Permit CITY OF TIGARD ' SEWER CONNECTION PERMIT
III q �
I COMMUNITY DEVELOPMENT P� / Permit#: SWR2015-00006
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ® Date Issued: 01/28/2015
Parcel: 2S112CB00900
•
Jurisdiction: Tigard
Site address: 15000 SW HALL BLVD
Project: Bonaventure of Tigard Subdivision: WILSON ACRES Lot: 8
Project Description: 2/26/15,correct EDU count is 108. Demo credit of 1 EDU applied,so charged for 107 EDU's.
Contractor: Owner: MWSH TIGARD LLC
3425 BOONE RD SE
SALEM,OR 97317
PHONE: PHONE: 503-566-5715
FAX:
FEES
Description Date Amount
Specifics: Sewer Inspection-Commercial 01/28/2015 $45.00
Sewer Connection Fee 01/28/2015 $524,300.00
Type of Use: COM
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 108
Total $524,345.00
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. Thos- - - e 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 b ailing 503.232. •87 or 1 :10.332.2344. --.
Issue. By: � Permittee Signature: . , ,
Call 503.639.4175 by 7:00 a.m.for the next available inspec • date.
This permit card shall be kept in a conspicuous place on the job site • completion of the project.
Approved plans are required on the job site at the time of each inspection.
Tenant Name: Bonaventure Accumulative Sewer Tally SWR# 2015-00006 REVISED
Site Address: 15000 SW 83RD AVE ***REVISED*** PLM# 2014-00259
Parcel#: 2S112CB00900
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s 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 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 0 0 0
-3 inch 5 0 0 0 0 11
-4inch 6 0 0 0 0 0
-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 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 108 1728 108 1728
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 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 1 16
TOTALS 0 0 0 0 108 1728 _ 108 1712
Current Fixture Value 1712 divided by 16= 107.000 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 1712 divided by 16= 107.000 over (under) $ 524,300.00
Enter EDU Change Here 107.000
Notes: 69 units w/kitchen+81 bedrooms @ first 5= 1 EDU+ 1 EDU for each additional 2 bedrooms=38:
69+ 1 +38= 108 less 1 EDU demo credit for total 107 EDU.
Authorized Name/Signature: Debbie Adamski Date: 1/22/2015
Building Division
ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\SewerTallySheet_4900._070114.xlsx
CITY OF TIGARD SEWER CONNECTION PERMIT
E COMMUNITY DEVELOPMENT Permit#: SWR2015 00006
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/28/2015
Parcel: 2S 11X800900
Jurisdiction: Tigard
Site address: 15000 SW HALL BLVD
Project: Bonaventure of Tigard Subdivision: WILSON ACRES Lot: 8
Project Description: 112 EDU's. Demo credits of 1 EDU applied so actual fee charged is for 111 EDU's.
Contractor: Owner: MWSH TIGARD LLC
3425 BOONE RD SE
SALEM, OR 97317
PHONE: PHONE: 503-566-5715
FAX:
FEES
Description Date Amount
•
Specifics: Sewer Connection Fee 01/28/2015 $543,900.00
Sewer Inspection-Commercial 01/28/2015 $45.00
Type of Use: COM
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 111
Total $543,945.00
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: • .1 ittee Signature:
Call 50 .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.
Accumulative Sewer Tally
Tenant Name: Bonaventure SWR# 2015-00006
Site Address: 15000 S\C'I Iall Blvd PLM# 2014-00259
Parcel#: 2S112CB00900
Fixture \altit Previous Previous Credits Capped Fixture l:ixture New New
# value count capped#s 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 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 0 0 0
-3 inch 5 0 0 0 0 0
-4 inch 6 0 (I 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 Hl') 32 0 0 0 0 0
-Industrial(over 5 I IP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 112 1792 112 1792
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 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 1 16
TOTALS 0 0 0 0 112 1792 112 1776
Current Fixture Value 1776 divided by 16= 111.000 Current EDU 1 EDU = $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 1776 divided by 16= 111.000 over (under) $ 543,900.00
Enter EDU Change Here 111.000
Notes: 69 units w/kitchen+81 bedrooms @ first 5= 1 EDU+ 1 EDU for each additional 2 bedrooms=38:
69+5+38= 112 less 1 EDU demo credit for total Ill EDU.
