Permit (121) RECEIVED
AUG 2 2017
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City of Tigard ( .1‘•NI..)., . t. , , N .,N i . , NI tN ., ..
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CITY OF rIGARD
Request for Permit Action
BUILDING DIVISION
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I 1, oI I / W Ilan Blvd •Tigard,Oregon 97223 • 503-718-2439•wm...w ttgard-orgov
TO: CITY OF TIGARD
Building Division
13125 SW Ilan Blvd.,'figard,OR 97223
Phone 503-718-2439 Fax 503-598-1960 TigatdBuildingPerrnitsnga rd-or gov
FROM: ID Owner 0 Applicantk(-71 ,...,
u.itt ontractor E City Staff
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REFUND OR Name:
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PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/VOID PERMIT APPI,ICATION.
nEl REF[ PERMIT FEES(attach copy of orignial receipt and provide explanation below).
INVOICE FOR FEL DUE (attach case fee schedule and provide explanation below).
0 REMOVIL1.R1,,11),LACE CON1RACVOR ON PERMIT(do not cancel permit).
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Permit #:
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EXPLANATION: 4)el ree_ /vo 1-- C c "Lf./.04 6---7?-
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1 *I to cny's(...ommunny Development Dtrector,Building i) fictal or tity 1.mr,incer may whorl.% ii', refund of
o lny fee whir IT NVIIS erroneously paid or eolkered
* Not mote drat 80''0 of the application or plan ra view far when an appbranon Is wttildrawli tarcanceled before-rewww effort
has been expended.
9 Not more than 8t°,e.of the apphcatiou or permit'fee.for turd p,rmits poor is,an inspection run.
2. All refunds wit be rc turned lo the original payer in the form of a check via LS poral service
3 Please allow 34 week,.for processing refund requests,
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FOR(),FIACE USE
L Route tts Admin. Date B- Roote to Records: Date
Refund Proceised: Date 4 /7 By It1=4"— Invoice Processed: Date By
I.Permit Canceled: Date?/ //7 By ..q.-". arcel,ra)6Added: Dare By
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TIGARD
September 21, 2017 City of Tigard
DR Horton, Inc.
Attn: Emerald Weeks
4380 SW Macadam Ave.,Ste 100
Portland, OR 97239
Re: Permit No. PLM2016-00601
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 8550 SW Schmidt Lp
Project Name: Heritage Crossing,Lot 22
Job No.: N/A
Refund Method: ® Check#226146 in the amount of$64.96.
0 Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
0 Trust account"deposit"receipt in the amount of$
Comment(s): Per applicant's request as work was not completed. 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
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 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: DR Horton,Inc. DATE:
9/18/2017
Attn: Emerald Weeks
4380 SW Macadam Ave., Ste 100 REQUESTED BY: Dianna Howse
Portland, OR 97239
TRANSACTION INFORMATION:
Receipt#: 408729 Case#: PLM2016-00601
Date: 2/6/2017 Address/Parcel: 8550 SW Schmidt Lp
Pay Method: CreditCard Project Name: Heritage Crossing,Lot 22
EXPLANATION: Per applicant's request as work was not completed. Refund 80%of permit fees.
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FPlumbin. Permit 230-0000-43101 $58.00 State Surchar.a 100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIG ••1101 DATE:
If under$5,000 Professional Staff I. •
%•
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
CaseR TE .~ �1 . ON; . P ' {'
Refund Processed: Date: ?r "
I 13a3i�- B .
itt
I.\Building\Refunds\RefundRequest.doc x 09/01/2010
4CITY OF TIGARD RECEIPT
F 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T I GARD
Project Name: Heritage Crossing, Lot 22
Site Address: 8550 SW SCHMIDT LOOP /e-6---
Receipt Number: 416294 - 03/23/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2016-00601 $-64.96
Total: $-64.96
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 226146 DHOWSE 03/23/2018 $-64.96
Payor: D R Horton, Inc.
Total Payments: $-64.96
Balance Due: $64.96
Page 1 of 1
CITY OF TIGARD RECEIPT
u
1; >. 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIC ARD
Project Name: Heritage Crossing, Lot 22
Site Address: 8550 SW SCHMIDT LOOP
Receipt Number: 408729 - 02/06/2017
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2016-00601 Backflow Preventer 230-0000-43101 $31.27
PLM2016-00601 12%State Surcharge-Plumbing 100-0000-24001 $8.70
PLM2016-00601 Minimum Fee Adjustment-Plumbing 230-0000-43101 $41.23
Total: $81.20
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 007087 PUBLICUSERO 02/06/2017 $81.20
Payor: dr horton inc
Total Payments: $81.20
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD PLUMBING PERMIT
ill1: COMMUNITY DEVELOPMENT Permit#: PLM2016 00601
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/06/2017
Parcel: 2S 111 DA20300
Jurisdiction: Tigard
Site address: 8550 SW SCHMIDT LP
Project: Heritage Crossing,Lot 22 Subdivision: HERITAGE CROSSING Lot: 22
Project Description: Backflow preventer for irrigation.
Contractor: TRADEMARK LANDSCAPES INC Owner: DR HORTON INC.
