Permit •
CITY OF TIGARD PLUMBING PERMIT
s -7. COMMUNITY DEVELOPMENT Permit#: PLM2013-00329
T i GARL) 13125 SW Hall Blvd.,Tigard OR 97223 503,718.2439 Date Issued: 09/18/2013
Parcel: 1 S133CA14200
Jurisdiction: Tigard
Site address: 11082 SW SAGE TER
Project: Village at Summer Creek, Lot 65 Subdivision: VILLAGE AT SUMMER CREEK Lot: 65
Project Description: Building 19,Lots 65-68. Installation of residential backflow preventer for irrigation of common area for this
building.
Contractor: ASHLAND BROTHERS LANDSCAPES Owner CENTEX HOMES
2153 MOLALLA HIGHWAY ATTN: OCHSNER, JOHN
WOODBURN, OR 97071 11241 SLATER AVE NE, STE 100
KIRKLAND,WA 98033
PHONE: 503-981-6131 PHONE: 971-246-1417
FAX: 503-981-1058
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/18/2013 $31.27
Specifics: 1 12%State Surcharge- 09/18/2013 $8.70
Plumbing
Type of Use: SFA 41 ea Minimum Fee Adjustment- 09/18/2013 $41.23
• Plumbing
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 952-001-0090. You may obtain a copy of the rules
or dire uestions to-OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By',; ' / � ' / Permittee Signatur
• lam-`,
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.
Sep 16 1304:44p Ashland Brothers 503-981-1058 p.2
I
Plumbing Permit Avulica °.ECEIV°'D FOR OFFICE USE ONLY
City of Tigard p 16 2013 Date/R: 9 /g./3 ( Permit No.: jv/�D/3- j• °�
111
Q ]3125 SW Hall Blvd.,Tigard,OR 9 DatdBy
Phone: 503.6394171 Fax: 503599.1 Ptah Review Other Permit No.: MI:AV 49
Datcllty:
3iG_IEiD Inspection Line: 503.639.4175 ClL FTIGAR DateReadylSy: huts. 1 0 See Page 2for
Internet: www.tigard-or.gov I3ILDtING DIVISION n.otitt J1McLhod: Supplemental Inform[tion
i TYPE OF WORK FEE*SCHEDULE
J NI New construction 0 Demolition For special information use cLeeklisl.
Description I Qty. I Ea. I E Vial
I 0 Addition/alteration/replacement 0 Other: New 1.2-family dwetlin c(includes 100 ft.for each utility unction)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
®,1-and 2-family dwelling 0 Commercia]rmdustrial SFR(2)bath 350.00 l
0 Accessory building 0 Multi-family SFR(3)bath 399.00
es
Each additional bath/kitchen 45.00
0 Master builder 0 Other.
Fire sprinkler(_s .ft.) Page
JOB SITE INFORMATION AND LOCATION Site utilities I
Job^te address: f ID S d 3 W SA (-1E, T 4LF Catch basin orarca drain 16.60
City/State/ZIP:T l G, ,I r-5z- �-P.a 3 Drywell.leach line.or trench drain 16.60
5 Footing drain(no.linear ft.:_) Page 2 T
SnitelbldgJapt.no.: Project name: 5 V m t"v-1 ev- Cv.e t-C
Manufactured home utilities 1/0.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no.linear ft.:_ ) Page 2
- • • Storm sewer(na linear ft:-_) Page 2
Water service(no.linear ft.: ) Page 2
}
Subdivision: Lot no.:�`�- ...,p3 Water
or item
Tax map/parcel no.: _ Absorption valve • 16.60
CC DESCRIPTION OF WORK Baci:f/owpneventer Page'-
L_ 3 �C. %(t'n cj o4)0e1 Backwater valve 1 16.60 I . o o
tl Clothes washer 16.60
•
Dishwasher 16.60: I
Drinking fountain 16.60
jEr-PROPERTY OWNER I 0 TENANT IE
l /�1�e3•, Ali"it? ‘" 16.60 •
Name: ��rIA " + • -e--S t eAi `X I "'� GJ Expansion lank 16.60 I
Address: g ro re-1Inp OP. So j r C,. 3CU Fixture/sewer cap 36.60 I
CilyfStatefZIP: Floor drain/floor sink/hob 16.60
a V+ � C�.Ma q 7i��?CO' Garbage disposal 16.60
Phone:151 ) R(0 -- f 0 Fax: 53 TSSA '
• APPLICANT [.]-CONTACT PERSON Hose blb 16.60
toe maker 16.60 I I
Business namm 1P51n1,,,.•c, s '7s Intercepter/grease trap 16.60 I
Contact name:•••-T60,,1/4 tek1 (0. Medical gas(value:$ ) Page 2 I
Address: 1,,,,,I41/0. ac,/ Prima 16.60
CityIStateiZlP: Gatx '9b✓rn eel 57011 Roof drain(commercial) 16.60 1 I
G 3) t-,o$ p Sink/basin/lavatory 16.60 I
Phone: 5'�' f ( Fax: O
Tub/shower/shower pan 16.60 'I I
E-mail: Urinal 16.60 I
CONTRACTOR Water closet .1 6.60 I
Business name: Lac1A1 4) 6tv er' G /5 . Water heater 16.60 I
Address: J. $'3 I1N10 Iid.I Ilia. ra Other. I
y cR uY - ore. 7 i Subtotal '�
City/State/ZIP:'StatGZIP: ,� Minimum permit fee: 57250
Phone:(tfbj) 5 7 4431 Fax:01) t,l -101-7
CCB Lic.: "'7( 7 t f Plumbing Lie.no.: ._ , Plan review (25%of permit fee)
State surcharge(8%of permit fee) 1 ,t�
Authorized signature t �-_�� r TOTAL PERMIT FE 39,11.- .go
Print name: -d am taro 0 Date- l i b (l This penult application expires if a permit is not o rained within gl
180 days after it has been accepted as complete.
