Permit CITY OF TIGARD PLUMBING PERMIT
''� ° . `` COMMUNITY DEVELOPMENT Permit #: PLM2009 -00229
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/19/2009
Parcel: 2S 111 C B05200
Jurisdiction: Tigard
Site address: 10042 SW LADY MARION DR
Subdivision: Lot: 0
Project: Myers
Project Description: (2) hose bibs
Owner: FEES
MYERS, CLARENCE DEAN & MARGARET Quantity Description Date Amount
EILEEN
10042 SW LADY MARION DR 2 ea Hose Bib 08/19/2009 $33.20
PHONE: 1 12% State Surcharge - 08/19/2009 $8.70
Plumbing
39 ea Minimum Fee Adjustment - 08/19/2009 $39.30
Contractor: Plumbing
CROWN PLUMBING
23172 SW STAFFORD RD
TUALATIN, OR 97062
PHONE: 503 - 771 -9449
FAX: 503- 771 -9454
Type of Use: SF
Class of Work: ALT 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ' - Permittee Signatur 0/s/ f}7°P4-/ 7--77 _ /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. c 1T �/
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.
:. � 08/18/2009 13:53 5037719454 CROWN PLUMBING PAGE 02/02
Pl 31±.,a Arm>it A l>icatioq
Building Futures RECEIVED a RrR, rAw':a uR a: Risk.: zn �n..1
City of Tigard Received / /, mi l/• Per NoP - I,
■ 13125 SW Hall Tiled.. Tigard, OR 97223 Pin Review (/
pr, to 1 8 2009 Dale/By: Other Permit No.:
III
Phone 503,6,39.4171 Fax: 503.59. G(Y
Inspection Line: 503.639.4175 Mae Rcndy /ny: � s' �' ® $re Page 2 I w
TlCiAHk? firr - Icmenta1lnfmmntioar i
It7lernes.: wtvtv,tigard- 01'.goV w Al my• - , ,, Notit;cr /Mcl.ho
"w . 'r I . V For s )oct in armulinn use chec.Q , I
•�-� y r '.� - Description Ot . ra, Total
-
0 New construction ii Detnoliti N'W 1 - 2- family dwellings (includes 100 ft. Tor each utility connection)
Acldit .ion /altcration/replacement El Other: SFR (1) bath _ 249.20
CATEGORY OF CONSTRUCTION , (2) bath 350.00
1---, _„ SFR (3) bath 399.00
061.1- and 2- family dwelling ❑ Commercial /industrial - -
E a dditional bath/kitchen 65.00
El Accessory building; ❑ Mtalri- family- Fire sprinkler( sq. ft.) Pogo 2
❑ Master builder ❑ Other: 91te utilities
• JCIiD SITE: INFORMATION AND LOCATION ' • Catch basin or nrca drain 16,60
101, site address: I 00 C1Z. < e� L a. pi ; . Drywe11, leach line, or stench drain 16,60
T Footing drain (nn. linear n.,; ___.) Page 2
City'St:atc /ZlP: .--r, ( '7,"2. y - •-
T
NInnufnCturCd home utilities 110.00
no.:
Suite /bid . a t. Project name: 16.60
p Manholes 16.60
Crass sireetldiroetions to,joh site: - ___ Rain drain connector' - 16.60
sanitary sewer (no. linear lt.; _) Page 2
~" Storm sewer (no. linear ft.: _) Page 2
- — —" . Water service (no. linear ft.: ,) Page 2
, 1'ixl,urc or item
- Subdivision: 1...ot no.. ._. -- —
,. _ Absorption valve_ 16,60
Tax map/parcel no.: '
w I3acicllow pru�etticr Page 2
DESCRIPTION OF WORK Backwater valve 16,60
I- rf a Q y �� -N6 a ti • . / /_ Clotltas washer .. 16,60 —
t I�RL
I � ,., , 4 17ishtitayhcr 16.60
!' u r -.�.i'+� D,'inking tb,lntnin 16.60
• Hcctors /sump 1 6,60 M,
0 .Pl'tO1'' R't"Y OWNER • Li .T10 AN . _.. r xpans i nn tank 1 6.60
Name: 1' ixturese.wcr cap 16.60
Addrres s; _ r; „-n,.. Floor drain /floor sink /hub 16.60
— Garbage disposal 16.60
Ctt /Sra
to /ZiP;
Y w — ll ,b 16 n 3
Phone: ( ) trap ;.l Ice maker 16,60
>
n '- i ; ° �, ' '
, -,+i" ' ''VJatWii i ii ,; hi 1ii;.l,ll - a _ ._.