Authorized Name/Signature: Debbie Adamski Date: 1/22/2015
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 T ally\Sewer TallySheet_490(1._070114.xlsx
1
TIGARD
City of Tigard
February 26, 2015
Bonaventure Senior Housing
Attn: Eric Rouse
3425 Boone Rd SE
Salem, OR 97317
Re: Permit No. SWR2015-00006
Dear Mr. Rouse:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 15000 SW 83`"Ave.
Project Name: Bonaventure Senior Housing
Job No.: N/A
Refund: ® Check#216546 in the amount of$19,600.00.
❑ Credit card "return" receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Refund of overpayment on sewer connection fees collected. See attached sewer tally
sheet for new fixture count.
If you have any questions please contact me at 503.718.2430.
Sincerely,
■
Dianna Howse
Building Division Services Coordinator
Enc.
I:\Building\RefurnM n:d44 c hicbrt4kgar4li regon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
- 1
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 Reqiiestjbr 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: Bonaventure Senior Housing DATE: 2/19/2015
Attn: Eric Rouse
3425 Boone Rd SE REQUESTED BY: Dianna Howse
Salem, OR 97317
TRANSACTION INFORMATION:
Receipt#: 199176 Case#: SVR2015-00006
Date: 1/28/2015 Address/Parcel: 15000 SW 83.-4 Ave.
Pay Method: Check Project Name: Bonaventure Senior Housing
EXPLANATION: Refund overpayment of sewer connection fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No Refund
Example:.Building Permit Fee Example: 2300000-43104 $Amount
Sewer connection fee 500-0000-25500 $19,600.00
TOTAL REFUND: $19,600.00
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 ONNLX:
Case Refund Processed: Date: 02/o2k//s' By:
is\Building\Refunds\RefundRequest.doc x 09/01/2010
Accumulative Sewer Tally
11114. Tenant Name: Bonaventure SWR# 2015-00006 REVISED
Site Address: 15000 SW 83RD AVE ***REVISED*** PLM# 2014-00259
IIGARD
Parcel#: 2S112CB00900
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s 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 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 0 0 0
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 Hp)_ 16 0 0 0 0 0
r
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 108 1728 108 1728
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 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 1 16
TOTALS 0 0 0 0 108 1728 108 1712
Current Fixture Value 1712 divided by 16= 107.000 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 1712 divided by 16= 107.000 over (under) $ 524,300.00
Enter EDU Change Here 107.000
Notes: 69 units w/kitchen+81 bedrooms @ first 5= 1 EDU+ 1 EDU for each additional 2 bedrooms=38:
69+ 1 +38= 108 less 1 EDU demo credit for total 107 EDU.
Authorized Name/Signature: Debbie Adamski Date: 1/22/2015
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:\Building\Sewer Tally\SewerTallySheet_4900._070114.xlsx
1111' Accumulative Sewer Tally
Tenant Name: Bonavcnturc SWR.# 2015-00006
Site Address: 15101 S\\ 1 Tall Blvd I'LM]# 2014-00259
Parcel#: 2S1 12CB00900
l:ixturc Value Previous Previous Credits Capped Fixture Fixture New New
# value count ..capped#s 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!\X'hirlpool 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 0 0 0
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 111') 16 0 0 0 0 0
-Commercial(to 5 Ill') 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 0 112 1792 112 1792
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.\'chicle 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 0 0 0
-Bradley 5 0 _ 0 0 0 0
-Com,'Serv/Util-Food Related 3 0 0 0 0 0
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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Should be 1 EDU 1 16
1'O"1'. S (First 5 = 1 EDU) 0 0 0 0 112 1792 112 1776
Current Fixture Value 17'6 divided by 16= ]1].000 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 1T,6 divided by 16= 111.000 over (under) $ 543,900.00
Enter EDU Change Here 111 000 Q
Not • 69 units w./kitchen+81 bedrooms @ first 5= 1 EDU+ 1 EDU for each additional 2 bedrooms= 38: $524,x00
69+ 5+38= 112 less 1 EDU demo credit for total 111 EDU.