PO BOX 2410 4380 SW MACADAM AVE STE 100
OREGON CITY, OR 97006 PORTLAND, OR 97239
PHONE: 503-631-3893 PHONE: 503 222-4151
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/06/2017 $31.27
Specifics: 1 12%State Surcharge- 02/06/2017 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 02/06/2017 $41.23
Plumbing
Class of Work: OTR
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: CaCALIA(.4..Q4 Permittee Signature:
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.
Plumbing Permit Ann lie 1 ' ' ' '
illek P f 'hi 11
Building Fixtures ftik of 1-0 c 1 sl' %IN! 1 :; '.I„
City of Tigard :', ' ' i •:' RDeca,:ird) 1 ,1.111
, al 13125 S' Hall Blvd,Tigard.OR 97223
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' I Phone. 303 718 2439 Fax 504W19.Xsi, Plan Ravin..i,4, •, 4r,A A Dato fl,
11114
°The'Per7t457)-0/6-vocti .
Inspection Line 503.639.4175L i I 1( 1..1 F I Porrl PIO Dam Rends.Ov Jetts ill Ste Page 2 for
Internet. wie.Al ttgard-or gm-
\onfiedAtethixi: Supplemental Information
LifALgt,f7qc ni-v;sif)N
TYPE le • ' -- FEE* SCHEDI.LE
l
14 Nos construction 0 Demolition for special it:fin-um:lion use checklist
Description [ Ore I Ea I Total
0 Addition`alterationireplacement 0 Other
Nen 1-2-family dwellings(tm:ludes(0:2 ft for each ut1.14,,connection)
CATEGORY OF CONSTRUCTION SFR t 0 bah 312 701—
1 1
I-and 2-family dwelling 0 Commercial,industrial SFR(2i bath 437 78
0 Accessory building 0 MulSFR(3)bath 500.32
ti-famil±i
Each additional hathkitehen 25.02.
0 Master builder I 0 Other
Fire sprinkler( sq ft) Page 2 _
JOB SITE INFORMATION ND LOCATION Site utilities:
iN, 1—s
Catch basin or area drain 18 76
Job site address: () -OW CARIOU.0 UYY
Dr;welli leach Ime.or trench drain 18.76
City/StatelZIP. Tigard,OR 97223
Page 2
, Footing dram(no linear ft 'fr
Suite'bldg/apt no., Project name
*IAA-Ale,CrOc,-......1 ‘ne, Manufactured 1 home utilities 50.03 I
Cross street±directions to job site:
Manholes 18 76
i
Rain drain connector .., 18 76
Sanitary sewer too linear ft. ,t Page 2
Storm sewer(no linear ft t Page 2
Water service too linear ft. i 1 Page 2
Subdixision-
I Lot no.: 1.)-a3—' Fixture or items
Backlit);\presenter I 31 27
t
Tax map/parcel no.:
Backwater valve 12 51
DESCRIPTION OF WORK
Clothes ixasher 25 02
1 New SFR
_
Dishwasher 25 02
;
,
Drinking fountain . 25 02 1
Ejectors sump 25 02
a PROPERTY OWNER 0 TENANT 1 Expansion tank 12 51
Fisituresewer cap 25 02
Name: DR Horton Inc.
Floor dramilloor sinklhub 25 02
Address.4380 SW Macadam Ave Suite 100
Garbage disposal 25,02 ,
'
CirOtate/ZIPPortland,OR 97239
Hose bib 25 02
,
Phone.(503)222-4151 Fax. ( ) ice maker 12 51
0 APPLICANT CONTACT PERSON Interceptor'grease trap 25.02
, Medical gas value( S i Page 2
Business name: DR Horton Inc.
Primer 12 51 , I
Contact name Emerald Weeks
•
Roof dram(commercial) (251
Address4380 SW Macadam Ave Suite 100
Sinkibasinflavator) 23 02
City/StateiZIP. Portland,OR 97239 Solar units(potable water) 62.54
Phone (503 )222-4151 x1107 [ ax l, Tubishowershower pan
I ' ( '
125
U -
nnal 2$02 i
E-mail esweeks@drhorton,com
.1
Water cloet s25 32
CONTRACTOR
Water heater 37 52
Business nameTrademark Landscapes Inc
Water pipina-DWV , 56 29
Address' PO Box 2410 Other
i 25 02
CityiState/ZIPOregon City,OR 97045
Subtotal
Phone'(503) 631-3893 f Fax '603' 6,3/--1-173 7
„ Mintrnum permit fee. 372.50
-
, _.
Plan re;icy, (15%of permit fee)
CCB Lie: i /3 S',3 .,....',41) 1>l'' ` ng,„Ltc,+,no. 4. - rel‘,.-
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
1
I This permit application expires if a perznie is not obtained within 1St cles
Print name: 5ii,/,',; J Date'2016 after it has been accepted as complete.
"Fee rriethodologis set 1.): Tri.Counts licilcung industr;Service Board
t Butithrtg PerrtutsPOIL%PetrreiApp a: Ice:09 440451010 02 COM WEB t