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Permit • a a • 7'IGARD City of Tigard October 30, 2014 Power Plumbing Attn: Laura Deos PO Box 19418 Portland, OR 97280 Re: Permit No. SNX7R2014-001 PLIML014-00328 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 10220 SW Greenburg Rd., #250 Project Name: Sodexo Job No.: N/A Refund Method: E Check#215425 in the amount of$715.46. n Credit card "return" receipt in the amount of$ . 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 customer cancelled job. Refund 80% of plumbing permit fees $78.46 plus 100% of sewer connection fees $637.00 for a total refund of$715.46. 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 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: Power Plumbing DATE: 10/23/2014 Attn: Laura Deos PO Box 19418 REQUESTED BY: Dianna Howse Portland, OR 97280 TRANSACTION INFORMATION: Receipt#: 197839 Case#: PLM2014-00328 Date: 10/2/2014 Address/Parcel: 10220 SW Greenburg Rd#250 Pay Method: CreditCard Project Name: Sodexo EXPLANATION: Customer cancelled job and work performed by another contractor. 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 $70.05 12% State Surcharge 100-0000-24001 8.41 TOTAL REFUND: $78.46 APPROVALS: SIGNATURES/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: j0/putt, By: 4 I:\Building\Refunds\RefundRequest.doc x 09/01/2010 City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVED NI / II Request Permit Action OCT 21 Z014 Tic;A II D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.ti and-or. o 'GARD TO: CITY OF TIGARD BUILDING DIVISION Building Division Services Supervisor 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov (a 3d//y FROM: ❑ Owner leApplicant D Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Pn W e/ P I W Y,t b 1 (t9 to Mailing Address: PD (i) !co./1g, City/State/Zip: Ate. b k 61-1 2�t Phone No.: -- / Al PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL/VOID PERMIT APPLICATION. IT 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#: P LM �20 - O0 3 a 8 Site Address or Parcel#: 10 ZZO 5i V v'Yl.b wLD PA . Ccb Project Name: Sor;Lex1) Subdivision Name: Lot#: EXPLANATION: POW e 1( P l u 1/44.b1 & Of do job — 61-3/151-14-1)\-- P Ivy w�ti�� CA - cu a w Signature: a I2 US Date: I O'1 .D! J L/ Print Name: CL u I-c& bfac).S J 2 s -- 7o,05 = /7,5/ Refund Policy �Q ' s� r_ e,1". a,/e 1. The Community Development Director or Building Official may authorize the refund of e•9!. /9; Co/ a) any fee which was erroneously paid or collected. / 1� 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. c) not more than 80%of the building permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check. Please allow 3-4 weeks for processing refund requests. FOR OFFICE USE ONLY Rte to S s Admin: Date f® B Rte to Bid:Admin: Date fi�2, B 4PM Refund Processed: Date ,Vr'TA, B' ',PM Invoice Processed: Date B' Permit Canceled: IIEMEWRI211 B � � Parcel'Fa:Added: Date B Receipt# Date Method Amount$ • I:\Building\Norms\RegPermitAction_062614.d oc yy CITY OF TIGARD PLUMBING PERMIT 1111 t COMMUNITY DEVELOPMENT Permit#: PLM2014-00328 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2014 Parcel: 1 S135AB01004 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 250 Project: Sodexo Subdivision: METZGER,TOWN OF Lot: 9 Project Description: Adding(1)sink,(1)water heater and(1)emergency only hub drain. Contractor: POWER PLUMBING CO Owner: LINCOLN CENTER LLC PO BOX 19418 BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97280 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503-244-1900 PHONE: FAX: 503-244-8825 FEES Quantity Description Date Amount 1 ea Floor Drain/Floor Sink/Hub 10/02/2014 $25.02 Specifics: 1 ea Sink 10/02/2014 $25.02 1 ea Water Heater 10/02/2014 $37.52 Type of Use: COM 1 12%State Surcharge- 10/02/2014 $10.51 Class of Work: ALT Plumbing Type of Const: Occupancy Grp: