Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013-00339
T l CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/26/2013
Parcel: 2S112AC01801
Jurisdiction: Tigard
Site address: 14965 SW 72ND AVE
Project: Oregon Bolt Subdivision: FANNO CREEK ACRE TRACTS Lot: PTS 45
Project Description: Replacing 30 ft.of storm drain.
Contractor: LOVETT EXCAVATING Owner: SANTA FE PACIFIC REALTY CORP
PO BOX 86280 201 MISSION ST
PORTLAND,OR 97286 SAN FRANCISCO,CA 94105
PHONE: 503-504-2847 PHONE:
FAX: 503-288-1630
FEES
Quantity Description Date Amount
30 If Storm and Rain Drain 09/26/2013 $62.54
Specifics:, 1 12%State Surcharge- 09/26/2013 $8.70
Plumbing
Type of Use: 10 ea Minimum Fee Adjustment- 09/26/2013 $9.96
Class of Work: 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: MOP Permittee Signature:
L - __
��
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. 26. 2013 9: 15AM Lovett Excavating No. 9583 P. 1
Plumbing Permit Application
‘,Ac
Site Utilities c' )\-.--, i ou oI'I lcc u4E ONLY
CI of Tigard � �� Received PermitNo.:
Ili + 13125 SW Hal Blvd.,Tigard,;�' �'O Date/By: _13 �i"5� p 26 1 3-01-.13 7
f g i 6p Plan Review
f� ® Other Permit No.: 2 d
C Phone: 503.718.2439 Fax: 50 5•:.1 Q \� 5 Dale/By: M I�'Qv/�d
Inspection Line: 503.639.4175 �\ ``,,\�\�`� Dale Ready/By: kris: 61 See Page 2 for
T I iL�It L� Internet: www.tigard-or.gov - \V ` NotiftedlMethod: - Supplemental
�'k. !. ,r r fiaK dal a ` p 9 CI ) .
❑New construction ❑DROition For special igforrrrnrlon use elreck//sf
Description I Qty. 1 Ea. I Total
'Addition/alteration/replacement. ❑Other: New 1-2-fanllly dwellings(includes 100 ft.for each utility connection)
CATEGORY Or CO R OTibb <,t SFR(I)bath 312.70
1DI ing V Commeroial/industrial SFR(2)bath 437.78
'\ SFR(3)bath 500.32
ID ID ❑
Accessory building Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
• JOB SITE'INFORMATION AND LOCATION ^a'' Site utilities:
Job site address: (--{Ct S 7 2. Pi) A--t)C• Catch basin or area drain 18.76
Drywell,leach hue,or trench drain 18.76
City/State/ZIP: 11 C,A-I. 0 i OIL 9 -7 Z Lt Fooling drain(no.linear ft. ) Page 2
Suite/bldg./apt.no.: Project name: Otac,v ad 19- Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
CJ ak r 3 A ,i• Rain drain connector 18,76
IC) 1y- Sanitary sewer(no.linear ft.: ) Page 2
Orrrcz Q0/d' Storm sewer(no.linear n,;?10) Page 2 ` 2. $
Water service(no.linear Il„, 1 Page 2
Subdivision: i Lot no.: Fixture or item:
Tax map/parcel no.: Backfow preventer 31.27
Backwe[er valve 12.51
p Clothes washer 25.02
1�z (,I�G 3�) I OP STS r'` 'L N Dishwasher 25.02
Drinking fountain 25.02
ICI ,,�11 Ejectors/sump 25.02
:A:...• ❑ PROPEl�T7 Q11Y11EI2 ' _�. 4l,A0 fi� 4 rr,r`Y Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Pax:( ) Ice maker 12,51
r[;O:!APPL1C NT '• , h 6017`Agr!'PERSON Interceptor/grease trap 25.02•
Business name: i V E:ri- [(J) G Medical gas(value:$�) Page 2
Primer 12.51
Contact nanree'4 Ut L(',. -
Roof drain(commercial) 12.51
Address: l'. 0 . 6 dy L� c-G Sink/basiltllavatory 25.02
City/State/ZIP: e 0 ('rLA_A._1 / at- C7 / 2- L Solar units(potable water) 62.54
Phone:(c)stir--Qd 3 '- Pax::(963)-L&g- .-/6 3 4) Tub/shower/shower pan 12.51
E-mnil: 4.0.,r 4_t-(I P.,Y1 c(�V erf 5�0 C t S• (-Oyu-,
Urinal • 25.OZ
+ r„ Water closet 25.02
CO,N TRAC3 Oki. ••::' '''':'";5' ::. Water heater 37.52
Business name: I-()YtT'T Xt./G Water piping/DWV 56.29
Address: Q. 0. 6 g"try 2 U Outer: 25.02
Cily/Slate/ZIP; 9 U (-(-G�� C4 try Z Subtotal
Phone: ) '13'7 - 0 4.2._ . F Faux:(S- Z yr ic- lc F0 Minimum pencil fee: $72.50 2.9)
.2 e�G- Plan review (25%of permit fee)
CCB Lie.; J Plumbing Lie.no.:-Z(+"/7 3 P
Stale surcharge(12%of permit fcc) • •7 0
,‘,Lc___Authorized signature: TOTAL PERMIT FEE `a . Q
Print namt'�a.�(� ESC crhfkixf 4/g rDately fj( 3 This permit application expires in pernd(is not obtined within(00 days
after It has been accepted as complete.
