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Permit (61) v 0 1 D ECE1VED City of Tigard ® COMMUNITY DEVEL�I 1 I;� NT Request for / U 11.E t11 q Permit ActionIN MY OF TIGARD TIGARD, 13125 SW Hall Blvd. • Tigard,Oregon 97223 • 503-718-2439 •www.tl ard- vISION 11 TO: CITY OF TIGARD Building Division 13125 SW Hall Blvd.,Tigard,OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor ❑ City Staff Check(/)one REFUND OR Name: INVOICE TO: (Business or Individual) VV- 6r-L7S541't- ‘ it Ai< Mailing Address: L ' 5141 City/State/Zip: ! t "2,, /7 i/V Phone No.: �'� 7 --� --L PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): $.' CANCEL/VOID PERMIT APPLICATION. /1110- REFUND PERMIT FEES (attach copy of and original receiptprovide explanation below). pp III INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: N o f c?-L.%( •---©0 l Site Address or Parcel#: /See; S — 5 611 Cl 1 c Project Name: ee.--- h 41( i t / Subdivision Name: 51,1114/14 '' !{ - f ii i; e ). Lot#: EXPLANATION: (re 6 p0e,v a 4_ 2‘,, 9 s Signature: /��, ____._9dJCI' l------ '' Date: (L�. 7,/i0/10? Print Name: ,Joei C,j,,-;4-t.,3O-'1 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. /G ,/y._ /> . 9/ --= --= 3. .2-3 //-.3" 0, 1.,F /.27.5757—'y -13 e, /. v FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date 3 7 /y By . 4.4 Refund Processed: Date 4p 22//1- B4� Invoice Processed: Date By Permit Canceled: Date/2 !/t -- B ;' Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 9231 .doc II . II TIGARD City of Tigard July 16, 2018 Jon Erickson 15280 SW 94th Ave. Tigard, OR 97224 Re: Permit No. BUP2018-00174 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 15655 SW 114th Ct, #14 Project Name: Fountains at Summerfield Job No.: Refund Method: ® Check#228923 in the amount of$120.54. ❑ Credit card "return"receipt in the amount of$ Note: Please allow 2-5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account"deposit" receipt in the amount of$ Comment(s): Per applicant's request as job was postponed until 2019. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, <-1217 '16.7-fe----- 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 III - " 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: Jon Erickson DATE: 6/22/2018 15280 SW 94th Ave. Tigard, OR 97224 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 417864 Case#: BUP2018-00174 Date: 6/14/2018 Address/Parcel: 15655 SW 114th Ct#14 Pay Method: CreditCard Project Name: Fountains at Summerfield EXPLANATION: Per applicant's request as job was postponed until 2019. Refund 80%of permit fees. ****-4141-*fa i s ;:i: ' ? # : tl bu ,,4 ''.;,1;14,:i41::: s pt _ 1ee &• :: ,. :a:1,5*-w' Al 4 t Building Permit Fee 230-0000-43104 $107.63 12% State Surcharge 100-0000-24001 12.91 TOTAL REFUND: $120.54 APPROVALS: SIGNATURES/DATE: 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 FOR T)CDEl4 RBtSYSIEM AT WNISTR�IQN USE O LY ; °.z Case Refund Processed: Date: 2/2Vj7 By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD BUILDING PERMIT COMMUNITY DEVELOPMENT Permit#: BUP2018-00174 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/14/2018 7"f�; R Dg Parcel: 2S110DC90142 Jurisdiction: Tigard Site address: 15655 SW 114TH CT 14 Project: Fountains at Summerfield Subdivision:TAINS AT SUMMERFIELD CONDO-PH Lot: 14 Project Description: Deck dry rot repair:Replacing rim joists and guardrail. Contractor: JON EDWARD ERICKSON Owner: CHRISTENSON, ROBERT FOX 15280 SW 94TH AVE 15655 SW 114TH CT#14 TIGARD, OR 97224 TIGARD, OR 97224 PHONE: 503-730-9220 PHONE: FAX: Specifics: FEES Description Date Amount Type of Use: MF Class of Work: ALT Type of Const: VBPermit Fee-Additions,Alterations, 06/14/2018 $134.54 ' Demolition Occupancy Grp: R-2 Occupancy Load: 0 12%State Surcharge-Building 06/14/2018 $16.14 Dwelling Units: 0 Plan Review 06/07/2018 $87.45 Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 