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Permit 1111 41 TIGARD City of Tigard May 2, 2017 Gray I.C.E. Builders Attn: Mark McKeever 5410 SW Macadam Ave., Suite 150 Portland, OR 97239 Re: Permit No. SWR2017-00078 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 9522 SW Washington Square Rd Project Name: Pink Victoria's Secret Job No.: Refund Method: ® Check#224373 in the amount of$5,989.00. 0 Credit card "return"receipt in the amount of$ 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): Change in scope of work from "new" to "replaced"plumbing fixtures. Refund 100% of sewer connection fees paid for new fixtures. If you have any questions please contact me at 503.718.2430. Sincerely, r- 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 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT 503.639.4171 TIGARD Project Name: Pink Victoria's Secret Site Address: 9522 SW WASHINGTON SQUARE RD H07 /�� /Cess/./, Receipt Number: 415773 - 02/23/2018 CASE NO. FEE DESCRIPTION / REVENUE ACCOUNT NUMBER SWR2017-00078 S��/e,- (C,'VA/EC /ON �Q—Q —OOOO —oZssO C� PAID $-5,989.00 Total: $-5,989.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID Check 224373 CASHIER ID RECEIPT DATE RECEIPT AMT Payor: Gray I.C.E. Builders DHOWSE 02/23/2018 $-5,989.00 Total Payments: $-5,989.00 Balance Due: $5,989.00 Page 1 of 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 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: Gray I.C.E. Builders DATE: Attn: Mark McKeever 4/17/2017 5410 SW Macadam Ave.,Suite 150 REQUESTED BY: Dianna Howse Portland, OR 97239 TRANSACTION INFORMATION: Receipt#: 409304 Date: 2/27/2017 Case#: SWR2017-00078 Address/Parcel: 9522 SW Washington Sq Rd Pay Method: CreditCard Project Name: Pink Victoria's Secret EXPLANATION: Per applicant's request as plumbing fixtures were replaced and not new additional Jg yq yJ�V fixtures. Refund 100% of sewer connection fees. r ;' f3Fg rt.tV1V 4„et e tag P s Sewer Connection Fee 500-0000-25500 $5,989.00 TOTAL REFUND: $5,989.00 APPROVALS: SIGNATURES/DATE: If under$5,000 Professional Staff If under$12,500 Division Manager ' v J V� If under$25,500 Department "`���� VVV��� �` Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board Case Refund Processed. Date: rr_,tSTUVON B:P E y: I I.\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 2 13125 SW Hall Blvd.,Tigard OR 97223 li , 503.639.4171 TIGARD IReceipt Number: 409304 - 03/09/2017 I CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID SWR2017-00078 Sewer Connection Fee 500-0000-25500 $5,989.00 4-- Total: $5,989.00 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 272315 PUBLICUSER146 03/09/2017 Payor: Mark McKeever $5,989.00 Total Payments: $5,989.00 Balance Due: $0.00 Page 1 of 1 V 0 141ECEIVFD City of Tigard o\o' 1'1 \ \ILVI ,1' \WI :‘1 N I MAR 1 4 2017 tow-- er \i' OF , Request tot Permit Action fHARD lYN.r: DIVISION tattif 123 Vea I4 iilvd_ • igard, l)riip.on 9722 3 2019 r3 TO: CITY OF TII;ARD Building Division 131.22.0 loA II P BEd.,Tigard,OR 9-223 hoc: 503-718-20.i9 Fax: 003-398,19(auI 1Wu413 41 tniyR orgov • FROM: J Owner L \pplicani [V Coraracror City Snit" REE'ENI) OR Name: INVOICE TO: 'I'll- Gray mlning Address: 5410 SW Macadam Ave, Suite 150 , (MA Portland; OR 97239 Phone No.: (503) 228-4729 PliEASF TAKE AC TIC)N FOR THE ITEM(S) (/): pERN11-/ vppLi.c:ArioN. rx NI I NE) I lR:\III 11 IS (attach copy it:original reccipl rinci pro\:d ii hI ii'()R dittacil case "cc schcdulc :ind provide explanalion below). RIM\l0VEl/R1::1>1 EN:TR,ACTOR ON 14 10111 (do no: cancel perinit). l'errnir SWR2017-00078 sitk. cIuo (irif r.