PFI2018-00051 City of Tigard
August 13,2021
Jeff Wall
17185 SW Cobble Ct
Sherwood, OR 97140
Re:Permit No. PFI2018-00051
Dear Applicant:
The City of Tigard has processed a refund for the deposit of fees on the above referenced
permit for the following:
Site Address: 11600 SW Bull Mountain Rd
Project Name: Wall Partition
Job No.: N/A
Refund: ® Check#240266 in the amount of$2,000.00.
❑ Credit card "return"receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Release engineering performance bond (cash assurance).
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Omelas
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
_ City of 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 RequestforPermit 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: Jeff Wall DATE: 8/6/2021
17185 SW Cobble Ct
Sherwood, OR 97140 REQUESTED BY: Dianna Ornelas
BB
TRANSACTION INFORMATION:
Receipt#: 424712 Case#: PF12018-00051
Date: 6/19/2019 Address/Parcel: 11600 SW Bull Mountain Rd
Pay Method: CreditCard Project Name: Wall Partition
EXPLANATION: Release engineering performance bond (customer deposit).
REFUND`INFORMATION-
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Exam le: 2300000-43104 $Amount
Cash Assurance customer deposit) 640-0000-22000 $2,000.00
TOTAL REFUND: $2,000.00
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
7
If under$12,500 Division Manager GLtiJ
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
211
Case Refund Processed: Date: Zj By:
1:\Badding\Refunds\RefundRequesedoc x 09/01/2010
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Wall Partition PFI
Site Address: 11600 SW BULL MOUNTAIN RD 12,e!5- W
Receipt Number: 435816 - 08/1312021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00051 $-2,000.00
Total: $-2,000.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 240266 DHOWSE 08/13/2021 $-2,000.00
Payor: Jeff Wall
Total Payments: $-2,000.00
Balance Due: $2,000.00
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Wall Partition PFI
Site Address: 11600 SW BULL MOUNTAIN RD
F- Receipt Number: 424172 - 06/19/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PF12018-00051 Customer Deposit 640-0000-22000 $2,000.00
Total: $2,000.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 190619E3C-812! PUBLICUSERO 06/19/2019 $2,000.00
Payor: Jessica E Wall
Total Payments: $2,000.00
Balance Due: $0.00
Page 1 of 1
Dw
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action
13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439• www.tigard-or.eov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits e tigard-or.gov
FROM: ❑Owner ❑ Applicant ® City Staff
pp ❑ Contractor
Check one
REFUND OR Name: Jcff Wall
INVOICE TO: (Business or Individual)
Mailing Address: 17185 SW Cobble Ct.
City/State/Zip: Sherwood, OR 97140
Phone No: 503-840-7524
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED:
❑ CANCEL/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 #:PFI2018-00051
Site Address or Parcel #: 2S110BD09000
City, State, Zip: Tigard, OR 97223 - -
Subdivision Name: Wall MLP Refund Amount: $2,000.00
REASON: Release of enRincerinR performance bond (customer deposit) for PFI permit.
Print Name: Brady Bullinger R. Date: 4/5/2021
Refund Policy
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 801/6 of the application or plan review fee when an application is withdrawn or canceled before review
effort has been expended.
Not more than 801/o of the application or permit fee for issued permits prior to any inspection requests.
All refunds will be returned to the original payer in the form of a check via US postal service.
Please allow 3-4 weeks for processing refund requests.
*For Office Use Only*
Route to Sys Admin Date By: Route to Records DaT11—TA)
13 Z By:
Refund Processed Date/A By: Invoice Processed Date By:
Permit Canceled Date- '/ By Parcel Tag Added Date By:
Dianna Ornelas
From: Brady Bullinger
Sent: Monday, May 17, 2021 1:49 PM
To: Jeremy Tamargo; Dianna Ornelas
Subject: Re: Refund Request PF12018-00051
Thank you, both !
