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Permit Support Document I ' ` . City of Tigard •• COMMUNITY DEVELOPMENT DEPARTMENT ?�. ', '- : ;' 2 ' Request for Permit Action 11111 MAY 2 8 2020 q i )(,,,,iz o 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-pr g�cW JrTIGARD RD TO: CITY OF TIGARD p 8 rl 0 Buildin Division 13125 SW Hall Blvd.,Tigard, OR 97223 Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: ❑ Owner Se Applicant ❑ Contractor ❑ City Staff Check(V)one REFUND OR Name: INVOICE TO: (Business or Individual) Melissa Cobb- MCG Architecture mcobb@mcgarchitecture.com Mailing Address: 7100 East Pleasant Valley Road, Suite 320 City/State/Zip: Cleveland, OH 44131 Phone No.: 216.520.1551 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): Qf CANCEL/VOID PERMIT APPLICATION. ❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). Permit #: 11 EC go — 00 a( 1 Site Address or Parcel#: 9589 SW Washington Square Rd. Project Name: Apple Subdivision Name: Lot#: EXPLANATION: Apple has decided to no longer move forward with the video wall upgrade for this location. This will cancel all work associated with the Permit#noted above including mechanical r/1/ Signature: pit Date: 5/28/2020 Print Name: M Iti i a Ct bb-MC ite ure 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 • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended.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. FOR OFFICE USE ONLY Route to Sys Admin: Date By Route to Records: Date /f -' j 7- By 40 Refund Processed: Date k/ 1 BJJ Invoice Processed: Date S/2f/�, By s p� Permit Canceled: Date 3 /2g) B /) Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_1 0518.doc Mechanical Permit Application FOR OFFICE USE ONLY Cityof TigardL '' Received _ g (1�e Date/By: Permit No.: /}x�i q�)i1..� �1 1 er e 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review / //ri(�Q�tQst/ t:ID� It 3 Phone: 503.718.2439 Fax: 503.598.19 r v ED Date/By: .y b Other Permit:�tD 9a 1 y 14 TIGARD Inspection Line: 503.639.4175 ��/ Date Ready/By: 2 Janis: (J®uSe/ePage22�fJor(J`'�� Internet: www.tigard-or.gov Notified/Method. Supplemental Information APR 212020 i r;, ; '" . = COMMERCIAL FEE' SCH*)VLE U CHE�., TYPE :0 WO t n 0 ®' n',, wsio Mechanical permit fees*are based on the value of the work New construction Addition/altera performed.Indicate the value(rounded to the nearest dollar)of all ❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit. Value:$ 50,000 ""< CATEGORY.d CONSTR1CI(IN 'J` - 'RESIDENT IA QIPMNT ISY8EMS FEES* , ❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building For special information use checklist. ❑Multi-family ❑Master builder 0 Other: Description I Qty. I Ea. I Total Heating/cooling: ( JOBSITE INFORMATION'AND LOCATION '��ri Jl } Air ticonditioningl Job site address: SW Washington Square Rd. (requires site plan showing placement) 46.75 Furnace 100,000 BTU(ducts/vents) 46.75 ACity/State/ZIP: Tigard, OR 97223 Furnace 100,000+BTU(ducts/vents) 54.91 Suite/bldg./apt.no.: Project name: '-4i'p/r C� ryr/ Heat pump J✓ hr (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 23.32 go Hydronic hot water system 23.32 Residential boiler(radiator or hydronic) 23.32 AN Unit heaters(fuel-type,not electric), in-wall,in-duct,suspended,etc. 46.75 Subdivision: Lot no.: Flue/vent for any of above 23.32 Other: 23.32 '" Tax map/parcel no.: Other fuel appliances: .