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Permit (44) RECEIVED ,- ,-,,,,- r SEP 0 7 2017 . . City ofTigard * COMMUNITY DFA ELOP11.1ILN I DEPARTMVNT . Request for Permit Action IN CITY Or l'ICARAir - ...:, _ y payykAT, rv,,„,,,,, f ,.,.\i:.i . 13125 SW Hall Blvd. .Tigard,Oregon 97223 . 503-718-2439 .www8tWhiLorivefil V 1110.N TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPertaits@tigard-orgov - FROM: 0 Owner El Applicant Cg. Contractor 0 City Staff ova.(yr')one REFUND OR Name; INVOICE TO: \: ( 1: - Mosiner$or Imihicluall I v 4..VOILef1/28ki 1.„CA_v 1,...'..... ‘...1: (i= i„,_c ,\)( Mailing Address: 11,.;)0 \Id'; C.)-\X ,:::,4‘4\1„,„_) City/State/Zip: (:,) °(1„ - (-2\'‘‘)''.--, k ((‘-'' 411) (47 Phone No.; PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED(1): CANCEL!VOID PERMIT APPLICATION. 0 REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ID INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). El REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit). Permit#: 0 (01,;- . Site Address or Parcel#: Project Name: ‘ ., Subdivision Name: \ V\ i'll .....LA/1-7.4',) A VA t, I-ot#: EXPLANATION: il1e/C/e_ Ale 7 ..b-,A/E- ...4. Signature: k,.". AN ,\r.tel ' ,, fl '). 6e:+;„ fr..7 it 2 Date: ' i tit I I I Print Natne: Refund Policy I. The city's Community I)evelopment Director,Building Official in Guy Engineer may authorize the refund of o Any fee which was erroneously paid or collected, o Not more than 8054 of the application or plan review fcv when an application is withdrawn or canceled before review effort has been expended o Not more than 80%ot the application or permit fee for issued permits prior to an inspection requests. 2. )i11 refunds will be returned to the original payer in the form of a check via LIS postal enice 3 Please allow 3-4 weeks for processing refund requests. — -5:PaIti =" /`Y, So eri 7e — 4 ,24, .- /, 7y, 6P1, o2-C) 6 V,9.4 f, ,SY FOR OFFICE USE ONLY Route to Sys Adman: .., Date 13- Route to Records: Date 3 023 /ce—B* r 7 Refund Processed. Date ' ite /2 B 9i.79. Invoice Processed: Date By Permit CanceledDare 9/7//7 By ,Si, arcel Tag Added: Date BY— IABuilding\Forms\ReciPermaAction_0021(4.Jor IIIIII G . 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. PLM2016-00612 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 8800 SW Schmidt Lp Project Name: Heritage Crossing,Lot 36 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 0 credited to your account by the company that issued your card. 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, /c! „..c2girczci...d..e .. 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 IIII IN ? City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipt s, documentation and the I�equestforPermit 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. DATE: 9/18/2017 PAYABLE TO: DR Horton, Inc. Attn: Emerald Weeks 4380 SW Macadam Ave.,Ste 100 REQUESTED BY: Dianna Howse Portland, OR 97239 TRANSACTION INFORMATION: Receipt#: 410172 Date: 4/20/2017 Case#: PLM2016-00612 Pay Method: CreditCar 201 Address/Parcel: 8800 SW Schmidt LI Project Name: Heritage Crossing,Lot 36 EXPLANATION: Per applicant's request as work was not completed. Refnd 80%of pmit f zee c r I ; w,s. � a t40,434,Lv,9 p ' ' it:A7iiito--17.:0 Atrial .¢, 'i . $58.00 Permit 230-0000-4310 6.96 100-0000-24001 Surchar:e TOTAL REFUND: $64.96 APPROVALS: SIG►A �- S. DATE: If under$5,000 Professional Staff � •�`I1/ � 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 :=13 . 'I - _ 1D Case Refund Processed. `I NKS ' ION4 : x'.s 'sir. Date: ©��` B S.