Authorized a/Signature: Debbie;1damslu 1107 I Date: 1:'22r 2015
108 Building DM ..
Note: The property owner sha,.�.......om 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\Sewed'allytihect_490t1_07u114.xlsx
y‘/1 -09f0‘'./ ‘I f rir) 6 ti,s,
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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
Request for Permit Action
on
i 1 k,,\k I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: 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 Contractor 6 City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) a 1Af KE7.-7 tiZ ' £m-7//O/2 ,1/2,,,,f,„0-
Address: w /C Rouse-
Mailing Add '4y /3aa/NTE- 62.6 SE-
City/State/Zip: S"'GF">, d2 9 9.3/ 7
Phone No.: 50-3 '3 73 — 3/4 .2--
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
I --- _- VOID PERMIT APPLICATION.
4O n r REF ► ! •ERMIT 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 #: -S'tug4.2D,'-5 - 0O40 (a
Site Address or Parcel#: / S O O 0 _Cc() 3 'Ls /97/S7
Project Name: aOA/ff7/E/■ TLc/-� c_S- --N/04 , rHS/i't//G-
Subdivision Name: Lot#:
EXPLANATION: /27u's/b D!'2RL "7/eC en/ "b 7 2/y/7- ` -
Signature: Date: 3 . y//`S
Print Name: f�„/„/� ry erAJA—
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.
FOR OFFICE USE ONLY
Route to S s Admin: Date B Route to Records: Date ■-r&grall B 1qA'
Refund Processed: Date.„ /JMi B 1.11i,W Invoice Processed: Date B
Permit Canceled: Date A4.1 9 By ,..14".1 '.rcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_09 14.doc
Debbie Adamski
From: Eric Rouse<erouse @livebsl.com>
Sent: Tuesday, February 17, 2015 9:31 AM
To: Debbie Adamski
Subject: FW: Sewer System Development Fees for Bonaventure of Tigard
Attachments: SPC_Permits 15012612070.pdf
Debbie,
Please see attached. I think there was a mistake in the sewer calculation. I think a 5 instead of a 1 EDU was inserted
inadvertently since the first 5 bedrooms= 1 EDU. Please see attached. As a result, I think we overpaid by$19,600. If you
agree, please process a refund for that amount. /67
Thanks you, ?/
Eric S 6--- '
Eric S. Rouse 76
Project Manager
Bonaventure
(2k)
RetirementPerfected.comTM
3425 Boone Rd SE I Salem, OR 97317
o: 503 373 3162 /0 Y 7-0 /A- L
c:503 572 0295
f: 503 480 3153
erouse @livebsl.com
From: Debbie Adamski [mailto:DEBBIE @tigard-or.gov]
Sent: Monday, January 26, 2015 12:37 PM
To: Eric Rouse
Cc: #Building Permit Technicians; Mark VanDomelen
Subject: Sewer System Development Fees for Bonaventure of Tigard
Eric,
Attached is the fee schedule showing the sewer fees due for this project. Also attached is the sewer tally worksheet
showing how this was calculated. Let me know if you have any questions regarding it.
This fee can be online or someone can bring in a check or pay by credit card in person, as long as the card is in the
presenter's name.
Debbie Adamski
Senior Building Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
1
From: CDCopier @tigard-or.gov [mailto:CDCopier @ tigard-or.gov]
Sent: Monday, January 26, 2015 12:07 PM
To: Debbie Adamski
Subject: Message from KMBT_C452
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."
•
2