From:Jeremy Tamargo<jeremyt@tigard-or.gov>
Sent: Monday, May 17, 202110:31:43 AM
To: Dianna Ornelas<Dianna@tigard-or.gov>; Brady Bullinger<Brady@tigard-or.gov>
Subject: RE: Refund Request PF12018-00051
Hi Dianna,
Refund request forthe Wall MLP is approved.
Regards,
Jeremy
Jeremy Tamargo, PE
City of Tigard
Principal Engineer
Direct: (971) 713-0281
From: Dianna Ornelas<Dianna@tigard-or.gov>
Sent: Monday, May 17, 202110:01 AM
To: Brady Bullinger<Brady@tigard-or.gov>
Cc:Jeremy Tamargo<jeremyt@tigard-or.gov>
Subject: FW: Refund Request PF12018-00051
Hi Brady,
Hope all is going well with you.
I am catching up on 2 months backlog of emails and refund requests. Yes, I will need Jeremy to initial his approval on
the attached refund form, or email approval and I will add this to the batch to be processed by end of May.
Thank you.
Dianna
From: Brady Bullinger<Bradv@tigard-or.gov>
Sent: Monday,April 5, 20211:46 PM
To: Dianna Ornelas<Dianna@tigard-or.gov>
Cc:Jeremy Tamargo<jeremyt@tigard-or.gov>
Subject: Refund Request PF12018-00051
1
Hello Dianna,
Please accept my submittal for a refund request (attached). Let me know if you would like Jeremy to send an
okay email for this!
Thank you,
Brady Bullinger
Engineering Technician 2
Cell: (503)718-8200
Email: brad (iitif ard-or_izov
City of Tigard Permit Center, Engineering Department
13125 SW Hall Boulevard,Tigard, Oregon 97223
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
a CITY OF TIGARD PUBLIC FACILITIES IMPROVEMENT PERMIT
COMMUNITY DEVELOPMENT Permit#: PF12018-00051
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2421 Date Issued: 06/27/2019
Parcel: 2S110BD08400
Jurisdiction: Tigard
Site address: 11600 SW BULL MOUNTAIN RD
Subdivision: 1998-144 PARTITION PLAT Lot: 2
Project: Wall Partition PFI
Project Description: Two lot partition located at 11600 SW Bull Mountain Road.
Owner: FEES
WALL, GEORGE E& PAMELA J Description Date Amount
11600 SW BULL MOUNTAIN RD PFI Permit Fee 03/01/2018 $300.00
TIGARD, OR 97224 In Lieu Engineering 06/25/2018 $2,700.00
In Lieu Underground 06/25/2018 $1,625.00
PHONE: In Lieu Engineering 06/25/2018 $5,600.00
Customer Deposit 06/19/2019 $2,000.00
Total $12,225.00
Contractor:
REQUIRED INSPECTIONS
PHONE:
FAX:
Applicant:
JEFF WALL
17185 SW COBBLE COURT
SHERWOOD, OR 97140
PHONE: 5038407524
Please sign below to indicate acceptance of conditions and return a copy with the proposed work schedule along with names and contact
information of responsible parties before beginning work.
Permittee/Applicant D
Signature:
1
Issued By:
Special Conditions(See Attached)
Note:THIS PERMIT DOES NOT COVER WORK ON PRIVATE PROPERTY
Conditions for PF12018-00051
Type: Condition Name: Status: Severity:
PFI_Street Imp 01 -WORK SITE REQUIREMENTS Applied Notice
Applicant must comply with all applicable provisions of federal and state law, the Tigard Municipal Code, and the terms of
any agreement with the City of Tigard regarding work to be done pursuant to this permit.
PFI_Street Imp 02-WORK SITE AREA Applied Notice
The work area and approach roads shall be maintained in a clean condition,free from obstructions and hazards. The
spreading of mud or debris or storage of materials or equipment of any kind upon any public roadway is strictly prohibited
and violation shall be cause for immediate cancellation of the permit. The City may at any time order immediate clean-up
and suspension of work to accomplish clean-up.
PFI_Street Imp 03-WORK SITE EROSION CONTROL Applied Notice
Prior to starting work,effective and approved erosion control devices must be installed and maintained meeting the Clean
Water Services and DEQ requirements. The City may at any time order corrective action and suspension of work to
accomplish effective erosion control.