•o. 9522 SW WASHINGTON SQUARE RD F.107 Prolian N. Pinkvictoria's secret Nmno: None lot 4: None EXPLA NA'F ION: A/IS/4(/46-ki?e vet,- 1-)ate: 3/13/201/ PrinE N,Inun mark MoKffever ; !I44o44 4 244!-IC;n0, )(..,,1,,plinnt ),6%.'t,n,,n 'n1C1,11. .1ty nnnn,lnn: 'n,n/J,04 44 \n• Ink'V,linh \. 4 II 111.1n , ,i1)1,:lcatl,,n ria“rc,-ic\\ 10, hvli ...41:41,94-44ieo A.441ul4:eiVn oloo.414f144011fe 04ico tTlor IsDouyee.,E/I. 444 No4 of:44s. tiHo 84.4' 44!el,;Ippl4442! rNotor IN fel 4444.4!NI poo02444 pow io Awy \.non rofU,',r.S... n tn (4. III 4 l \ u(. ,4.O4,1 000/e4F. : \A.it611: Dal(' ROIFe .t) D ,/7 • - 444-4,4NAI I focused: 1-7-4Ng /7 /7-- ;AN:;It:‘ _ _ PIU In bintz Permit ,APS 1iQ tiREEEIVED Building Fixtures - . •FOR OFFICE USE ONLY t 11., !I at{ MAR 14 201? <,,,,„� m !cl ti;A Ila iilsd Iiffard.OR 97')'7-> 17 arei3r a t�(I� U IY OF TIGARD Ph.ii,..!: t71S...'..1"t) 1 tti: (j? � I1,::::',';-\''''" i r t(�s ti� ._ _ __ B �l7 r�cxl �� TI.GARD� 1 ,P a 17( 7 I 7 _ BUILDING DiViSI©N • itt et a: tt ,tt It arcof gm t "�,��i� �. _. .._ Supptcntentai information I 1 I'I•_ OF 11ORk i HFI y{IiECii I,. I 1 v,t utnoiu u t 1}ten r i it iva l or special rr{/`ornurlion use checklist _ ,eri(ytayn Ott ldd t.i,i..,t as..,ra tclr!ac<a3snt 0(}rl.et: t i 1 1 a Sol Ii Neel 2 faniih titsc•ilittus inititirl�s lO t; forcad'utt'tts Corin. tr y,jl ( tiuoRA (?I" (0'SSlRt(TION j Sl}tiIJbath i El 1-:rcnith '�ttllia St f� i t,hath 7 . .. Qt x31117.3C(lt.ticiUsti3al ._ u \ccc t ht,attitt-` ❑\loft, I til E�!haul 3 + iii b � � -.- amt t .... , a �t}Il..i? 0 \la--.ter a olds: 0 .1...1,iae,17 i Ursa;O s))1 it,tic31 t>2 • f>tl c __. _ i 1?.t �,a,,i 2 JOB SUI. I\f'{)f21L11it)N 1\I) LOCATION tibttcti fo t•;.ifit --r.9624 S\% 11 tsbinglon Septa• IRoad Site u �., ( t a,h ,inrt irl frau 18 7t >nuylamccszl t lrI Ine 7thoe. .eitnt atrr cIl3 ifi drain4� : t ate 51=k /)JPortland,OR 97223 1 e5t, hii_ t y..iif' role, n.,utts:TSS PI\l.#I086 \1`uutt'ttt ttirrd holmuiil3ti , 1.ttc, �tt'eet dti'44tiltgS to job site: - .... - .. _ lc* i ),{S� 1 \l inholcs {tiih 1 li3,t,thb.r,,otmc carr i !S. G 1 _ -.. StIcR3T).Sc.;):)4.1{no 17k II IE. y Page. taartt,ioitrILO Ittt rr It' i 10 . -----_ arcs jCl6,t e f7111.)i 3e 3r 11" I I a,t• J tiui+d3t„a+,t. _... ' 1 of no.: I_ __ .._... _. .. ti\tore or item: Rack pfc.l.micr tit I ?7 t3terr v Ps g - c 12."'i DIS(RIPIION OF WORK -t ll s f11- .t �, + 1c ,1IUIti)fii° for tenant tttua enent 4 iI)Stt.1604‘ -1,16:1- t �t ®%6 /' !�— e2./c" U.thin foufiffill 1 E'i 4./oe/ S'40--61�� /'E/�/y/j A/0j �l/2a � tor,,t111141 25 021 t 5 PRUI'LR f k OWNER R 0 .f I`\A\I- 1 cpao,ton Iat7e 1 12 \a,r, #'Ptun Square I f t ait\\ash _ I'i\tt}ie ,o+ jay •_. l fi lt1 L...;:00 IRA 8-i? _-___ I11s d z.n r'yri ,tti.h.,.h 1 501 i tt-. j-. Cl `Clio;'/10: 4 arfsbatl,CCA 9'2018 (_i ut t,e d ty.v.31 , ii e int) I Piton.:.t 7 S,i'I'f I( \I' 1 0 {{}1'•rt f PERSON h14 f7.,Cr-,<_tc 1.,.trap _ 2:1.