The URL can be used to link to this page

Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT Request for Permit Action T 1 G A p I ∎ 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov 10: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits @tigard-or.gov FROM: ❑ Owner ❑ Applicant I Contractor j2r City Staff Check(1)one REFUND OR Name: 14- INVOICE TO: (Business or Individual) 1 6€(2. 1 1 C Mailing Address: G% 44: 7N Seftehe LL- City/State/Zip: v ge E � _weione+40.: 95 P5 a) 4JL9 ' 2. PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (1): �� 23 ■ :_ OID PERMIT APPLICATION. ``• REFUND tRMIT FEES (attach copy of original receipt and provide explanation below). • ' • FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: �Lt]�o9Q 1 L-coo $D Site Address or Parcel#: )off 3p (,3R--5N I 1.3 -,7-6.)Z 61f j . Project Name: �/-} ,v f, ,' Subdivision Name: Lot#: EXPLANATION: E:7) -ri 0 /13 ) f.2 673(- t 5 , �i 10 044, ��; U�, SI ��°" , CO212 .r�?� .Cef, aqint,'6° Rerut.S� coo 1.0 Signature: Date: /R/304/ Print Name: / t,4„/g/f gbf/,4154.../ Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or 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 via US postal service. 3. Please allow 3-4 weeks for processing refund requests. 1 ()R OFFICE USE O\I.1 Route to S s Admin: Date ®EMP_ Route to Records: Date AMMIBIBMWdlIl Refund Processed: Date 22//S By ,.#79. Invoice Processed: Date By Permit Canceled: Date A/141— B %'- arcel Tag Added: Date By l:\Building\Forms\RegPemvtAction_l 2314.doc TIGARD City of Tigard January 22, 2015 Macerich c/o Washington Square 9585 SW Washington Square Rd Tigard, OR 97223 Re: Permit No. SWR2014-00080 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 10230 SW Washington Square Rd Project Name: Panera Bread Job No.: N/A Refund: ® Check#216062 in the amount of$19,306.00. ❑ Credit card"return" receipt in the amount of$ ❑ Trust account"deposit" receipt in the amount of$ Notes: A reduction in sewer fixtures on the plumbing permit for this project resulted in an overpayment of sewer connection fees. Please revised accumulative sewer tally, sewer use information card for Clean Water Services and sewer permit. If you have any questions please contact me at 503.718.2430. Sincerely, "<„(279/4z12.-12-- Dianna Howse Building Division Services Coordinator Enc. I:\Building\Refundi.1 L C ,Mgatalimizb,frpTyigartitiQviegon 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 Jbr 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: Macerich DATE: 12/24/2014 c/o Washington Square Attn: Roger Ott REQUESTED BY: Dianna Howse 9585 SW Washington Square Rd DA Tigard, OR 97223 TRANSACTION INFORMATION: Receipt#: 198424 Case#: SWR2014-00080 Date: 11/17/2014 Address/Parcel: 10230 SW``Washington Sq Rd Pay Method: Check Project Name: Panera Bread EXPLANATION: A reduction in plumbing fixtures resulted in a decrease of sewer connection fees: orginal fee$43,512 less new fee of$24,206 = $19,306 refund. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: Building Permit Fee Example: 2300000-43104 $Amount Sewer connection fee 500-0000-25500 $19,306.00 TOTAL REFUND: $19,306.00 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager If under$25,500 Department Manager A it° If under$50,000 City Manager If over$50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONIA Case Refund Processed: Date: _ //Z y/j5 By: L\Building\Refunds\RefundReguest.doc x 09/01/2010 CITY OF TIGARD SEWER CONNECTION PERMIT III 2 COMMUNITY DEVELOPMENT Permit#: SWR2014-00080 Date Issued: 01/22/2015 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S135BA00102 Jurisdiction: Tigard Site address: 10230 SW WASHINGTON SQUARE RD Project: Panera Bread Subdivision: OAKBURG Lot: 9 Project Description: 8.88 EDU increase. 