PFI_Street Imp 04-WORK SITE REPAIRS Applied Notice
Disturbed landscaped areas shall be restored or replaced. Existing signs, pavement markings, mailboxes, etc. shall be
reinstalled or replaced,with like kind of material. Obtain City approval of restoration work.
PFI_Street Imp 05-TRAFFIC CONTROL SPECIFICATIONS Applied Notice
Applicant shall provide traffic control according to the current edition of the"Manual on Uniform Traffic Control Devices
[MUTCD]for Streets and Highways", U.S. Dept. of Transportation, FHWA, current edition,American Traffic Safety Services
Association[ATSSA], and Oregon Temporary Traffic Control Handbook[OTTCH].
PFI_Street Imp 06-TRAFFIC CONTROL PLAN Applied Notice
Submit a job specific traffic control plan. A copy of the approved traffic control plan shall be readily available at the work
area. Traffic control devices, flag persons, etc., shall be in place prior to initiation of construction work and shall be
effectively maintained.
PFI_Street Imp 07-TRAFFIC CONTROL ROAD CLOSURE Applied Notice
Public roadway shall not be closed to traffic, at any time,without obtaining written approval from the City Engineer. The
applicant is responsible to provide 48 hour advance notice of traffic flow disruptions to affected businesses, residents and
area wide Emergency Services: 503-629-0111 (Tigard Police Dept.,Tualatin Fire& Rescue)and to 503-962-8140(Tri-Met)
and 503-431-2345(Tigard School District)and other service providers impacted by such closure.
PFI_Street Imp 08-TRAFFIC CONTROL ADVANCE WARNING Applied Notice
Advance warning of traffic disruption shall be provided to the public by placement of an approved advance notification sign
at each end of the construction area 72 hours(min.)before initiation of construction work.
PFI_Street Imp 11 -TRAFFIC CONTROL LIMITED WORK HOURS Applied Notice
Hours of construction work on collector and arterial roads will be limited to 9:00 a.m.to 3:00 p.m. unless authorized by the
City Engineer. Work will not be permitted on collector and arterial roads between 3:00 p.m.to 9:00 a.m. unless authorized
by the City Engineer.
PFI_Street Imp 12-TRAFFIC CONTROL MODIFICATION Applied Notice
The City reserves the right to add to or modify traffic control requirements as necessary to effectively control traffic and to
assure public safety.
PFI_Street Imp 13-DRAINAGE CONTROL Applied Notice
Drainage shall be controlled within the work site and shall not adversely affect adjacent private property, public property and
the receiving system. The City may at any time order corrective action and suspension of work to accomplish effective
drainage control.
PFI_Street Imp 14-UTILITY NOTIFICATION Applied Notice
Oregon law requires following the rules adopted by the Oregon Utility Notification Center. Said rules are set forth in OAR
952-001-0100 through OAR 952-001-0080. Copies of said rules may be obtained from the Center by calling 503-246-1987.
If you have any question about the rules,contact the Center. NOTE: Damage to utilities shall be corrected at the permit
holder's expense.
PFI_Street Imp 15-UTILITY LOCATION CONFLICT Applied Notice
Applicant must verify all existing utilities for both vertical elevation and horizontal location prior to start of work(pothole
before digging if necessary). Should conflicts arise and redesign or relocation of facilities be necessary, it shall be done at
the applicant's expense. Changes must be approved by the City in advance of work.Applicant shall coordinate the work
with affected utility agencies.
PFI_Street Imp 16-TEMPORARY PATCH Applied Notice
A temporary hard-surface patch shall be placed on trenches within roadways at the end of each work shift. Obtain advance
approval of patching method. No trench shall be left at any time in an un-safe condition. Applicant is responsible for and is
liable for hazards or damage resulting from the prosecution of the work.
PFI—Street Imp 17-REPAIR OF EXISTING FACILITIES Applied Notice
Work under this permit shall include repair of existing facilities(roads, ditches,etc.)as may be necessary, as determined by
the Inspector, to overcome deterioration or damage which occurred in conjunction with the work authorized by the permit.