�i��� I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD RECEIPT 1111 U 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Heritage Crossing, Lot 36 Site Address: 8800 SW SCHMIDT LOOP Receipt Number: 416295 - 03/23/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2016-00612 $-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 Payor: D R Horton, Inc. $-64.96 Total Payments: $-64.96 Balance Due: $64.96 Page 1 of 1 CITY OF TIGARD RECEIPT $ 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TIGARD Project Name: Heritage Crossing, Lot 36 Site Address: 8800 SW SCHMIDT LOOP Receipt Number: 410172 - 04/20/2017 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2016-00612 Backflow Preventer 230-0000-43101 $31.27 PLM2016-00612 12%State Surcharge-Plumbing 100-0000-24001 $8.70 PLM2016-00612 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 098001 PUBLICUSERO 04/20/2017 $81.20 Payor: dr horton Total Payments: $81.20 Balance Due: $0.00 Page 1 of 1 CITY OF TIGARD PLUMBING PERMIT 13COMMUNITY DEVELOPMENT Permit#: PLM2016-00612 RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2017 C G" Parcel: 2S111DA21700 Jurisdiction: Tigard Site address: 8800 SW SCHMIDT LOOP Project: Heritage Crossing, Lot 36 Subdivision: HERITAGE CROSSING Lot: 36 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 04/20/2017 $31.27 Specifics: 1 12%State Surcharge- 04/20/2017 $8.70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment- 04/20/2017 $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...2 Issued By: iVflY/141— "L f/` Permittee Signature: fA44' GCI,�Zu�r� 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. P Plumbing Permit Am)lic EINE Building Fixtures I tilt 01 Fit i. ( 11 0\1 , City of Tigard 5 DtxeiBed /2- /' f( /7 Pent\o p�f 1'0 13125 SW Hall Blvd,Tigard. 'Ee� Ar ' Plan Review Phone: 503 718,2439 Fax. 0 �1b4 A 'Sii o Date% Other Permit N, )ko._t- lr_ Inspection Line: 303.639.41.2i. yy�� r wJ 10 t c,n It ti Internet. w1�11 tigard-or ILDI �DIVISIONfete Read�eBy tuns S See Page 2 for lotii3ed btphod: �_ Supplemental information TYPE OF WORK FEE* SCHEDULE la New construction 0 Demolition For special information use checklist Description l Qty. 1 Ea. I Total ❑Addition/alteration/replacement 0 Other. New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRICTION SFR(1)bath 312.70 >e I-and 2-family dwelling 0 Commercial/industrial SFR 121 bath 437 78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-famil} ❑Master builderEach additional bath{kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: g'&00 C�� ��err ,, /.t f Dtywell,leach line.or trench drain 18.76 Catch basin or area drain 18 76 City/State/ZIP. Tigard, OR 97223 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.. Project name v\'-hle.. (D tnl\ Manufactured home utilities 50.03 Cross street/directions to job site: 11 ,JJ�Y`"'(_) Manholes 18.76 Rain drain connector 18.76 — Sanitary serer(no.linear ft.:__ ) Page 2 Storm sewer(no,linear ft.:_,i Page 2 Water service(no linear ft..__) Page 2 Subdivision: Lot no.:(3 Fixture or item: Tax map/parcel no.: Backflow preventer 1 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 New SFR Dishwasher 25.02 Drinking fountain 25.02 Ejectorsisump 25 02 i* PROPERTi. OWNER 0 TENANT Expansion tank 12.51 Name: DR Horton Inc. Fixture/sewer cap 25 02 Floor drain/floor sink/hub 25.02 Address:4380 SW Macadam Ave Suite 100 Garbage disposal 25.02 City/State/ZIP: Portland,OR 97239 Hose bib 25.02 Phone:(503)222-4151 Fax,t ) Ice maker 12 51 0 APPLICANT •CONTACT PERSON Interceptor/grease nap _ 25.02 Business name: DR Horton Inc. Medical gas(value.$ ) page 2 ' Primer 12.51 Contact name Emerald Weeks Roof drain(commercial) 12.51 Address:4380 SW Macadam Ave Suite 100 Sinkibasinrlavaror', 25 02 City/State/ZIP: Portland,OR 97239 Solar units(potable water) 62.54 Phone.(S03 )222-4151 x1107 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 nameTrademark Landscapes Inc Water piping'DW V 56.29 Address: PO Box 2410 Other: _ 25 02 CityiState/ZlPOregon City, OR 97045 Subtotal i Phone-(503) 631-3893 Fax (v503) L3/'y737 Minimum permit fee: 572.50 Plan review (25%of permit feel CCB Lic.: 1 /35;3 �. PiumbintLic.no: ,,, 1 I ,- r , /r State surcharge(12%of permit fee) Authorized signature: die _. -' ..4( TOTAL PERMIT FEE Print name: � �� 1/7,:r1/7,:rDate'2016This permit application esplres if a permit is not obtained within 130 days after it has been accepted es complete. "fee methodolosn set bs Tri-Coanry Building Industry Service Board. I Buuding Pemuss PL\tU-PenrstApp.do. I0 01 09 +7046 i6Ti 10 02 COM WEB i