Permit City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
1r 11 WIAMD:
g�, K •'rY.
October 29, 2010
Tomomi Marzan
9585 SW Washington Square Rd.
Portland, OR 97224
Re: Permit No. BUP2010 -00130
Dear Ms. Marzan:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 9524 SW Washington Square Rd.
Project Name: Spec Space
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $400.00.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per Dan Nelson, Plans Examiner, refund 100% of (2) deferred submittal fees as they
are not longer required.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Ce 2,47 —
Dianna Howse
Building Division Services Coordinator
Enc.
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1: \ Building \ Refunds \ Administration \LtrRcfund - Overpay.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 . • www.tigard - or.gov • TTY Relay: 503.684.2772
Er i 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: Tomomi Marzan DATE: 10/22/2010
9585 SW Washington Square Rd.
Portland, OR 97224 REQUESTED BY: Dianna Howse
Debbie Adamski
TRANSACTION INFORMATION:
Receipt #: 178598 Case #: BUP2010 -00130
Date: 7/8/2010 Address /Parcel: 9524 SW Wash. Sq. Rd.
Pay Method: CreditCard Project Name: Spec Space
EXPLANATION: Per Dan Nelson, plans examiner, reqfund 100% of (2) deferred submittal fees as they
are no longer required items.
REFUND INFORMATION:
Tee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Additional Plan Review 2300000 -43106 $400.00
TOTAL REFUND: $400.00
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager
If under $25,500 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: I ie72/j t1 I By: 1 <L
1: \Building \Refunds \RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
I ,.
li g . . . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 180214 - 10/29/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2010 - 00130 $ 400.00
Total: $400.00
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 013790 DHOWSE 10/29/2010 $- 400.00
Payor: Tomomi Marzan, Washington Square
Total Payments: $400.00
Balance Due: $400.00 •
•
Page 1 of 1
11111 CITY OF TIGARD RECEIPT
a
a . . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
Receipt Number: 178598 - 07/08/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
BUP2010 -00130 Permit Fee - Additions, Alterations, 2300000 -43104 $5,303.45
Demolition
BUP2010 -00130 Metro Const. Excise Tax - Commercial 2300000 -24010 $1,020.00
Use
BUP2010 -00130 Plan Review - Fire Life Safety 2300000 -43108 $2,121.38
BUP2010 -00130 CDC Bldg Review, COM 2300000 -43112 $143.50
BUP2010 -00130 CDC Plan Review, COM 1003100 -43112 $143.50
BUP2010 -00130 CDC Plan Review, COM - LRP 1003100 - 43117 $42.00
BUP2010 -00130 12% State Surcharge - Building 1003100 -24001 $636.41
BUP2010 -00130 Beaverton School CET - Non 2300000 -24101 $3,517.00
Residential
BUP2010 -00130 M-� Additional Plan Review 2300000 -43106 $200.00 f.--'
BUP2010 -00130 .� Additional Plan Review 2300000 -43106 $200.00
Total: $13,327.24
PAYMENTMETHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 013790 DADAMSKI 07/08/2010 $13,327.24
Payor: Tomomi Marzan
Total Payments: $13,327.24
Balance Due: $0.00
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Page 1 of 1
. i e ° Community Development
r I c. n Ii Request for Permit Action
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor X City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) —1- H b , t•-k 2 e3
Mailing Address: r - / 5 g s w L)/ -if i Nc.. Tb ov .,Q 2-b .
City/State /Zip: 1C„ r i 2-r, t 0 (?.. 9 , .7 a ')-...5 Phone No.: 503- o� 5 - - ( 3 g V `t
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: 1 � u ,.p 9.0 k l7(' 1 30
Site Address or Parcel #: 9 5 a LI b.,,,D t. 4 , o �D
Project Name: PE L .Pa -cL.
Subdivision Name: fJ (fl Lot #: )3(4.
EXPLANATION: W t2, - ■■ p■ �. L 0 1 �1.,.1d -H ■ Tre't L - 1 1 N 5 A-0._ E.
t)0 L-0 I∎. 6€ (i au, x (2tn (,2, ti ii . �`[.(Cu.v r leo% of%
,r ft 1 02 l f @ 11
� , oo - °o ''C� 14 �-iO .' .
Signature: d .J `C _ Date: '7') SI ) v
Print Name: -- bE.Rj Ferl 4. Pt S1 1
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 1 -2 weeks for processing refunds.