Corrective work shall be done at the applicant's expense.
PFI—Street Imp 18-SEWER SYSTEM TEST Applied Notice
A sewer system air-test and/or DVD T.V. test report and one set of"As-Builts"shall be provided for review and approval.
PFI—Street Imp 19-PRECONSTRUCTION MEETING Applied Notice
Before initiating any construction activity, the applicant shall coordinate with the City's inspector, <Insert Name>at<Insert
Phone#>,to establish a preconstruction meeting.
PFI—Street Imp 20-NOTICE TO COMMENCE WORK Applied Notice
The applicant shall notify the City's Inspector twenty-four(24)hours prior to commencing work, prior to any staged
inspection, and after completing work covered by the permit.
PFI Street Imp 21 -PERMIT/PLAN ON SITE Applied Notice
A copy of the permit including a Certificate of Insurance, and all attachments, and a copy of the approved construction plan
and all amendments shall be readily available at the work area. All work shall conform to the permit terms, conditions and
provisions and to the City approved permit plans, and approved plan amendments and to the City's standards and
specifications and to these General Conditions. Changes to any of these must be approved by the City, in advance of work
performance.
PFI Street Imp 22-DAILY INSPECTION REPORTS Applied Notice
Applicant shall submit daily inspection reports, on a weekly basis, to the City's Inspector.
PFI—Street Imp 23-MONUMENT PROTECTION Applied Notice
Existing monuments, property corners, and survey markers shall be protected. Replacement shall be at the permit holder's
expense.
PFI—Street Imp 24-VALIDATION OF MATERIAL/CONSTRUCTION Applied Notice
The City's Inspector may, at his discretion, require tests and or reports from the applicant to validate claims of material or
construction adequacy/compliance. Such tests/reports shall be provided at the applicant's expense.
PFI Street Imp 25-EMERGENCY CONTACTS Applied Notice
Provide to the City inspector, in writing,the names and 24 hour emergency telephone number of two(2)persons who have
authority to resolve problems,take corrective action and, in general,will be responsible in case of any emergency. The
applicant shall notify the City Inspector, in writing,of any/all assignment changes.
PFI—Street Imp 26-RIGHT OF ENTRY/EASEMENTS Applied Notice
Applicant to obtain proper right-of-entry and/or easements prior to starting work. Proof of right-of-entry or properly executed
easements, shall be provided to the City. The City shall in no way be construed to be liable for the applicant's failure to
obtain or provide for proof of right-of-entry or easements.
PFI—Street Imp 27-PRIVATE PROPERTY AGREEMENTS Applied Notice
Provide the City a copy of an executed agreement[s]from the owner for each private property disturbed by construction
activity.
PFI—Street Imp 28-AS-BUILT DRAWING Applied Notice
One as-built drawing showing all new public improvements, including any revision made to the previously approved
construction plans and, also, any improvement which may impact an existing public system or facility, shall be provided to
the City by a registered civil engineer along with an engineer's certification of installation compliance(Certificate of
Compliance).
PFI—Street Imp 29-PRIVATE WATER QUALITY FACILITY Applied Notice
The Developer shall maintain the water quality facility and correct any defective work, and shall perform all scheduled
maintenance to assure proper functioning of the facility.
PFI—Street Imp 30-PUBLIC WATER QUALITY FACILITY Applied Notice
The Developer shall create and provide to the City a schedule for periodic(quarterly)maintenance of the water quality
facility. The Developer shall maintain said facility for a period of three(3)years from the date of City Conditional
Acceptance of the public improvements. On October 1st of each year during this three(3)years period,the Developer shall
report, in writing, maintenance activities to the Director of Public Works. City crews should monitor proper removal and
disposal of silt and debris. Prior to City final acceptance of the facility, the Developer shall provide a written evaluation of the
operation and maintenance needs of the facility and correct any deficiencies identified in the evaluation.
PFI_Street Imp 31 -OTHER Applied Notice