address: 9777 SW WASHINGTON SQUARE RD D09
Receipt Number: 436081 - 08/27/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2019-00188 $-67.26
Total: $-67.26
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 232939 DHOWSE 08/27/2021 $-67.26
Payor: PMSI LLC
Total Payments: $-67.26
Balance Due: $67.26
Page 1 of 1
CITY OF TIGARD RECEIPT
u
1,111
a 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Hollister Co.
Site Address: 9777 SW WASHINGTON SQUARE RD D09
U/Z/ems-/kittZ.--
I Receipt Number: 423253 - 05/03/2019
I
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2019-00188 Drinking Fountain 230-0000-43101 $25.02
PLM2019-00188 Sink 230-0000-43101 $50.04
PLM2019-00188 12%State Surcharge-Plumbing 100-0000-24001 $9.01
Total: $84.07
PAYMENT METHOD CHECK# AUTH CODE ACCT ID RECEIPT DATE RECEIPT AMT
Credit Card
Payor: Russ Kosters 030519E3D-4BB CASHIER ID
CASHIER
PUBLICUSER147 05/03/2019 $84.07
Total Payments: $84.07
Balance Due: $0.00
Page 1 of 1
To: Brandy Solano <bsolano@msi-systems.com>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: RE: Plumbing Permit Application: PLM2019-00188 -9777 SW Washington Square Rd.
Hi Brandy,
I spoke with our building official, and he is okay with voiding this permit since inspections have not taken place. I have
attached the Request for Permit Action form above for you to complete. Once we receive the completed form, we will
issue a refund. Refunds are currently taking us (2) months to process due to our current workload. Please let me know
if you have questions.
Thank you,
Branden Taggart
4r City of Tigard.
i ■ + Senior Permit Technician
Community Development
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or.gov
From: Brandy Solano<bsolano@msi-systems.com>
Sent:Tuesday,June 4, 2019 9:18 AM
To: Branden Taggart<brandent@tigard-or.gov>
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: RE: Plumbing Permit Application: PLM2019-00188-9777 SW Washington Square Rd.
Branden, at Hollister they eliminated all of the rough-in work for the sinks, and drinking fountain. All we did was switch
out two lay faucets. Can we cancel the permit for this?Or do we need to call in a final just to look at a faucet exchange? I
just do not want an open plumbing permit to hold the GC up from getting a building final. Please let me know our
options.Thank you.
Brandy Solano
Assistant Project Manager
•
LLC
Ph: 503.466.2222 Ext. 122
bsolano@msi-systems.com
2
lig CITY OF TIGARD 8/2/2019
13125 SW Hall Blvd.,Tigard OR 97223 10:34:45AM
503.639.4171
TIGARD Activity Listing
Case #: PLM2019-00188
Project Name: Hollister Co.
Site Address: 9777 SW WASHINGTON SQUARE RD D09
DATE DONE
CODE DESCRIPTION7.4 " " 4. 4, & -
tv-
(Descending Order) 4.
w ,
399 Plumbing final 06/11/2019 PASS-No C of Aaron Cillo-Gobel Note:existing fixtures ok.
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CaseActivityShortForm.rpt Page 1 of 1
111
City of Tigard • COMMUNITY DEVELOPMENT NT DEPARTMENT
Request for Permit Action er/r/f 4 —
i 1 G r! 13125 SW I fall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD RECEIVED
Building Division
13125 SW Hall Blvd.,Tigard,OR. 97223 JUN _
Phone: 503-718-2439 Fax: 503-598-1960 TigardBu ldingPermits@ti rd-or o2019
CITY f IGARD
FROM: E Owner ❑ Applicant ® Contractor [Z(( DIVISION
ch,,et ram)„tic
REFUND OR Name:
INVOICE TO: (13usine's or r„dividual% PMSI LLC
Mailing Address: 8295 NE Evergreen Pkwy., Ste. 204
City/Stare/Zip: Hillsboro, OR 97124
Phone No.: 503-466-2222
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES S (attach copy of original receipt and provide explanation below).
n INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: PLM2019-00188
Site Address or Parcel #: 9777 SW Washington Square Road, D09
Project Name: Hollister
Subdivision Name: Lot#:
EXPLANATION: Scope of work was eliminated.
i Art:, f i t -
/NSi° ---e 7-o ,77c 6/1V/
r�+ C c n�'�` �c��v�T �a� ��..iff-� Da./ T
Signature: `•- 1.0 ,{ � Date: 6/4/19
Print Name: Brandy Solano
Refund Policy
I. the city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• \ny fee which was erroneously paid or collected.
• Not more than 80°o of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 800 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. 7‹ 0 , p.y O
r1
FOR OFFICE USE ONLY
Route to Sys Admin: Dare 6 Ij jilt By _1 , Route to Records: Date 7�7 By!#
Refund Processed: Dare ./ / By Invoice Processed: Date By
Permit Canceled: Date /� q B' Parcel Tag Added: Date By
g\
1.\Buildin 'arms\KegPermic:\crion_i_t15I due
CITY OF TIGARD PLUMBING PERMIT
11111 "
COMMUNITY DEVELOPMENT Permit#: PLM2019-00188
TI AB D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2019
Parcel: 161260000300
Jurisdiction: Tigard
Site address: 9777 SW WASHINGTON SQUARE RD D09
Project: Hollister Co. Subdivision: None Lot: None
Project Description: Interior plumbing for TI: Replacing(1)drinking fountain and(2)sinks.