06/14/2018 $6.50 Bedrooms: 0 Bathrooms: 0 11x17) Value: $3,448 Floor Areas: Total Area: 0 Accessory Struct: 0 Basement: 0 Carport: 0 Covered Porch: 0 Deck: 0 Garage: 0 Mezzanine: 0 Total $244.63 Required: Required Items and Reports(Conditions) Fire Sprinkler: Parapet: Fire Alarm: Protected Corridors: Smoke Detectors: Manual Pull Stations: Accessible Parking: 0 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 f• more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules(fie -t forth in OAR 952-001-0010 through OAR 952- -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 .2344 Issued By: 1 /J r/ i C/4%�" 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. Building Permit Application Commercial FOR OFFICE USE ONLY CI Of TI and "M Received �+ `J g DateBy. /(:�// / J Permit No. 4/ �/S�- r 7// n 13125 SW Hall Blvd.,Tigard,OR 97 2 Plan Review fJ $ Other Permit: Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 6 j q -'g T I GA R D Inspection Line: 503.639.4175 I UN 6 :Z 018 Date Ready/By: Jens. Fil See Page 2 for Internet: www.tigard-or.gov Notified/Method�i 41/! / / 4 '." �,, Supplemental Information TYPE 013/141., ' tNG DIVISION REQUIRED DATA 1-AND2-FAMILY DWELLING ❑New construction ❑Demolition Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all ❑Addition/alteration/replacement ®Other: equipment,materials,labor,overhead,and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. Valuation: $ 1111-and 2-family dwelling ❑Commercial/industrial IDAccessory building ®Multi-family Number of bedrooms: ❑Master builder ❑Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address:15655 SW 114th Court New dwelling area: square feet City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet Suite/bldg./apt.no.: 14 Project name•Uvrk noa•-'ishi /yV,i ,1,14. Covered porch area: square feet Cross street/directions to job site: S&-t/ty j' e.(„4 Deck area: square feet Other structure area: square feet REQUIRED DATA:COMMERCIAL-USE CHECKLIST Subdivision: I Lot no.: Permit fees*are based on the value of the work performed. Indicate the value(rounded to the nearest dollar)of all Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the DESCRIPTION OF WORK work indicated on this application. Repair dry rot,re-coat solid decking,replace guardrail with 42"code compliant Valuation: $$3,448.00 Existing building area: square feet New building area: square feet ® PROPERTY OWNER ❑ TENANT ' Number of stories: Name:The Fountains at Summerfield Condominiums Type of construction: 5B Address:15685 SW 116th Ave.#105 Occupancy groups: City/State/ZIP:Tigard,OR 97224 Existing: Phone:(858)212-9105 Fax:( ) New: ® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES* (Please refer to fee schedule) Business name: Structural plan review fee(or deposit): Contact name:Jon Erickson FLS plan review fee(if applicable): Address:15280 SW 94th Ave.— If:'7 �� City/State/ZIP:Tigard,OR 97224 Total fees due upon application:' Amount received: Phone:(503)730-9220 Fax::( ) E-mail:jon.evenjobs@gmail.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* Commercial and residential prescriptive installation of CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System. Business name:Jon Erickson Submit two(2)sets of roof plan with connection details and fire department access,along with the 2010 Oregon Address:15280 SW 94th Ave. Solar Installation Specialty Code checklist. City/State/ZIP:Tigard,OR 97224 Permit fee(includes plan review $180.00 and administrative fees): Phone:(503)730-9220 l Fax-.( ) State surcharge(12%of permit fee): $21.60 \ CCB lic.:162397 Total fee due upon application: $201.60 Authorized signature: 4-' This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name:Jon Erickson Date:June 6,2018 * Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Permits\BUP-COM PennitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)