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Permit CITY OF TIGARD 0 PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2012 -00009 �� °Z TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 3 Date Issued: 01/17/2012 Parcel: 1S135AA04101 Jurisdiction: Tigard Site address: 8945 SW OAK ST Project: NGUYEN Subdivision: ASHBROOK FARM Lot: 11 Project Description: (2) showers for interior remodel. Contractor: WESTERN PLUMBING Owner: NGUYEN, THAI V & CHAVELA 9460 SW TIGARD, AVE STE 101 8945 SW OAK ST TIGARD, OR 97223 TIGARD, OR 97223 i PHONE: 503 - 639 -5296 PHONE: FAX: 503 - 684 -9015 FEES Quantity Description Date Amount 2 ea Tub /Shower /Shower Pan 01/17/2012 $25.02 Specifics: 1 12% State Surcharge - 01/17/2012 $8.70 Plumbing Type of Use: SF 47 ea Minimum Fee Adjustment - 01/17/2012 $47.48 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total $81.20 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: - " Permittee 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. 01/13/2012 16:14 5036849015. WESTERN PLUMBING INC PAGE 01/02 ,4,\ Plumbin Permit A li / - i� Building l xtures `1,% I?0IL ()NFICr USE, , .. City of Tigard . LPN ` Received s r 13125 SW Bail Blvd., Tigard, OR 97223 �R \‘.,,11? \\j \c D !11 � P il No.; �J L /y1 ( c , . • , .. Phone: 503.639.4171 Fate! 503.598.19¢(0 man Date/33 — Inspection Litre: 503 �` ' � © Date/33 . Ocher 1'ennit No.: Trcnuct �,��'•� Date �eady/By: ra 5a r or Internet www.tigard- or.gov 7 z ���' Noufiedl,R,latl�od: fin e Su ]ems tai Info nation I=1 New construction QDertiolition 1: •.• to �• 100 ft. connection � 'on ■ New 1- Z- familyy dweliln _r includes 1 for each utility y conn on X AF Cbl�STR itc`I #Ql SFR (i) bath L►if 1 - and 2 - family dwelling Cl Commerciai/industrial Skit (2) bath [ Accessory building ■ • t 25.02 ■ 0 f i sat Wtalities: .. address: N CaYCh basue or area drain 18.76 r /� Dryweli, leach line, or trench drain inizzi • ' •Ala Footing drain (no, linear R: ) page 2 Suite/bldg. /apt. no.: Project „e: Q AZ Cr) A 1 C.k Manufactured home utilities IIMI 50.03 Cross street/directions to job site: Manholes MEER -. * / lain drain connector I T Ir.- f Sanitary sewer (no, linear ft.: ) Page 2 EEO Water service (no. linear 11 ) page 2 Subdivision: IAA lit?.: Fixture or item: Tax amp/parcel no.: I1 rI .... . ., ,: ,,;,,;,::,:::.:), :':: ::::.,::. . ..:..,.' F. , ..i.: , .. in 2 12 5 ..5 02 ) Prinking MI Ejectondsomp © it/ Name:i b (r q' ik + 1 ti i ... � as.o2 ,� . ` Add r "Lo I Floor drainfloor silnk/laub 25.02 Ostb4ge disposal 1111 25.02 z�` le' Medical gas (value: $ _ _.) page 2 Ci �l •, name: �. 12.51 Roof drain (commercial) 12.51 V 40 Address: Sink/basin/lavatory • 25.02 Solar units (potable water) 62.54 Tub/shower/shower pan Mill 12.51 r E-mail: ,. , w Uri ater nal closet e a Business moue: Western Phmibing, Um- ° Water ■ 25.02 pipingDWV 56.29 Address: 9460 SW"rAgard Aveuue Suite 101 eater: p c h ity on i e Sta ( te/ 50 :7 63 '. Tiga OR 91223 Fax; (543) 68.4_9015 • p minun. um permit if... / 7 - * 4 )6'a Authorized signature: �� , iJ t� surcharge (12 01 permit Fee) w a j so $ '+� i _ ,,, . / E .. • TOTAL 1'ERMrL FU: �►1 w Print name: Dana Jensen '- This penult appileat e elipires if a permit /s ot obtained within 180 drays • • - alter It hay bean racceptad complete •Rs.. re.e"rnininm. a.