Contractor: PMSI LLC Owner: PPR WASHINGTON SQUARE LLC
21195 NW EVERGREEN PKWY#204 PO BOX 847
HILLSBORO, OR 97124 CARLSBAD, CA 92018
PHONE: 503-466-2222 PHONE:
FAX: 503-466-2211
FEES
Quantity Description Date Amount
1 ea Drinking Fountain 05/03/2019 $25.02
Specifics: 2 ea Sink 05/03/2019 $50.04
1 12%State Surcharge- 05/03/2019 $9.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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: Permitteg Signature:
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.
. . -
Plumbing Permit Anulicattoilli
E 1
( EVEC)
Building Fixtures FOR (.1111( F 1 SE ONEN
APR 2 9 2019 ()atom . il Permit
City of Tigard
503e5t4-; lkit: tjirlFliIRN/
Received, Alr -
,114 4 13125 SW Hall Blvd.,Tigard_OR 97€2 - .........
Plan'ReYsiew.
: 3 Phone: 503,718.2439 Fax: . . Dateffir Other Permit
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Joris WI See Page 2 for
Internet: www.tigard-or.gov NotitiediMethod: /1-4; Supplemental Information
TYPE OF WORK''- '"'-7-'1';,:71-''',','',.''"'-''''''',----- -"--- - ----------'-'rEE*-60itEntilit--
Far 0 special information use checklist Nexv construction 0 Demolition
Description I Qty. I Fa. I Total
r4 Addition/alteration/replacement i 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF coNsTRucTioN . - ''' '''''" SFR(I)bath 312.70
0 I-and 2-family dwelling r0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq,ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address:9777 S.Washington Square Road
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Portland,OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.:1)09 .1 Project name:ilollister#30511 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
______......_..... - - •
Sanitary sewer(no.linear fl.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF,WORK
Clothes washer 25.02
Plumbing for TI
Dishwasher 25.02
Drinking fountain 1 25.02 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 1 0 TENA,NT,j',:;‘:':',2:: '' '' Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: _____ Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
i;::4 APPLICANT ' ' 0 'CONTACT r"P*RtSON ''''''' Interceptor/grease trap 25.02
Business name:PAIS! LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Brandy Solano
Roof drain(commercial) 12.51
Address:21195 NW Evergreen Pkwy.,Ste.204 Sinkibas€1aViiii;ry- 2' 2 25.02 50.04
..._........_...
City/State/ZIP:Hillsboro,OR 97124 Solar units(PaibleWater) 62.54
Phone:(503)466-2222 Fax::(503)466-2211 Tub/shower/shower pan 12.51
Urinal 25,02
E-mail:bsolano@rnsi-systems.com
25.02
CONTRACTOR Water closet
Water heater 37.52
Business name:PNISI EEC
Water piping/DWV 56.29
Address:21195 NW Evergreen Pkwy.,Ste.204 Other: 25.02
City/State/ZIP:Hillsboro,OR 97124 Subtotal 75.06
Minimum permit fee: $72.50
Phone:(503)466-2222 Fax:(503)466-2211
Plan review (25%of permit fee)
CCB Lie.: 158286 Plumbing Lie.no.:34-434PB
State surcharge(12%of permit fee) 9.01
Authorized signature: x, eA ., XxIcAst TOTAL PERMIT FEE 84.07
'this permit application expires if a permit is not obtained within ISO days
Print name:Brandy Solano
Date: -2.9 it has been accepted as complete.
Date:9-.29.../9
*Fee methodology set by Tri-County Building Industry Service Board.
I\Budding\PennitsVPLINIJ-PermitApp doe 10/01109 440-4414T(10i02/WWWES)
Plumbing Permit Application - City of Tigard
Page 2 -Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities w Fee(ea) Total
StibiiieFootagefi4,' Permit Fee:
Footing drain-l 10050.03 0 to 2.000 SI21.90
Footing drain each additional 100' 37.52 2,001 103.600 $169.69
3.601 to 7.200
Sesser 1st 100* 62.54 7,201 and greater $327.54
Sewer-each additional 100' 37,52
Water Service-1st IOW 62.54
Medical Gas Systems:
Water Service-each additional IOU' 37,52 Valñatjo ; Permit Fee:
Storm&Rain Drain-1st 100' 62.54
S1.00 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
Qty Fee(ea) Totat
Other Inspections or'Fees each additional$100.00 or fraction thereof to
and including$10,000.00.
Inspection of existing plumbing or fir $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$100.00 or fraction thereof to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first 550,000.00 and$1.20 for
(minimum charge 1/2 hour)
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 PlanReview faif.Plu*kiii*Installations
Fixture Type for Man review is required for any of the following.
Work Performed: CAPPed Addcd Relocate
Please check all that apply.
liaptistrv/Font Any new commercial building with water service 2"and
Rath -"fob/Shower
-Jactizzi/WhirlDool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thru 0 New exterior plumbing site utilities for any complex structure
as
Cuspidor/Water Aspirator 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 i 0 Any complex structure as defined in OAR918-780-0040.
Eve Wash
Floor Drain/sink - Submit 2 sets of plans with any of the above.
.3"
Isometric or RI-0er',Diagram
Car Wash Drain 0 Isometric or riser diagram is required for new buildings
Garbage -Domestic—non-food
Disposal -Domestic—food related that meet the qualifications above.
-Commercial—food related
-Industrial-food related
Ice MachlRefrig.Drains
Oil Separator((ias Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/lav -Non-food related 2 4-1
-Bradley
-Commercial-food related
-Service
Swimming 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
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures:
MAlob Files\PWISIJobs\SDP's\71350-1 lollister#305 I -Wa.SqlCity ofligard Plutubing.doc