° ,l DESCRIPTION '!F':WORD,. i Water heater 123.32 � Gas fireplace 33.39 Flue vent for water heater or gas !l TENANT IMPROVMENT OF EXISTING RETAIL STORE.WORK INCLUDES,NON-STRUCTURAL fireplace 23.32 PARTITION'S Log lighter(gas) 23.32 FINISHES,FURNITURE,AND ENGINEERING WORK ASSOCIATED WITH THE ADDITION OF A --- VIDFO WAI I Wood/pellet stove 33.39 ]/ '),��,� t / l ?I f .;,'r Wood fireplace/insert 23.32 ( ^1 � �' � ? ' 1(1f'^f�f. � � Iimne /liner/flue/vent 23.32 ,- � � .� d� 1 � . y ®;,PROPER VtR, uk TENANT.= 23.32 Other: le_111Name: Macerich-Eric Fong Environmental exhaust and ventilation: t. Range hood/other kitchen Address: 11411 N.Tatum Blvd. equipment 33.39 City/State/ZIP: Phoenix,Az,85028 Clothes dryer exhaust 33.39 Single-duct exhaust(bathrooms, 3 Phone:( ) 602-953-6200 Fax:( ) toilet compartments,utility rooms) 23.32 (] APPLICANT . ' ,/ ' ':"� ❑`::CONTACT PERSON; Attic/crawlspace fans 23.32 Other: 23.32 Business name: Permit Advisors Fuel piping: -.........ContactM name: Justin Vilhauer $14.15 for first four;$4.03 for each additional i TeetFumace,etc. Address: 8370 Wilhsire Blvd. Gas heat pump City/State/ZIP: Beverly Hills,CA 90211 Wall/suspended/unit heater Phone:( ) 559-802-8255 Fax: :( ) Water heater Fireplace tE-mail: Justin@permitadvisors.com Range CONTRACTOR Barbecue 4 Business name: TBD Clothes dryer(gas) Other: Address: !MECIIANI 7AL))ERMITPEJ1$ ':111 City/State/ZIP: Subtotal Minimum permit fee($90.00) Phone:( ) Fax:( ) Plan review(25%of permit fee) CCB lic.: State surcharge(12%of permit fee) TOTAL PERMIT FEE This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: / — Justin Vilhauer Date: April,21 2020 * Fee methodology set by Tri-County Building Industry Service Board I:\Building\Permits\MEC-PermitApp.doc 09/09/10 440-4617T(I1/02/COM/WEB) City of Tigard COMMUNITY DEVELOPMENT DEPARTMENT TIGARD Building Permit Review — Commercial - No Land Use Building Permit #: /L'f 0� 0 —00,g/ 7 Site Address: 6)15 09 &A/ UvAshi >DJI o 124. Suite/Bldg#: Project Name: p , (Name'oficommercial business occupying the space. If vacant,enter Spec Space.) Planning Review Proposal: pooc -top mecha i C GQ Existing Business Activity: I Pc Proposed Business Activity: S4 Verify site address/suite# exists and active in permit system. tg River Terrace Neighborhood: ❑ Yes No Zoning: 1.)1 LAC/ Permitted Use: ❑ Yes ❑ No ❑ Spec Space Confirm no land use required. NI A usiness License: Exists: ❑ Yes ❑,,,`No,applicant was provided a business license application Notes: N V 150 04 f1 VI 1�t0 I K L S 1d..e,V\fGa l&- Approved by Planning: /Q/L� Date: 4'23/20 Revisions (after Building Submittal only) Reviewer Date Revision 1: ❑ Approved ❑ Not Approved Revision 2: ❑ Approved ❑ Not Approved Revision 3: ❑ Approved ❑ Not Approved Building Permit Submittal Original Submittal Date: YAa/a-© Site Plans: # Building Plans: # Building Permit#: Enter building permit#above. Workflow Routing: Planning ❑ Permit Coordinator & uilding Workflow Sign-off: 'Er-- -off for Planning(include notes from planning review) Route Application Documents: a'$Wig: original permit application, site plans,building plans,engineer and beam calculations and trust details,if applicable, etc. Notes: By Permit Technician: ��'fiir� _. Date: t1 �y I:\Building\Fonns\BldgPermitRvw COM NoLandUse 111819.docx ittestititormirsirstiseriosimeasiw Permit Coordinator Review ❑ Conditions "Met"prior to issuance of building permit ❑ Approved,NOT Released: Date: Notes: Revisions (after Building Submittal only) Revision Notice 1: Date Sent . Applicant: Revision Notice 2: Date S- t to Applicant: Revision Notice 3: Dat- ent to Applicant: ❑ SDC Fees Entered: % ash Co Trans Dev Tax: ❑ Yes ❑ N/A Tigard Trans SDC: ❑ Yes ❑ N/A Parks SDC: El Yes ❑ N/A ❑ OK to Issue Per ' t Approved by Permit Coordinator: Date: L:\Building\Fonns\B1dgPennitRvw_COM_NoLandUse_111819.docx