()2 .. lita� c rat 1'v15f IAA I 1i ifi t1 .,tt itu� S } i , , i ohi tet if 71r4.:Brandi Solari() ___ • a -- - . _ -- 07 rater _ l Pap,: Wtlf: 21195\11 E%ergr'een Phm,Ste,,204 ;c� 1 c1r at(c y 3arrn3aalt i t 75 of, C its �,.,,.•YIP: Hillsboro,OR 97124 1 ' St;t t.a,ia'fal.ottua 1 3 , Solar im.is{177 t tt 1 oat`rt i�1f3d(r{a22?2 1_ 6°7i s 1 .,,. ,t:ift.3t 466-2211 I t,} h atect �t u,.1 pdp i 11,,,,,,: 11 f-milt 1tsnlattt7 arnsi-s).sicnls.ctrut -- , Hindi f �;❑ ti,vitt t 13S! f 1 t \ui a tater 1 i7 :1 ,tit a 41.;t r I liver,.!,.IfV,r dt�ev, ?11'1$ c teen 1 arhnat Suite 20 4 :;art .,�.._.._. - �dI. [it+ •',.;...1c,'/14). Hillsboro,f}ft'J?12# 2 (1) Subtotal C( 1._ �lauu� i33; tGfs 222? 2777)1•l i at 5031 466-2211 i rf317i1r i,}yrttnrt 1 c $7,....c(7 ;it t ttt=•� I ie 3,7,.:34--I3�iPi .,.. _ _. 'i34 S o 01;16,711M i ac.3 1 . 'if,i4 5tir,ilti3 i 1 ?;n 71 permit lops , '._F 02t:.t;tr 16`6,I tt 114-dull) rail AlPt 1t\}tt 1 1 �{ f, 'kik.:2/24/17 I hi,permit tpprlic abort ecpztec if a permit t4 not ohtaitoM»7thin 184 Slit), ; iftu it ha Immo accepted a,complete. c,L,..;;4,,4c, LI t i n4,;,ray 7 ;3t t.Jic_i-r(s,.`; Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: [Square Footage: -' -1 [Site Utilities QtY. rfe(`.4) ibtal LSquare Footage: ,I Permit Fee: 1 f op Jinn drain-; ' iii0 0 to 2 000 $12.1.90 I o,:ii1,:Z7lti-each.;1001tIon0It!!) ----- -7"7 52 ---- --- ..--..-__ `,,e‘er d.; too; Sc‘icr-caeh;;iidit;na1 In,I h.2„'s';1 I L loo I to 3.600 1 1 tioi u,7 200 1 --,-;); . , , . 1 I _4/1 „Ind .,n,rat r 37,.;i2 f Ion 62.5.4 ' S160(is) ,,,,,_,:i,..ii 1 S32754 Medical Gas Systems: kk awl.,;,T,co-erii:h additional 100- 37 52 Valuation: I Permit Fee: I Io ,k: Rain Omni- 1st 100" ol'54 , r l SI 00 to S';000 rig ' \linunum leo,571 c0 Rn n:Nam each addinonai 1;10 3777;2 i S$01 (u4 to$10n;( fu S71.5ti tor the first$5.000.00 and SI $2 for Other Inspections or}ees QtY- vet(co 0'31 . „ [ Other Inspections ol c‘ndete pluinhinp or for I ; each additional$100.00 or haci ion theiedf,to ; inchithne S10.000,00 f $.10 00 1,itit to,;,;,5"f 10;);70 S148'it)for die I its!S10.000 t.ii)tind S I.!•;•;1 no to is snircitioallN indk:ated l 00(4 lit i each additional$I f10.00 or fraction thereof to : i i 111111.1ffittili...17 ..'.e ! 2 hour) and incluifin;L$25.000.00 t , mho&of normal htcone-.;;;-, 90(5 hr , i s25,001,00 to S50,001;00 ; $379 54'i for the lirsi$15,0011.00 and Si-45 tor l ' ' Irma,(4i inn mum cliarifc 2 hours; ; 1 ca ch additional$100.00 on fraehon thereof to Rom-lick:lion I cr., 90 0Thr 1 . I l and includn4i S50.000 00. n1(11ir1Tio.++ to iiT\Tsiurn7: j—JiTiriorri: I i $-'4)-("1 140 anm)up 5742((0 14 the first,S.''.•()1r10i00 and$4.20101 s...hw.,, -, i14,41).)...,. 1 i L L.,,,:id i:,,do:1“)nat S100 U0 or haelion thereof Il Subtotal: ...Pi+ W•11.1411410•1*. Commercial Fixture Work: Arc sou capping,adding or replacing fixtures? If"yes", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sew Quantity by Fixtur -tyPe Plan Review for Plumbing Installations i Fixture 13pe fut Replace/ Plan reki.."‘A. is reqtrired for am of the. rolliovi IIV.. i SA.,(Irk perfbnuctit ..t.apped Added Relocate - L iiqfisir,r 1 on; 1111111111.°- I Please cheek ail that appl) i ,__., I 1 Ld Arc.% ilelk commercial budding 44(444 SNater er%ice 2-and 1 -.fir 6..//: \\hi 7;poIl erCLIer.CleeP1 S>!...letn.b,desinfied and stamped in., licensed i l i at+I ash -i ach Stall i — ' cngineer. 