'Tee methodology set by Tri-County Building Industry Service Board. Gat
i• uildtVN'rnn4s'124-P-mmxApttdpe a5120r06 eaomaterctomua>TSnvnn)
IN : „
TIGARD
City of Tigard
December 26, 2013
Ashland Brothers Landscape
Attn: Emily Comstock
PO Box 130
Woodburn, OR 97071
Re: Permit No. PLM2013 -00329
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11082 SW Sage Terrace
Project Name: Summercreek Village, 65 -68
Job No.:
Refund Method: n Check # in the amount of $ .
® Credit card "return" receipt in the amount of $64.96.
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): Per applicant's request as permit was a duplicate. Refund 80% of permit
fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
, V i
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
Irr City of Tigard
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 Request for Permit 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: Ashland Brothers Landscape DATE: 12/19/2013
Attn: Emily Comstock
PO Box 130 REQUESTED BY: Dianna Howse
Woodburn, OR 97071
TRANSACTION INFORMATION:
Receipt #: 193130 Case #: PLM2013 -00329
Date: 9/18/2013 ' Address /Parcel: 11082 SW Sage Terrace
Pay Method: CreditCard Project Name: Summercreek Village, 65 -68
EXPLANATION: Per applicant's request as this was a duplicate permit (general pulled original). Refund
80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 - 43104 $ Amount
Plumbing Permit 230- 0000 -43101 $58.00
12% State Surcharge 100 - 0000 -24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIGN ES DATE:
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 $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
,
Case Refund Processed: I Date: I /.L /. (`,C3 By: �(�!' Y -
I:\ Building \Refunds \RefundRequest.doc c 09/01 /2010
Dec 17 13 05:26p Ashland Brothers 503 - 981 -1058 p.1 V V
RECEIVED
111 City of Tigard • COMMUNITY DEVELO ?MENT DEPARTMENT DEC 17 2013
i 111 r Request Permit Action
TIGARD I3125 SW Hall Blvd. • Tigard, Oregon 97223 - 503.718.2439 • www.t C - TY OF TIGARD
. DIVISION
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Hall Blvd., Tigard, OR 97223 V 0 I D
Phone: 503.718.2430 Fax: 303.598.1960 www. tigard- or.gov 7„2/.24, /j3
FROM: ❑ Owner ❑ Applicant 2 Contractor ❑ City Staff
(check onc)
REFUND OR Name: l �, z ,, �� / ;
INVOICE TO: (Business or Individual) A_}-) calla 5 - Hier s La n6Cee• e..5
Mailing Address: PD 6r //( 1 3 0
City/State/Zip: ('v'f DOi/L thYYI , OTC_ g 7 o q i
Phone No.: q ) — & i i
( PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
l
• Mi CANCEL /VOID PERMIT APPLICATION. O
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below)_ t `•
1111 INVOICE FOR FEES DUE (attach case fee schedule acrd provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). 1
Permit #: Pun 1 r �
.5 - 003q �
Site Address or Parcel #: hi 0 g Sty So g f?. TeA ra(,e__,
Project Name: Gum m 1/(V ' i lid I nix;
Subdivision Name: Si ? rii ni`k'-r(,vell;. Lot #: (oS - -/ g
EXPLANATION: Do 1PU (W[(. P6- C? M i l , 0 Lii ski c!
1
Signature: : ( ?ah?I( , Date: / 2.`/ 7jj�3
e2 ad Ya
Print Name:
bil11 Cp 0161-0 -
1 OCK 9�.3) 6 -p -t �y,sa
p. - G .34 i 7 Y'_ . 7-1 .
Refund Pnbcy
1. The Director or Building Official may authorise the refund of: // `� 6 /
a) any fee which was erroneously paid or collected.
p � I • a i) to y . / C. c.2$
b) not more than 80% of the land use application fee when an application is withdrawn of canceled before any review effort has been expended. d
c) not more than BO% of the land use application fee for issued permits.
d) not more than BO % of the building plan review fee when an application is canceled b:fore any plan review effort: has been upended
c) not more than 80"i of the building permit fee for issued permits prior to any inspectior rt c
2. Refunds will be returned to the original Paver in the same method in which payment was rearmed Phase allow 2 -4 weeks for processing refunds.
FOR OFFICE LSI: ONL\
Rte to Sys Admin: Date /A p SMIEVIZal Rte to B1d . A.. ' : Date et AMEal B • iis21/ d
Refund Processed: Dare /2/24,//..3 By , 7 Invoice Process =d: Date : By
Permit Canceled: Date .24 /3 B rte Parcel T. _. Add ..: Date B
Rece' . t # Date Method Amount $
I: \Hui ing\Fomw \ RegPcrmit_Actioa.doc Rev 05/25/2012