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Permit
r.) n City of Tigard COMMUNITY DINE .<3r),�� : `r-r P yr r' iz I Request for Permit Action OCT 1 9 2017 T7 GA RD 13125 SW I lall Blvd • Tigard, Oregon 97223 • 503-718-2439 • l; : OF.„fiGiARD -11 TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 5ti3-718-21-39 Fax: 503-598-1960 TigardBui1dingPermit:s(ditil ard-or.gov FROM: O�w-ner Applicant c h,4k{✓)on, ` l I' ❑ Contractor City Staff REFUND OR Name: INVOICE TO: Itu;a:x, orinilaw,Eicdlt ,Jlica�,cd1 NcI ujj /94r4--/ A/ /AJ C,, Mailing Address: 4380 SW Macadam Ave, Suite 100 City/State/lip: Portland,OR 97239 Phone No.: 503-222-4151 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V): al CANCEL/VOID PERMIT APPLICA']ION. Rill,`NIS P1i:Rt'\11`1" 1 L 1ES (attach copy of original receipt and provide explanation below). INVOICE, FOR FEES S DVI (attach case fee schedule and provide explanation below). E RL-.;�IC \'1:/R1 PL.1C,1 CONTRACTOR ON PERMIT (do not cancel permit). Permit #: PLM2016-00617 Site Address or Parcel : 8570 SW Schmidt Loop Project Name: Heritage Crossing Subdivision Name: Heritage Crossing Let#: 24 EXPLANATION: We applied and purchase an irrigation permit,but we are not installing irri'ation at this lot. We need to remove the irritation .ermit so we can obtain certificate of occupancy on this home. Signature: / ----°--w Print Narne: � Date: 10/19/17 „. t M1ark Grismer Btfnnd 1acalicE Che city's t.camtnunav Derelopntenr I)tre:ctrar,Building Ot`f-icial or(:a=f:ttginc:cr tstav;auth<artzc�rhe rc hind of: • .\n,let which was erroneously paid car collo:zeel. * Not nu>re than 80';3 of the application t,r plat;recta wv fee When an application n ww�ithdrawvn or cancaeie I Iac Bare rc°virwv effort has boa]cxpruded. 2. • Not more than 80'''a of tic application or permit fa:cr for issued permits prior to any inspccnon rt ctucsts. 1lI refunds.still h returned tea Ow origin&payerin the form of a check vial;.postal,;crvnct:. 3. h(taac:allow,. 3-.1 wit ks for pruccsnng refund rc°<Iue8t<. C - a a AOR OFFICE USE ON Route to Record ■� Refund Processed: ii ,�� . � � •� Invoice Processed; ®J��l�:'!I"1'��9111�1R�IVRl�1�VJllI� �7�.�Er`� t>at� I. Itualdaaa_ � I r}m�..�RFaarrx:at\ct;r tt_f).e33�.�x<a:, 113.1111111 . RI TIGARD November 20, 2017 City of Tigard D R Horton, Inc. 4380 SW Macadam Ave.,Suite 100 Portland, OR 97239 Re: Permit No. PLM2016-00617 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 8570 SW Schmidt Lp Project Name: Heritage Crossing,Lot 24 Job No.: N/A Refund Method: ® Check #226743 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 irrigation backflow was not installed. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, AO 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 111 al City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building ermit 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: D R Horton Inc. DATE:. 11/8/2017 4380 SW Macadam Ave.,Suite 100 Portland, OR 97239 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 409599 3/24/2017 Case#: PLM2016-00617 Date:y Method: Ce4/201d Address/Parcel: 8570 SW Schmidt Lp Project Name: Heritage Crossing,Lot 24 EXPLANATION Per applicant's request as backflow was not installed. Refund 80%of permit fees. x _ -,7N• � iaCx V ,r �pVii- c)!ItSaclt1 . 4N • r APlumbing Permit 230-0000-43101 $58.0012%State Surchar•a 100-0000-24001 6.96 ••11111111111111111111111111111111111111111111 MEM..111.111111111111111111111111111111111111111111111111.......11.1.1111.1111111111111111.1111 IIIIIIIIIIIIIIIIIIIIIIII.111.1111111111111111111111111 1111111111111111111111111111......11.1111.1111111111111 111111111111111...........111111111111111111111111111111111111111111111111111111111111111111111111111111 TOTAL REFUND: $64.96 APPROVALS: S ... ' DATE: If under$5,000 Professional Staff 4,,=��l` 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 4, .._ Case Refund Processed: Date: ©� « 3z . I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT 503.639.4171 "IIGARr Project Name: Heritage Crossing, Lot 24 Site Address: 8570 SW SCHMIDT LOOP Receipt Number: 416578 - 04/06/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2016-00617 $-64.96 Total: $-64.96 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 226743 Payor: D R Horton Inc. DHOWSE 04/06/2018 $-64.96 Total Payments: $-64.96 Balance Due: $64.96 Page 1 of 1 CITY OF TIGARD 111 a 