Stories: Total $98.07 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 Notifica'on 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 estions toNC by calling 503.232.1987 or 1.800.332.2344. Iss d By: Permittee Signature(— 6:16-144-41-1-1- r cAl 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/30/2014/TUE 08:52 AM RECEIVED P Gu. Plumb 1ica in Permit A tio'I SEP 3 0 2014 Buildiug Fixtures FOR OF1'ICL USE ONLY CITY OFTIGARD Received City of Tigard 30 / Permit N°_ ,,- . ,- -J� g g 1 ING DIVISIOt w 4 (``""' t / 13225 sec Hail Blvd.,Tigard*aid.oR y i other Permit No.: �w Q r 0!1 -en01 .--' Phone: 503.718..439 Fax. 503. .. ..t DatdBy: Inspection Line: 503 639 4175 Date steady/By r el See Page 2 for TI G ARD l t . www tigard-or gov HotrfutMeWod. _ Sep,teoresrtat Information ❑New construction 0 Demolition For s information use checklist Description I Qty- I Ea, r Total i� Addition/alteration/replacement ❑Other New 1-2-(amity dwellings(includes 100 ft.for each uity til connection) 1 7' ;1 ; '(Yiia ifi hurl 4 irlii5 t + , +..17.:.)." '.'... ` - ' _1 SFR(1)bath 312.70 a CommercialJindnstrial SFR(2)bath 437.78 Q 1-and 2-family dwclltn, = �,t_ get(3)bath 50032 ❑Accessary building - ❑Multi-family Each additional batb/kitchen 25.02 ii ❑Master builder ❑Other Fire sprinkler( sq.f-) Page 2 1-N w �,+ r t-'��• " s Site utititaes: _ ;.r-Fr,tf �� 11E•P,E lyy-„I 1)x,+i11-E.._.p... C_•�1� F- y' r .�,.r _ p� - r �� -cx'. ..ta.e ;' Catch basin or area drain 18.76 r Job site address jO��() 5 w 6Y-c.e-�h►. Drywell,leach line.or trench drain 18.76 61722 City/State/ZIP: /,d/ r 1 3 Footing drain(no.linear ft_: ) Page 2 Suite/bldg./apt.no: J Project name: Sod eX O Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 - - Rain drain connector 18.76 Sanitary sewer(no.linear ft: ) Page 2 Storm sewer(no,linear f.:.j Page 2 Water service(no.linear ft.:_,_) Page 2 Subdivision: I Lot no.: Fixture or item: --- - --- - Bacowpreventer Tax map/parcel no.: /5j/ 3-5-,,9-7�c D ) lc6 x Backwater valve 12.51 I`..- -- . __,---”--y-t t ,Eck f` ry_-, �L. -1- /� Cluthr^s washer 25.02 bU Y items' r 11i 4. Dishwasher 25.02 .--- �.P.fil GI/ L[.. /7.eJf��UL•L.'2- Drinking fountain 25.02 `' Ejectors/sump 25.02 I :,77- _7-4-67-' -' a5 T7 a�' ; .`r k ,n�.-iA �✓ k Expansion tank 12.51 Fixture/sewer cap 25.02 Name Floor drain/Boor sinle) 1 25.02 Z5,67- Address: Garbage disposal 25.02 City/State/UP: _ Hose bib 25.02 _ Phone ( ) Fax ( ) Ice maker 12.5] µti , 1„14 "' I o"•6 , : Interceptor/grease trap 25.02 I i . i �i,R f.k.L 4..1`:mss..-+�}i Medical gas(value;S ) Page 2 .Busineit Mime:.... ��/y - ---- f�01�IF�C PI tun h►V29_ LV' - Primer 12.51 Contact name: 1 A Q / •.I J Roof drain(commercial) 12.51 Address: t , . I i IL, 111 V Sink/basin/lavatory '1 25.02 25,Qz ` City/State/ZIP: T70 Attuji of_ i7-3 Solar units(potable water) 62.54 Pholoe: (�3) iq q-j 97 Fax::( ) !, !N.. 5 ggZ Tub/shower/shower pan 12.51 ''ryry Urinal 25.02 ,ii l� ► E-mail:--- •l/� i ✓ _ �. -.,�, rn, qq] Water closet 25.02 , : t1,17_1I�. �C) ptJ, W ,,r •;-- ."a^r,1 ^.A;'-1 Water heater i 37.52•_ - ,. -,-, - �':_ ...._, , .�. �, -_ .�.�� _ 37.5 $usiThesstuuna FOOk.II PI u. nb(i1 t Waterpipmg/DWV 5629 Address: PO .OX L41f 1$ J Other. 25.02 City/State/ZIP: r' J Q t 9 ? j Subtotal g 7.S / (7 NY g•SL5 Minimum permit fee: S72.50 ------- Phone:( ) 1.414-1 q 07� Fa" Plan review (25%of permit fee) CCB Lie.: 52V1 p Plumbing Lie.no.: 3 - t► Pg State surcharge(I2%of permit fee) (O Authorized signature: t 0 i 'I TOTAL PERMIT FEE qt.() • �� This permit application expires N a permit is pet obtained wifbht 180 days Print name: / roc D e L, Date. after it has been accepted as template. 'Fee methodology set by Tri-Connty Building Industry Service Board. ...1. �pumEtiTLK1 itApp-doe 10101/09 440-e6t6700/02ICOM/WFB1 SEP/30/2014/TUE 08:52 AM P. 002 Piumbi nE Permit A. ,pliicatioa - City of Tigard . . Page 2-Supplemental Information Fee Schedule: Residential Fire Su! .cession Systems: '; f 'tc . '; '4� �• 1. 