.,; I. "\ 40 ,on. „ li, o y ' 4, �. itlt=era:or /grease trap 16,60
Business name: Christian Plumbing Inc. DBA Crown Plumbing Medical as (Value: ) _ Page
�
Contact name: Dennis Underwood Primer .- 16.60
Address; 5429 SE Francis Street Roo I (commercial) 16.60
■ City /State /Z1P; Portland, OR 97206 Sink /l7a /lavatory 16.60
Phone: ( 503 ) 771 -9449 I Fax: : ( 503 1 771 -9454 Tub /shower /showcl'pan 16.60
ti nnl 16.60
E-mail;
;1 " , Q fl .4tik`'p'kt', Water closet 16.60
Water heater 16.60
13usiness name: Christian Plumbing Inc. DB rown Plumbing )
�� Other:
Address; 5429 SE Francis Street - .. "" subtotal
City/State/7.1P: Portland, OR 97206 . . Minimum permit fee: 572.50 �,
Phone: ( 503 ) 771 - !8.449 t"a't: ( 503) 771.9454 Rcnidcminl hackllow minimum permit. fee: $36,25
Plumbin iic,; 34.70Pt3 Plan review (25% of permit fcel _
.� g ✓' State surcharge (12% of permit iec) 7Q
0-mail;
lie : 42671 2 >r MI City ma
r° m'o lic .: Metro 1 431 -
_ , TOTAL PERMIT FEE B 1.7,0
Authorized — 1 This permit application expires if a permit it rrnt o within
signature: _ _ I 1$0 days after it has Men accepted as enmplctc,
, fce mellmdology set by Tri- County Building Industry Service l3onrcl,
Printnarne: Dennis Underwood .. f)aie: �J
•
r\ Building \Prrmirn \PLMr -Por itAap.rInc 12/27/46 ,Inn- ,I5i AT( lnin2/COM;wt;n)
r ` 0919/ 2009 14:40 5037719454 CROWN PLUMBING PAGE 01/03
i' 01/23/2007 :12:26 FAX 5036981960 CITY OF TIGARD Z001
EC'EI1i; i G PI' R
�' Building Divi sio;USILT u AUG 19 ECEIVED 2009
/ R� t for Pe>rtx>uit Y AUG •, CITY GP ..� .� r DIN t: B UILD TIGARD
INr v DIVISION
TO: CITY OF TIGARD
Permit System Administrator
1M25 SW k32ll Blvd_, Tigard, OR 97223
Phone, 503.718.2430 Fax: 503398.1960 wvtw. tigaxd.orgov
FROM: 0 chimer " [+ Appl cmr [Contractor 0 City Staff
(check one)
REFUND OR Name:
INVOICE TO! (Baaa;nessorznaiviaunl) C trp w f 1* u 1 44, I ; v4 ,y.,,,..,.,.....
- Mailing Address: 5 4 Z. , s e cr ,,..t r-r •
City /State /Zip: Po tr 1 ) c. .. p rd er 7 Z. c
Phone No.: 5 o ?' 7 7 / - 9' '" 4 ,.
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANC PERMIT A.PPLICA.TION,
liff REFUND PERMIT FEES (attach receipt, if available).
R INVOICE FOR FEES DUE (attach case fee schedule and explain below),
REMOVE CONTRACTOR FROM PERMIT (do not called petty it).
Permit #: PL Y}'7 21220 - 0 o "t. "r
Site Address or P #: / O 0 '! Z. S / - a or r = 40 .. p , • t, ., Q /
]Project Name:
Subdivision Name: Lot #:
EX1PL r[AXTON: C. c..3 c f m ...t..✓ C cr ..- C.. r...(sc_cr _
SignatillM: ...■ A. D a tez Ph_ 5.1;: ,.