FOR OFFICE IJSL'. ONLY
Rte to S s Admin: Date 7®zmiu ai Rte to Bld: Admin: Date ArMl B 4
Refund Processed: Date fei/ 2 0 t By 'li r Invoice Processed: Date By
Permit Canceled: Date /J I- By Parcel Tag Added: Date By
Receipt # j %2,F5 j Date 9 the Method C.. Amount $ 4,4, . )-7..Z /
I: \ Building \Forms \RegPermitAction.do Rev 07/26/07
, M CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2010 -00130
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/08/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9524 SW WASHINGTON SQUARE RD H08
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Spec Space
Project Description: 7000 SF addition of second story level.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Permit Fee - Additions, Alterations, 07/08/2010 $5,303.45
CARLSBAD, CA 92008 Demolition
PHONE: Plan Review 06/15/2010 $3,447.24
Metro Const. Excise Tax - Commercial 07/08/2010 $1,020.00
Use
Contractor: Plan Review - Fire Life Safety 07/08/2010 $2,121.38
WESTERN CONSTRUCTION SERVICES CDC Bldg Review, COM 07/08/2010 $143.50
4612 NE MINNEHAHA ST CDC Plan Review, COM 07/08/2010 $143.50
VANCOUVER, WA 98661 CDC Plan Review, COM - LRP 07/08/2010 $42.00
PHONE: 360- 699 -5317 12% State Surcharge - Building 07/08/2010 $636.41
FAX: 360 - 694 -7818 Beaverton School CET - Non Residential 07/08/2010 $3,517.00
Additional Plan Review 07/08/2010 $200.00
Specifics: Additional Plan Review 07/08/2010 $200.00
TDT - Transportation Development Tax 07/08/2010 $49,658.00
Type of Use: COM
Class of Work: ADD
Dwelling Units: 0
Stories: 2 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $850,000
Floor Areas:
Total Area: 7034
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $66,432.48
Required: Required Items and Reports (Conditions)
1 BUP Licensed Fabricated Steel
Fire Sprinkler: Yes Parapet: 2 BUP Structural Welding
Fire Alarm: Yes Protected Corridors: No 3 BUP Piles /Caissons
Smoke Detectors: No Manual Pull Stations: Yes 4 BUP Reinforced Concrete
Accessible Parking: 0 5 BUP Bolts in Concrete
6 BUP Structural Observation
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 accrd ice -wittL eproved 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. AT NT Oregon law re4: you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 -0010 through OAR 952 -r. -. .0, u may obtain a copy of the rules or direct questions to OUNC by - g v3.246.6699 or 1.800,332 2344.
I ued By: //44,1/13,41 Perm ittee Siature: y �� Q ��i
Call 503.639.4175 by 7:00 a.m. for an inspection that busin)' s 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.
Building Permit Application Htit 96 COO 1
'u \ "?` V'� 'e o � ,, k �I, �����y, �, i`I a,,,• , �� •, , F ,,,, , r I ,w, �M e
0 1 t t °4 , \ ,n, OFFICE SE 4,',, 1
0Wt 1.• r., 1 c d (
Commercial �, ����� +( � „��, kN, FORtUONLI � !,'.',..•,,,''''U,;10.,,;'' ;,�,`,, � ''C
�, ` 0.511 9 ' 'a a t \ ti P r r ,tl 1 �lU � 1,0. ��, 1
,,, 1F„ti 1!.., .��,,,,, p t a ,,,,. ,,:,„,, k nhC,1 4 „u v,, r „1 L t i,i� ,,1. fi a,,,„ Mtnlvl,,,,, „� �xPo ,
4”, ,, iv;:, 1,�1m R eceived
� ' t oro � 1 1 t y' ' Of Tigard • RECEIVED Date /B Permit No.:
\n)e I' nn 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie - �®/��r 13(41096)u 'ti ( "`a; Phone: 503.639 4171 Fax, 503.598.•+ 1 5 01@ Date /By: ( �� Other Permit: /' • • rox ' "' inspection Line: 503 639 4175 Date Ready /By: _ Juris s See Page 2 for
TI
z ,u,t, a�3sB 1 Internet www. tigard- or.gov CITY OFTIGARD Notified/Method; 7, .'p 6 Supplemental Information
SIC' . �i-; -fv ►r'.*�ar t
s , , <r . TYPE ; DIU' REQUIRED DATA .1 AND2 FAMILY DWELLING ,
❑ New construction ❑Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition /alteration /replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY -OF CONSTRUCTION '
work indicated on this application.
❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
l i�v`- it 5 JOSISITE INFORMATION AND LOCATION ` Total number of floors:
_..� .���..... .. r
Job site address: 1511- 11t/ HNV 7N s-9. p p� New dwelling area: square feet
City /State /ZIP: � `1 9 Garage /carport area: square feet
Suite /bldg. /apt. no.:.TT - - 2
✓ l� 0 G � (Project name: o f M V d t 4 Covered porch area: square feet
Cross street /directions to job site: t 't 1 l (N Deck area: square feet
Other structure area: square feet
REQUIRED DATA : COMMERCIAL USE CHECKLIST ;
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
� . ; DESCRIPTION OF WORK , ', work indicated on this application.