12/22/14,revised(&reduced)to 4.94 EDU's 1/22/2015: Issue permit and refund for reduced amount. Contractor: Owner: PPR SQUARE TOO LLC PO BOX 847 CARLSBAD, CA 92018 PHONE PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 11/17/2014 $24,206.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: 4.94 Total $24,206.00 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: �T!�%' )47 ., per_ Permittee Signature: �. / ,Q` /(1�2770A/ "�� "`" 1��!lllll fff 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. r Accumulative Sewer Tally Tenant Name: Panora Bread SWR# 2014-00080 Revise. 12/22/1. Site Address: 10230 SW Washington Square Rd PLM# 2014-00276 Parcel#: 1S1 35BA00102 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#s value count added# added value. total#s total values Baptiscry/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 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 19 38 19 38 -3 inch 5 0 0 0 0 0 -4 inch 6 0 0 0 0 (I -Car Wash 6 0 0 0 0 0 •Garbage Disposal: -Domestic(to 3/4 HP) 16 0 0 0 0 0 -Commercial(to 5 HP) 32 0 0 0 0 0 -Industrial(over 5 11P) 42 0 0 0 0 0 Ice Machine/Refrigerator Drain 1 0 0 0 0 0 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Station) 6 0 0 0 0 0 Rec.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: -Lay/Bar-Non-Food Related 2 0 0 4 8 4 8 -Bradley 5 0 (I 0 0 0 -Com/Sery/Util-Food Related 3 0 0 3 9 3 9 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 I) 0 0 0 Water Closet-Toilet 6 0 Ii 3 18 3 18 Urinal 6 0 II 1 6 1 6 Previous EDU Count 0 11 Capped EDU Credit 0 TOTALS 0 0 0 _ 0 30 79 30 _ 79 Current Fixture Value 79 divided by 16= 4.938 Current EDU 1 EDU= $4,900.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 79 divided by 16= 4.938 over (under) $ 24,206.00 Enter EDU Change Here 4.940 Notes: Revised fixture worksheet to match CWS fixture count taken from plans examiners worksheet. Per CWS,ok to calculate 3"floor drains at the 2"rate, as 2"is required and 3"is being installed for maintenance purposes. Authorized Name/Signature: Debbie Adamski Date: 12/22/2014 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:\Bull ding\Sewer Tally\Sewell'allySheet_4900._070114.xlsx Sli Tenant Name: Panera Bread Accumulative Sewer Tally Q//6-/A74-Z---- SWR# 2014-00080 Site Address: 10230 SW Washington Square Rd P1.M# 2014-00276 Parcel#: IS135BA00102 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#5 value count added# added value total#s total values Baptisery/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 1 4 1 4 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye 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 14 84 14 84 -Car Wash 6 0 0 0 0 0 Garbage Disposal: -Domestic(to 3/4 11P) 16 U 0 U 0 0 -Commercial(to 5 IIP) 32 0 0 U 0 0 -Industrial(over 5 HP) 42 0 0 (I 0 0 Ice Machine/Refrigerator Drain 1 0 0 1 1 1 1 Living Unit 16 0 0 0 0 0 Oil Sep(Gas Station) 6 0 0 0 0 0 Rec.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: -Lav/Bar-Non-Food Related 2 0 0 4 8 4 8 -Bradley 5 0 0 0 0 0 -Com/Serv/Util-Food Related 3 0 0 7 21 7 21 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 0 3 18 3 18 Urinal 6 0 0 1 6 1 6 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 0 31 142 31 142 Current Fixture Value 142 divided by 16= 8.875 Current EDU 1 EDU= $4,900.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 142 divided by 16= 8.875 over (under) $ 43,512.00 Enter EDU Change Here 8.880 Notes: Authorized Name/Signature: Debbie Adamski Date: 9/4/2014 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. 1:\Building\Sewer Tally\Sewer 1'allyShect_4900._070114.xlsx