4= +..� 1 . ?.0. ' i I 6',.7.te k -� , I. rL.t II c l,_' � .�rF j a: N -a e K �r 91 �.r T,. ..;,_-....r4 k c. , I r„ ,� -!-.1),..t !I: .�1.' F _ _.- T._L.-:'rs., +�....�.. .- -. _:.'1 Footing drain-1"100' 50.03 0 to 000 $121.90 Footing drain-each additional 100' 2 001 to 3 600 $169,69 _�_ 3 60]to 7,200 5233.20 Sewer-1st 100' 62.54 7 01 and?-ter £327.54 • Sewer-each additiona1100' 37'52 MEI Water Service-1st 100' 11=11 62.54 Medical Gas Systems: Water Service-each additional 100' 37.52 (7,',-;,:.-s•2.-:;:.K=- , - _ ,.r.:--i[LJ-I1/. .� �� -4k-_:. ''r1ii;:° _ -_i Storm&Rain Drain-1st 100' 62.54 S1.00 to$5.000.00 Minimum fee-i7-275-0 - Storm&Rain Drain-each additional 100' 37.52 55,001.00 to 510,000.00 572.50 for the first$5,000.00 and 5132 for -, 1F',1' w•[ .:,p,-��,-; each additional 5100.00 or fraction thaeot to I r. Y�' ,'. ... .-.�-y ,r t l _-, .,.' wr- 5-y,,�i m BP71. ':w�-='..'f!� and inc1udin'510,000.00. Inspection of existing plumbing or for 510,001.00 to 525,000.00 5148.50 for the first 510,000.00 and 51.54 for which no*is specifically indicated 90.00/hr .-e ._- ach additional.S100.00 or fraction thereo -- ib-to- - ---• -- minimum ch .. -1/2 hour) and includin:$25,000.00. Inspections outside of normal business• - 90.00/hr - 525,001.00 to 550,000.00 S379.50 for the first S25,000.00 and SI.45 for hours{minimum-• -2 hours each additional 5100.00 or fraction thereof to Eeinspection Foos 111111 90,00/hr MI and inciudin:$50,000.00. Additional plan review for revisions - 90.00/hr - $50,001.00 and up 5742.00 for the first 550,000.00 and 51.20 for minimum -1/2 hour each additional$100.00 or fraction thereof. Subtotal: _-111111 • Commercial Fixture Work: - -Are you cappin;adding or replacing g Bocce.?Jf y s',- - -- ---- --- - - - - -- please Indicate work performed by fixture. Failure to accurate]'resort fixtures could result in increased sewer fees`. E-2 .S.Y, rk r i -' 1 I, a Irk C .l lid. [C,.nn i ' �; t r K^ '.1 I '. `y ? r ..-r yiF- CJCLCa3 /. L/i.�.r rr'a� e l .J 1 .1 1 1' F 1'. r i, r , a: .vr f r wr �1>(ICp/.K � ��_.r, 4�_� �c�.+�_.=�--� -I,G f �:IC I_ --��� _ � .:; I° rF � ' d r . Plan review is required for any of the following. Baptistry/Font i" Please check all that apply. Bath -bit/Shower i © Any new commercial building with water service 2"and -Jacuzzi/Whirlpool f greater,except systems designed and stamped by licensed Car Wash -Each Stall engineer. -Drive TIIru - ❑ New exterior plumbing site utilities for any complex structure Cuspidor/Water Aspirator as defined in OA1t9I5-780-0040. Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities. -Domestic ❑ Any multipurpose fire sprinkler system. Drinking Fountain ❑ Any complex structure.as defined in OA.R91S-780-0040. Eye Wash Floor Drain/sink -2" Submit 2 sets of plans with any of the above. -3,r 4.. F-r., r `� y r,-r J y t Car Wash Drain t T ,,02....t.. [nnt- j' ,Z l:t f�r r t `.. -3 Garbage Domestic-non-food ! ❑ isometric or riser diagram is required for new buildings Disposal -Domestic-food related I that meet the •ual fications above. -Commercial-food related • -Industrial-food related Ice Mae-h./Rd-1E,Drains Oil SeparatorSGas Station) Comments regarding fixture work: Vehicle Duma Station �R IS ���ryt CJ c1^ Shower -Gang -Stall Sink/I-ay -Non-food related i -Bradley JIlC>•r7//iSrJ.�/ _ i. a !�i -Commercial-food related h112 1ti• ' _EP �, r. • 4 -Service Swimming Pool Filter I *Note: If the fixture work under this permit results in an Washer-Clothes --- increase of sewer,EDUs,a sewer permit will be issued and Water Closet- fees assessed for the sewer�increase must be paid before the Water Closes-Toilet p • u _ _plumbing_permit can be issued. . . -Other Fixtures: , /_.,_, ,!0-I-f-1 . http://www.tigard-or.gov/city_haWdepartments/cd/docs/PLMF-PermitA.pg2cioc