13ri+c hri. — ri No+, e\((Tim plirruhini_i site utilities or am+. condi...\ structure rf...,_ iiii ',7.;4er Vinntior - - deliik.d in();\101S-780-00;40. i __DC,h,A,c,lier A.0;aniO'ilaf i 0 Medical 42.as and ‘actinin;,;N.slef in,10) health cure Inc:Hine7. tic - -iromes - 1 L...J ni Ammulti+ purpose lire sprinkler s)slam 1-771-nti,iii.: I ontitain I D Atri inn ple‘,structure as dclined in OAR918-780-61-10. —j 'dome I ein,-ink - _ I L Submit 2 sets of plans bith any of the above. - --...i i ---- 4 Isometric or Riser Diagram 1. al Lk tish I Iran) --- 1 ___ t, (41r- p 4,-,,,f 0 Isometric or riser diagrams required for new buildings b,., m2,n,- non-tood 1-I) 411k laud rdakd ( that meet the qualifications above. i I v .nonierc0 hoai lc-lined -Ind;ndiialdie'd rcidicd ;---_- _ I 1e N.1 .Rch-n; Didun- 1, 0st.4,,J — — —1, Comments regarding fixture work: - I ! Shoe,;r d;c1Q; -------- ----- 7- .......____ -Shill ',Ink': ..:k -'',.00-r:A rcixed itnal;c, ;(onat;%;.;1-1;;;,,1 il.;ACd - '--------- t -1 1 ----- - -S‘'i‘ 1 I --....- - 'Note: If the fixture ssork under this permit results in an traan 77 increase of sewer EIX's,a sewer permit will be issued and ,. ----- Vcalct ;;,:.e;- loilet ' — —4 --1 1 1 dual i hhei f!Nturcy: i ........__ ' -- _ fees assessed for the sewer increase must be paid before the plumbing permit can he issued, xl::Joh 1 i:::-...1':',•I'si tIon's 20116-VSS Pints rt'1806-Portland Pdrmil ,Apptilk CITY OF TIGARD SEWER CONNECTION PERMIT COMMUNITY DEVELOPMENT Permit#: SWR2017-00078 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/09/2017 Parcel: 151260000300 Jurisdiction: Tigard Site address: 9522 SW WASHINGTON SQUARE RD H07 Project: Pink Victoria's Secret Subdivision: None Lot: None Project Description: 1.13 EDU increase. Contractor: Owner: PPR WASHINGTON SQUARE LLC PO BOX 847 CARLSBAD, CA 92018 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 03/09/2017 $5,989.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: 1.13 Total $5,989.00 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. Ank Issued By: / - Permittee Signature: e401 7er 77 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. I Accumulative Sewer Tally 111 ® e Tenant Name: PINK VICTORIA'S SECRET SWR# 2017-00078 (�,,�, Site Address: 9522 SW WASHINGTON SQUARE RD PLM# 2017-00058 ATn,' Parcel#: 1 S 1260000300 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 1 5 1 5 -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 -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 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 2 4 2 4 -Bradley 5 _ 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 0 1 3 1 3 „- C nc-.. .i.. ..Pr,-,i.V iIle, _.__.. --1- _---- ---Q- - ♦ -.- Q-.. _ 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 00 0 0 Water Closet-Toilet 6 0 0 1 6 1 6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 0 5 18 5 18 Current Fixture Value 18 divided by 16= 1.125 Current EDU 1 EDU= $5,300.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 18 divided by 16= 1.125 over (under) $ 5,989.00 Enter EDU Change Here 1.130 * *Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01. Notes: Authorized Name/Signature:BRANDEN TAGGART X2449 Date: 2/27/2017 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_5300_070116.xlsx