Pint Name: Dc-4. J ( n ^ cl " r� J .J a, a r
R,et'uttdblisgz
1. The Director or t ldiatg Official tray sIlthorite the cefued oft
a) ;a t, fee which vnt¢ exronaoualy paid or collactcd,
b) riot enoro thAe 80% of the laud ■i0o n rplleadon fct wham zaa airiplieatio• i$ withilmn, of canceled bcfotc any tcvaew effort has been expended!
e) net more than VA sir the land use Application at Ebt leaned pctterits,
c) not mom tim g0% ',Hie building Elan review fcc when, an application is taocalcd bcfotc guy plan review affott ban born expended.
el) n+ot *nose than BM of the building permit fen for la ucd priming ptine in My innpeedon eeyanatia
•
• 2, li,e6inde vat be returned m the original Part. tin the came method In -which payment was received. Fieaso avow 1 - wrecks for peocea!etag enfunda. .
. \
Rte to SYd3 .Admire . Dale Br Rix to 131x1_ . drain: Date ./ A j B ! %/'
Aril gl•Pzecterod: - Daft ' V :,,� j '�� haw +ice PMftegd_ Date B ,
Pet Canceled; Date VI B • ; ,!r�•� Patleel T w Added: Late B
• ktaae�4 t # ' ra Date McdtmLe C - Ax run -
T:VBur7d4,pex.nxrRez,Pdmit.A tion -a c,c it.,- i /24/or
City of Tigard, Oregon m 13125 SW Hall Blvd. ° Tigard, OR 97223
• ,
. .
. .i ! ':J.A.:. .
September 24, 2009 _... _ _ _ _. _
Crown Plumbing
5429 SE Francis St.
Portland, OR 97206
Attn: Dennis Undenvood
Re: Permit No. PLM2009 -00229
Dear Mr. Underwood:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 10042 SW Lady Marion Dr.
Project Name: Myers
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $64.96.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Per applicant's request as customer cancelled job. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Z .
Dianna Howse
Building Division Services Supervisor
Enc.
1: \ Building \ Refunds \ Administration \LtrRefund- CancelPermit.doc 01/16/07 .
Phone: 503.639.4171 a Fax: 503.684.7297 0 www.tigard- or.gov ® TTY Relay: 503.684.2772
City of Tigard
Ph a
TIGARD Accela Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela .
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Crown Plumbing DATE: 09/22/2009
5429 SE Francis St.
Portland, OR 97206 REQUESTED BY: Dianna Howse
Attn: Dennis Underwood
TRANSACTION INFORMATION:
Receipt #: 174916 Case #: PLM2009 -00229
Date: 8/19/09 Address /Parcel: 10042 SW Lady Marion Dr.
Pay Method: CreditCard Project Name: Myers
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% of permit fees.
`REFUND INFORMATION: - • . . •
' Fee Description From Receipt • •Revenue Account•No: • - Refund
Example [BUILD] Permit Fee' , Example: 245' =0000- 432000 $Amount.
Plumbing Permit Fees 2300000 - 43101 $58.00
12% State Surcharge 1003100 -24001 6.96
TOTAL REFUND: $64.96
APPROVALS:
If under $500 Professional Staff f '�
If under $7,500 Division Manager 0/0Alk �,/ t1 '.
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract. Review Board
. • FOR ACCELA SYSTEM.ADMINISTRATION_ • :�,; ; .r'
Refund Request Reviewed: Date: 973 � By: 4` j/
b .- Case Refund Processed: Date: u-/ i • e 5 = By: ,--r( =---
I: \ Building \Refunds \RefundRequest.doc 04/13/09
il ig q CITY OF TIGARD RECEIPT
2 . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
e lei our
Receipt Number: 175329 - 09/24/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2009 -00229 $
Total: $ -64.96
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 09286G DHOWSE 09/24/2009 $ -64.96
Payor: Claudia D Sommen, Crown Plumbing
Total Payments: $ - 64.96
Balance Due: $64.96
Page 1 of 1
71 CITY OF TIGARD RECEIPT II
✓ : 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 174916 - 08/19/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2009 -00229 Hose Bib 2300000 -43101 $33.20
PLM2009 -00229 12% State Surcharge - Plumbing 1003100 -24001 $8.70
PLM2009 -00229 Minimum Fee Adjustment - Plumbing 2300000 -43101 $39.30
Total: $81.20
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 09286G DHOWSE 08/19/2009 $81.20
Payor: Claudia D Sommen, Crown Plumbing
Total Payments: $81.20
Balance Due: $0.00
Page 1 of 1