II dF. +.�.(;02. 17 ; Valuation: $ , (
•
l ,, t , � 5IN 1 , , /s; r � e Vve zyn'y Existing building area: square feet
4: � V / N W V V . . VV r � / L I y r , l v Y'�� 1� -w v- New building area: square feet
`` PROPERTY OWNER . , 1 ` ? t - ❑ TENAN Number of stories:
Name: TO 9 M I M/tscp —' F2 S r :
Type of construction:
Address: t I 514/ i4 Hiri iN s - . I r 7 Occupancy groups:
City /State /ZIP: T('i7f (21 .2 Existing:
Phone ) ^ • •¢� Fax ( f ) w N
�,s, h APPI';TCrANT,P ; t ; 0. x ❑ s CONT - .. <.. -r I ..NOTIC
Business name: All contractors and subcontractors are required to be
Contact name: licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address jurisdiction in which work is being performed. if the
City /State /ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) Fax:'( )
E-mail:
r CONTRACTOR t s
Business name: 11.A.)./2„.„,,,t,,,I t/L, i . 1 ,.. - Q._' ' . , PERIVIIT FEES*
Address: r- " (Please refer fo` fee schedule) ,
City /State /ZIP: Structural plan review fee (or deposit):
FLS plan review fee (if applicable):
Phone: ( ) Fax: ( )
�.�p
_ 6 7 Total fees due upon application: 3 L 4
CCB tic.: a
Amount received:
4.
Authorized signature.
This permit application expires if a permit is not obtained
(9/4/1,C2 within 180 days after it has been accepted as complete.
Print name: "11 )A iln �� A Date. * Fee methodology set by Tri- County Building Industry
� (�"�/ Service Board.
1: \Building \Permits \BUP -COM Pen nlitApp.doc 2/23/07 440 4613T(I 1 /02 /COM /WEB)
- rc d rr t f V\i
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' Building Division
Accessibility: Barrier Removal Improvement Plan
'TIGARIy
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and
related facilities shall be made to insure that the path of travel to the altered area and
the restroom, telephones and drinking fountains are readily accessible to individuals
with disabilities unless such alterations are disproportionate to the overall alterations
in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed
disproportionate to the overall'alteration'when the cost exceeds twenty -five per -cent
(25 %).
VALUATION: Total of all renovation, alteration or modification being
done, excluding painting and wallpapering: [1] $
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be
given to those elements that will :provide the greatest access. Elements shall be
provided in the following order:
•
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones: $
(f) Accessible drinking fountains: and, $ •
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $
I ,
I: \Building\Permits \BUP -COM PermitApp.doc 06/25/08
•
e •
Debbie Adamski
From: Marzan, Tomomi [Tomomi.Marzan @macerich.com]
Sent: Thursday, July 15, 2010 2:15 PM
To: Debbie Adamski; Dan Nelson
Cc: Ridge Engineering LLC
Subject: RE: BUP2010 - 00130 (Permit Fee Refund for Deferred Submittals)
Hi Debbie,
Can you send me the refun receipt via email?
Thank you,
Tomomi K. Marzan I Tenant Coordination
Macerich
9585 SW Washington Square Road
Portland, OR 97224
p. 503.352.8884
f. 503.620.5612
From: Debbie Adamski [mailto:DEBBIE @tigard - or.gov]
Sent: Thursday, July 15, 2010 2:13 PM
To: Marzan, Tomomi; Dan Nelson
Cc: Ridge Engineering LLC
Subject: RE: BUP2010 - 00130 (Permit Fee Refund for Deferred Submittals)
Tomomi —
I processed a refund request for the (2) deferred submittal fees yesterday. I am not exactly sure how long it will
take, I believe about 2 weeks. Since the payment was made by credit card the refund will be credited back to the
same card number.
Debbie Adamski
City of Tigard
Senior Permit Technician
503.718.2450
From: Marzan, Tomomi [mailto:Tomomi.Marzan @macerich.com]
Sent: Thursday, July 15, 2010 2:06 PM
To: Dan Nelson; Debbie Adamski
Cc: Ridge Engineering LLC; Marzan, Tomomi
Subject: BUP2010 - 00130 (Permit Fee Refund for Deferred Submittals)
Importance: High
Dan and Debbie,
Can you please send to me and email with the refund receipt for $400 for BUP2010- 00130? This was paid on my
Macerich credit card and it needs to be properly documented on my side.
Best Regards,
'
Tomomi K. Marzan I Tenant Coordination
Macerich
9585 SW Washington Square Road
Portland, OR 97224
p. 503.352.8884
f. 503.620.5612
Please consider the environment
...:�
be fare p int]ng this message.
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."
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