Permit (42) RLE
City of Tigard . COMMUNITY DEVELOPMENT DEPARTMENT DEC 2 e 2017
Request for Permit Action Aa.:
TI GAL) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www tv
t gator go ' r �E l
TO: CITY OF TIGARD /
Building Division 0 ''' .'
13125 SW Hall Blvd.,Tigard,OR 97223 47/4/7 ` 1
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tlgard-or.gov
FROM: Owner ❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) D.R. Horton, Inc. - Portland
Mailing Address: 4380 SW Macadam Ave, Suite 100
City/State/Zip: Portland, OR 97239
'Phone No.: 503-222-4151
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (V):
J CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
In INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: PLM2016-00625
Site Address or Parcel#: 15445 SW Applewood LN
Project Name: Heritage Crossing
Subdivision Name: Lot#: 43
EXPLANATION: We are no longer installing irrigation on this lot and need irrigation removed from
the permit.
Signature: 7'`/a-4 ,,2.e...kfr Qi1, Date: 12/20/17
Print Name: Mark Grismer
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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. 7 5- ,._ + t°t zI _
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FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date fl' G /d' By •tr$'
Refund Processed: Date/2M- A 7 By e/ Invoice Processed: Date By
Permit Canceled: Date/7/71//2 By�� " Parcel Tag Added: Date By
I:\Building\Forms\RegpemutAction_o 2314. oc
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TIGARD
City of Tigard
January 18,2018
D R Horton, Inc.
Attn: Mark Grismer
4380 SW Macadam Ave., Ste 100
Portland, OR 97239
Re: Permit No. PLM2016-00625
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 15445 SW Applewood Ln.
Project Name: Heritage Crossing,Lot 43
Job No.: N/A
Refund Method: ® Check#227176 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 job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
0<aifrie..7z_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
n
,111
City of Tigard
T I G AR D 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: D R Horton, Inc. DATE: 12/28/2017
4380 SW Macadam Ave., Ste 100
Portland, OR 97239 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 410159 Case#: PLM2016-00625
Date: 4/20/2017 Address/Parcel: 15445 SW Applewood Ln.
Pay Method: CreditCard Project Name: Heritage Crossing,Lot 43
EXPLANATION: Per applicant's request as job was cancelled. Refund 80%of permit fees.
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Plumbin. Permit 230-0000-43101 $58.00
12%State Surchar.a 100-0000-24001 6.96
TOTAL REFUND: $64.96
APPROVALS: SIG T S/ ATE:
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
zti
Case Refund Processed: Date: � , "
/�� ,... By: I �� —
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
111/
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
iiGAIx.D
Project Name: Heritage Crossing, Lot 43
Site Address: 15445 SW APPLEWOOD LN
Receipt Number: 416599 - 04/06/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER
PAID
PLM2016-00625
$-64.96
Total: $-64.96
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 410159 DHOWSE 04/06/2018
Payor: D R Horton, Inc. $64.96
Total Payments: $-64.96
Balance Due: $64.96
Page 1 of 1
CITY OF TIGARD RECEIPT
III • 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Heritage Crossing, Lot 43
Site Address: 15445 SW APPLEWOOD LN
IX/45/4/05Z-Z--
Receipt
2/45/4/0L
Receipt Number: 410159 - 04/20/2017
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
PLM2016-00625 Backflow Preventer 230-0000-43101 $31.27
PLM2016-00625 12%State Surcharge-Plumbing 100-0000-24001 $8.70
PLM2016-00625 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 089099 PUBLICUSERO 04/20/2017 $81.20
Payor: dr horton
Total Payments: $81.20
Balance Due: $0.00
Page 1 of 1
7FCITY OF TIGARD PLUMBING PERMIT
I COMMUNITY DEVELOPMENT Permit#: PLM2016-00625
Date Issued: 04/24/2017
f,f1 AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111 DA22400
Jurisdiction: Tigard
Site address: 15445 SW APPLEWOOD LN
Project: Heritage Crossing,Lot 43 Subdivision: HERITAGE CROSSING Lot: 43
Project Description: Backflow preventer for irrigation.
