Permit + v
`` CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 -00290
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/26/2007
PARCEL: 1512600 -00300
SITE ADDRESS: 09499 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: BINYON'S
Project Description: .2 EDU increase.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 0.2
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner:
WASHINGTON SQUARE LLC FEES
BY THE MACERICH COMPANY Description Date Amount
9585 SW WASHINGTON SQUARE RD
TIGARD, OR 97223 [SWUSA] Sewer Connection Fee 11/26/2007 $560.00
Phone: Total $560.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the
date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side
sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance
given. If not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION.
Oregon law requires you to follow 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 copies of these rules or direct questions to OUNC by calling 503.246.6699
or 1.800.332.2344.
Issued by: � / !- Permittee Signature: / /G�� .---
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Parcel # 1S12600 -00300
i 1 cnant Name Binyons This SWR# 2007 - 00290
Site Address 9499 SW Washington Sq. Rd This PLM# 2007 - 00522
Fixture Value Previous Previous Credits Capped Fixture Fixture New Ncw
# value capped off value added added total total
count off #s count # value #s values
Baposcry /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 0 0 0
Drinking Fountain 1 0 0 0 0 0
Lye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -IP) 16 0 0 0 0 0
- Commercial (to 5 FIP) 32 0 0 0 0 0
- Industrial (over 5 I IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
1Zec Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 3
- Service 3 0 0 0 0 0
Swimming Pool Filter z , 1 0 0 0 0 0
Washer - Clothes / 6 0 0 0 0 0
Water l,xtractor / 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'l'CYI'ALS . 0 0 0 0 1 _ 3 1 3
Current Fixture Value 3 divided by 16 = 0 2 Current EDU 1 EDU = $ 2,800
Previous Fixture Value 0 divided by 16 = 0 0 Previous EDU
Change 3 divided by 16 = 0 2 over (under) $ 560 00
Enter EDU Change Here 0 2
Notes
Authorized Name /Signature: Barbara Butler Date: 11/26/2007
Building Division
Note 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 \ Forms \Scwcr'I'allyShcet als 02 /02/07
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Action
Request for Permit ,�. -- .,,
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TO: CITY OF TIGARD • �I 5 � '
Building Division Services Coordinator It r 1 � 200 ,.i y�
13125 SW Hall Blvd., Tigard, OR 972.23 - l
Phone u
503.718.2430 Fax_ 503.598.1960 Aw.tigatd-ot.gov i p
FROM: Owner 0 Applicant C ontractor ❑ City Staff
(check one)
REFUND OR Name: i II I i
INVOICE TO: rn�a ,nin or lndioidtat) T IP Gl h ( i ` I U t i b 1 LI
Mauling Address: j d. o O
VOID Cry /State /Zip: [ c f +) - (S- rev Y>k lsi y1 d4
phone No.: (— (3 bQ -- 3 9 SS
/; a Vo 7
PLEASE TAKE ACTION' FOR THE ITEMS) CHECKED (
O CANCEL PERMIT APPLICATION.
• REFUND PERMIT PEES (attach receipt, if available).
• INVOICE FOR FEES DUE (attach case fee schedule and explain below).
I] REMOVE CONTRACTOR PROM PERMIT (do not cancel permit).
Permit #: S W IR 2 b�__ - C)Q� 2•`
Site Address or Parcel, #: 0 - ( S IN , hQ -LS st -
. t J
Project Natne: 1 -----
Subdivision Name: d f
d Lot n #:
EXPLANATION: W 'e. e Q eR ct $ I Y1 ,. add - r • n etz,
S nIC w Wt. cA ; _ d Yi Cif vw w ev cd eVuo 1
Signature: • A i t&i. ai l Date: . (2, l - 07
Print Namc: COY` ( 1il a MO 4 C
8.d.di
1. The Director or 'Building Official may authorize the refund of
• op fee which was a?onientsly paid or collected.
11) not more than Rirl4 of the hod we application fee when an application is withdrawn or emceed beRne any review effort has been expended,
c) not mom thin R0% of the land um application fee for bread peoritt-
tl) not mote than RtRo of the balding plan review Fee when an applictdon ic canceled befoto any pbmn review cffnrt haft been expended.
e) not more than FJO'Ve of the building peonie fee for ieeucd pmwi os Prior to any inatieedori napanzt.
2. Refunds will be tenoned to the original Pagx in the name m=tltnd in whida payment was received- Pleaee alOw 1 -2 weds for processing tefvnde,
F(ik OFFici_ I: ':i: ON I
Rte to . - a Mania: Mintal511 guS Rte to S • : Admirm Dale 1270 . ��I
Refund Pnocesse& Date %d 926 AM B .6 Invoke Processed: Date
Permit Canceled: Date „ , . Q` '?'„�, Parcel 1' - Added: Due
IMZELIWOM Date ab B Metho. Amount 3 S; O , •
T \Th ldioglFt,rnas \Roe •erroirAcssnn.d• P. 07/26/07
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
1
I1
T I GARD
January 14, 2008
Tapani Plumbing Inc.
P.O. Box 2350
Battleground, WA 98604
Attn: Carl Homola
Re: Permit No. SWR2007 -00290
Dear Mr. Homola:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 9499 SW Washington Square Rd.
Project Name: Binyon's
Job No.: N/A
Refund: ® Check #55382 in the amount of $560.00.
❑ Credit card "return" receipt in the amount of $ .
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Overpayment for sewer EDU as fixture was a replacement, not new as charged.
Refund 100% of sewer connection fee.
If you have any questions please contact me at 503.718.2430.
Sincerely,
/C(' 677
•
Dianna Howse
Building Division Services Coordinator
Enc.
I \ Building \ Refunds \ Administration \LtrRefund - Overpay.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
City of Tigard
TIGARD Tidemark 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 Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Tapani Plumbing Inc. DATE: 12/26/07
P.O. Box 2350
Battleground, WA 98604 REQUESTED BY: Dianna Howse
Attn: Carl Homola
TRANSACTION INFORMATION:
Receipt #: 2007 -5182 Case #: SWR2007 -00290
Date: 11/26/07 Address /Parcel: 9499 SW Washington Sq. Rd.
Pay Method: Check Project Name: Binyon's
EXPLANATION: Per applicant's request as fixture was a replacement, not new. Refund 100% of sewer
connection fee.
REFUND INFORMATION: •
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245 - 0000 - 432000 $ Amount
[SWUSA] Sewer Connection Fee 500- 0000 - 207000 $560.00
TOTAL REFUND: $560.00
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager � U
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: I Date: 1 y;>„ /c..te.7e. '2 I By: I
I. \Building \Refunds \ReFundRcqucsc.doc 05 /23/07
Er CITY OF TIGARD 12/7/2007
. 13125 SW Hall RI% d.
I 0.52.34AM
' Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200700000000005182
Date: 11/26/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
SWR2007 [SWUSA] Sewer Connection Fee 500 560.00
Line Item Total: $560.00
Payments:
Method Payer User ID Acct./Check No. Approval No. How Received Amount Paid
Check TAPANI BB 053164 In Person 560 00
Payment Total: $560.00
c Receipt.rpt Page I o1 I