• 1r.+ T.:,.(rwe -ev An;)riir, , Imi„ae C --.,;.-. Anon,' a • . s MI GAR:0 r � City of Tigard January 31, 2012 Western Plumbing Attn: William Dovers 9460 SW Tigard St., Ste. 101 Tigard, OR 97223 Re: Permit No. PLM2012 -00009 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 8945 SW Oak Lane Project Name: Newton Job No.: N/A Refund Method: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $81.20. 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): Permit created in error for Washington County jurisdiction. Refund 100% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. 1:\ Buildin \Refunt342 t tiaLthaiiid aAc fd on 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard or.gov 111111 " City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Western Plumbing DATE: 1/20/2012 Attn: William Dovers 9460 SW Tigard St., Ste 101 REQUESTED BY: Dianna Howse Tigard, OR 97223 Debbie Adamski TRANSACTION INFORMATION: Receipt #: 185175 Case #: PLM2012 - 00009 Date: 01/17/2012 Address /Parcel: 8945 SW Oak Ln. Pay Method: CreditCard Project Name: Newton EXPLANATION: Refund 100% of permit fees for permit issued in error for Washington County jurisdiction. Fee Description From Receipt RevenueAccount No , fi Re`fiiiicl 2 E�arnple , >Fee . Earnple. 2300000 - 43104 , . _ $ Arm_ ounf Plumbing permit fees 230 0000 - 43101 $72.50 12% State Surcharge 100- 0000 -24001 8.70 TOTAL REFUND: $81.20 APPROVALS: If under $5,000 Professional Staff If under $12,500 Division Manager If under $25,500 Department Manager r / If under $50,000 City Manager If over $50,000 Local Contract Review Board ; l _ T, _;`� IFOR,TIDEMA SI' T -: r -,,.:�_ -- _ _ .,, . _ S , EM:ADMINISTRAT- IOl_V�U_ ONLY;.;,.•.,�:��,,_r�� _ a;�° " - - _Case - Refund Processed: B l:\ Building \ReFunds \RcFundRc x 09 /01/2010 1 III Community Development TIGARD Request for Permit Action VOID / TO: CITY OF TIGARD Building Division Services Supervisor 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor IX1 City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) LA.D 6.. 6 / NI6 Mailing Address: 9 ( 6W 7 6 Ai - r ,6-r . 5-r /o/ City /State /Zip: ---r f} / L 7) , 02 F7 202 3 Phone No.: 'o3-, 5a2 ? 4 , PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): ►I CANCEL PERMIT APPLICATION. ►' REFUND PERMIT FEES (attach copy of original receipt). INVOICE FOR FEES DUE (attach case fee schedule and explain below). n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: L..1 ‘ 9 0 /g - C o0 9 Site Address or Parcel #: 9 , /fi 61 Q F)1/ L_PrK.) Project Name: j\t GJTb /J Subdivision Name: 44-- Lot #: N /i9 EXPLANATION: j1 '1 - O U Q al t 5iD f CT1 0A-1 6-0A • 0,0 . 14.0 cL�j No r f4A - A I66 i,t1 - . ( ---,,,, Signature: ( Date: /// 7 /,2— Print Name: ` f hg L - R. nr) Priv\`ak) Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2 -4 weeks for processing refunds. 9':t.:.. -./ _ _91 -° Rte to S s Admin: Date I � A Rte to Bid Admin: Date J ®� B AT Refund Processed: Date / 3/ /2— By .#17 Invoice Processed: Date By Permit Canceled: Date 0 By Parcel Tag Added: Date By Receipt # CPS -/'75 Date $ // Z Method G ' ' Amount $ SY, o2a L \Buil ding \ Forms \RegPermitAction.doc ev 04/26/2011