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT 503.639.4171 TIGARD Project Name: Heritage Crossing, Lot 24 Site Address: 8570 SW SCHMIDT LOOP euttcy.091_ Receipt Number: 409599 - 03/24/2017 CASE NO. FEE DESCRIPTION PLM2016-00617REVENUE ACCOUNT NUMBER PAID PLM2016-00617 BackflowoPreventer 12/o State Surcharge-Plumbing 200-0000- 01 $31.27 2 0 PLM2016-00617 Minimum Fee Adjustment-Plumbing 10-000 3101 $8.7001 $41.23 Total: $81.20 PAYMENT METHOD CHECK# CC AUTH.CODE Credit Card ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT 034724 PUBLICUSERO Payor: dr horton 03/24/2017 $81.20 Total Payments: $81.20 Balance Due: $0.00 Page 1 of 1 1 CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2016 00617 Date Issued: 03/27/2017 tGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 111 DA20500 Jurisdiction: Tigard Site address: 8570 SW SCHMIDT LP Project: Heritage Crossing,Lot 24 Subdivision: HERITAGE CROSSING Lot: 24 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 ea Backflow Preventer 03/24/2017 $31.27 Specifics: 1 12%State Surcharge- 03/24/2017 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 03/24/2017 $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: Permittee Signature: ht-7 _-, 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 Application • Building Fixtures NOV012 ? 6 iiII{ C)t i•ii{_ ! ...1 i1\1 'v ' City of Tigard __ Recei+ed 14 111 13125 SW Hall Blvd,Tigard. O F TiG. I) Pat.'s) l?,i/ 416 f Fend‘i4.1,41,4':::16,—6W, Phone: 503 718 2439 Fax.: g#gyp i t .i R Plan Review Inspection Line: 303.639.41 t f tai. [�1 a,� =T " ate Re JuniOthPenmf` �t� �J�J i IR,1 c n t z t )' ` ( Dau Ready By runs I See Page 2 for Interne!: w1+w tigard-or goy Dat ifiedNReadeihod: Supplemental information TYPE OF WORK FEE* SCHEDULE a Ness construction 0 Demolition For special information rise checklist 0 Addition/alteration/replacement 0 Other. New I Qty- 1 Ea. I Total dew I.2-family dwellings(includes 100 fr.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 la l-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437 78 ❑Accessory building 0 Multi-family SFR(3)bath 500.32 ❑Master builderEach additional bath'kitchen 25.02 0Other Fire sprinkler( sq.ft.) Page 2 I JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 5j 7 s(,," S' i,ir 1 / Catch basin or area drain 18 76 City/State/ZIP: Tigard, OR 97223 (� [� Dtywell,leach line.or trench drain 18.76 I r linear ) Page age 3 � Footing drain(no.lft.: i Suite/bldg./apt.no.. 1 Project name *,\A"\141,61. r —1 C�4' Manufactured home utilities 50.03 Cross street/directions to job site: �,,) Manholes18.76 Rain drain connector 18.76 Sanitary sewei(nu linear ft: ) Page 2 Storm sewer(no.linear ft.:_r Page 2 Subdivision: Water service(no linear ft,.,__,_„) Page 2 I Lot no.: d.I-f Fixture or item: Tax map/parcel no.: Backflow preventer j 31.27 DESCRIPTION OF WORK Backwater valve 12.51 New SFR Clothes washer 25 02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors-sump 25 02 PROPERTY OWNER 0 TENANT Expansion tank 12.51 Name: DR Horton Inc. Fixture'se++er cap 25 02 Address:4380 SW Macadam Ave Suite 100 Floor drain/floor sink hub 25.02 Cit)/State/ZIP: Portland,OR 97239 Garbage disposal 25.02 Hose bib 25.02 Phone:(503)222-4151 I Fax:( ) Ice maker 0 APPLICA.jT 15 51 4C'Q�TACT PERSON Interceptor.�grease trap 25.02 Business name: DR Horton Inc Medical gas(value $ ) Page 2 Contact name Emerald Weeks Primer 12.51 Address:4380 SW Macadam Ave Suite 100 Roof drain(commercial) 12.51 Sink/basinnavaron 25 02 City/State/ZIP: Portland,OR 97239 Solar units(potable water) 2. 6 5( Phone.(503 )222-4151 x1107 I Fax: :( ) Tub/shower/shower pan 12.51 E-mail. esweeks@drhorton.com Urinal 25 02 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name Trademark Landscapes Inc Water piping DV+v Address: PO Box 2410 25.09 Other: 25 0 City/State/ZIPOregon City, OR 97045 Subtotal Phony(503) 631-3893 [Fax ( 1 } 1 4 G3/-v 73 7 Minimum permit fee: $72.50 CCB Lic.: i /33-3 �_,- Plumbing,Lio.tin.: C` -t - Plan review (254,of permit fee) Authorized signature: � �,' start surcharge(12°1°of permit fa) - TOTAL PERMIT FEE - I Print name: t�> l. £74:t ` Date:2016 i This permit application eapires ira permit is not obtained within I80 days atter it bas been accepted as rnmlete. "Fee methodolopr set In,Tri-County Building industry Service Board. t Building Permits PL'.lL'-Perm.lApp.do: 10 01 09 .40-An 10 02 COMMIS)