'Fee methodology set byTri-County Building Industry Service Board.
I:\Duildina%PermitslPI.MU-ParlciiApp.dot I0/oI/09 440-4616T(10/02JCOMMTB)
TIGARD
City of Tigard
December 3, 2013
Lovett Inc.
Attn: Danielle Hankins
PO Box 86280
Portland, OR 97286
Re: Permit No. PLM2013 -00339
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 14965 SW 72n Ave.
Project Name: Oregon Bolt
Job No.: N/A
Refund Method: ❑ 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 job was changed and plumbing was not
installed. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
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
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 forPermit 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: Lovett Inc DATE: 12/3/2013
Attn: Danielle Hankins
PO Box 86280 REQUESTED BY: Dianna Howse
Portland, OR 97286
TRANSACTION INFORMATION:
Receipt #: 193260 Case #: ''` ' ' PLM2013 -00339
Date: 9/26/2013 • • " ' Address /Parcel: 14965 SW 72nd Ave.
Pay Method: CreditCard • Project Name:' Oregon Bolt
EXPLANATION: Per applicant's request as job was changed and pluAbing was not installed.
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: SIGNATURES /DATE:
If under $5,000 Professional Staff
If under $12,500 Division Manager (" DUAL
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: 1 Date: 1 42/3/43 By:
I: \Building \Refunds \RefundRequest.doc x 09/01/2010
Oct, 3. 2013 11:57AM Lovett Excavating No, 9678 P. 1 ,�
C
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMEN 1 1
q � R e uest Permit Action ``� 3
T1(; A r1.1) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.ti v ED
TO CITY OF TIGARD OCT 3 2013
Building Division Services Supervisor CITY OF TIGARD
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov BUILDING DIVISION
FROM: ❑ Owner Applicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name.
INVOICE TO: (Business or Individual) LLX W. . , 1 ei
Mailing Address: 1O (b
City /State /Zip: TOM bid, Ok q r
Phone No.: 7 j — 7 i,l ` 14 `,
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
i:� CANCEL /VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR. FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit #: L t4 �O) i )" " 0 0 339
Site Address or Parcel #: j 11,1"
q / c
Project Name: 01(10/ W )1 -
Subdivision Name: (f Lot #:
EXPLANATION: . c. l� . .ih 'a l. ' i !'
•
1
Al! 01 '.k _ 12 it _I 1'. fL__?.'. #' LlA / lbl'. 144
Signature: £ 1 1 .1.. / r1/,,. A _ :1•_- Date: /O // //3
Print Name: MA ;616., W /riiit nS 202 • -C° 5°, 7O
-se, re 7.- r 96 - 6 Y. 9to
Refund Policy U
1. The Director or Building Official may authorize the refund of. / / y r So 1 7 / — �6 "� Y rAfC 13
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 fcc for issued permits.
d) not more t B0% of the building plan review fee when an application is canceled before any plan review effort has been expended
c) not more than 80% of the building permit fee for issued permits prior to tiny inspccaon requests.
2. kefunde will be returned to the original Payer in the same method in which payment was received Please allow 24 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date d , By / Rte to Bldg Admin: Date /.2 3 /3 B.4/
Refund Processed: Date % 3 B Invoice Processed! Date By
Permit Canceled: Date Parcel Ta: Added: Date B •
Receipt # Date Met od _ Amount $
1: \ Building \ Forms \RegPemtitAction.doc Re'-05/25/2012
MIME
3
.9bhl
-ANAL •p(q.
;da 4.1
'd 8856 '°N
uIIPAP)x3 } }an01
WVSH6 810 9Z 'd'S