Contractor: Owner: DR HORTON INC.
4380 SW MACADAM AVE STE 100
PORTLAND, OR 97239
PHONE: 503-222-4151
PHONE:
FAX:
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
41 ea Minimum Fee Adjustment- 04/20/2017 $41.23
Type of Use: SF 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 callingA
503.232.1987 or 1.800.332.2344.
Issued By: i / .r Permittee Signature: 5
L�'�Ard
iii,fhCall 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.
il
.. Plumbing Permit Annlicat .4 Vit
Building Fixtures .
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City of Ti rd ''''n I 1 5 1016 Reeeuea . /�L,/Lte2G�`�
Dues).i,Z /�i�2n& Perna'N° ' 4
1111• 13125 SW Hall Blvd,Tigard.OR 9743 Plan Review
I Phone: 503 718 2439 Fax 5 )f '`1 s' Other Permit.
s a Y.uk lata B„ ��iL /(o- F,
Inspection Line. 503.639.417
I i c,��it t) 1 7"� �'1 1I r, w� Due Read>:B)� tutus 0 See Paye Z for
interni. w„\,tigard-orgov totjI ot192J VLS!!Oft' \oti6ed,Metbod: ! Supplemental Information
TYPE OF WORK FEE* SCHEDULE
la New construction 0 Demolition For special information use checklist .
Descripnon l Qty. 1 Ea. f Total
0 Addition/alteration/replacement 0 Other, New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORI' OF CONSTRUCTION SFR(1)bath 312.70
el I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437 78
❑Accessory.building 0 Multi-family SFR(3)bath 500.32
Each additional bathicitchen 23.02
❑Master builder 0 Other' Fire sprinkler( sq.It.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
r
0A,wk Catch basin or area drain I 18 76
Job site address: i
'�_ yt5 Drywell,leach line,or trench drain 1 18.76
City/State/ZIP: Tigard, OR 97223
Footing drain(no.linear It.: _) Page 2
Suite/bldg./apt.no.. Project name dAli Ito C� AnO Manufactured home utilities 50.03 I�
Cross street/directions to job site: J�"' Manholes 18.76
Rain drain connector 18.76
—
Sanitary sewer(no linear ft:-,,,__) Page 2
Storm sewer(no.linear ft.:i) Page 2
Water service(no linear ft.. ) 1 Page 2
LiSubdivision: Lot no.: "l Fixture or item:
Tax map/parcel no.: Backflow preventer 1 V 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25 02
New SFR Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25 02
al 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 trap 25.02
Business name: DR Horton Inc.
Medical gas(value $ ) Page 2
Primer 12.51
Contact name Weeks u eeks Roof drain(commercial) 12.51
Address:4380 SW Macadam Ave Suite 100 Sink/basin/lavatory 25 02
City/State/ZIP Portland,OR 97239 Solar units(potable water) 62.54
Phone.(503 )222-4151 x1107 Fax':( ) Tub'shower'shower pan 12.51
E-mail: esweeks@drhorton.com urinal 25 02
CONTRACTOR Water closet 25.02
Rater heater _ 37 52
Business nameTrademark Landscapes Inc Water piping'DWV 56.29
Address: PO Box 2410 Other: 25 02
City+'State/ZlPOregon City, OR 97045 Subtotal
Phone:(503) 631-3893 Fax (SOP &3/—1/73 7 Minimum permit fee: $72.50
Plan re%iew (25%of permit fee)
CCB Lic.: i /.3 3-3 - - Plumbin.i.ic.no: -I ti r
State surcharge(12%of permit fee)
Authorized signature: ��`�/ '. if
'- TOTAL PERMIT FEE
1/, This permit application expires if a permit is not obtained within 180 days
Print name: i Date 2016 after it bit been accepted as complete.
"Fee methodolog set by Tri.Counn Building industry Service Board.
i Bending PermnrPL%f 'PernitApp.do. 10 01 09 -40-4s i6TI 10 02 CO)tWEEI