Permit Support Document, 1
911D
Zei7 RECEWEP
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
ilill II 4 Request for Permit Action
JUN 29 2017
r i k;A R r) 13125 SW Hall Blvd. • Tigard, Oregon 97223 . 503-718-2439 •www.ti rd-o . OF TIGARD
DaDIAIG DIVISION l
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 Ni Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Vega Architecture
Mailing Address: 25107 Genesee Trail Rd
City/State/Zip: Golden, CO 80401
Phone No.: 720.390.3891
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
*4 CANCEL/VOID PERMIT APPLICATION.
0 REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: BUP204-6-081-99;-EEG26+6-60446, MEC2016-00408, 299+6-00295"
1311 S- PrtaPt e —L 01.4/n OMFT1
Site Address or Parcel#: 13125 SW Pacific Highway;Tigard, OR 97223 -/28T?RM
Project Name: Specialty Retailer
i
Subdivision Name: Lot#: 200
EXPLANATION:
The developer and tenant have decided against building the pre-engineered metal building that was
submitted in 2016 in order to construct the new tenant prototype building that has recently submitted.
J
Signature: Date: 06.29.17
Print Name: isher
Refund Policy
I. 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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
Route to Sys Admin: Date By Route to Records: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date By Parcel Tag Added: Date By
I:\Building ortns\ReeernutActirm_092314.doc
H v
.t
,0 , • ECEIV:r A ,
t' Mechanical'Permit ApplicatiioIIII.. FOR OFF WE USE ON1.1
City of Tigard Received ��/ N�--/( ,/�9 t/-�,p
g �U 1�1 7 2016 Date/By. 7 tT'� Ii 11• etmit No.14 020*..- /V /tCT
IN x 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review n_
R. Phone: 503.718.2439 Fax: 503.598.1960 �f Date/By.atDate/By. Other Perm' p1 fJ
/fi 40
P II.,A I) Inspection Line: 503.639.4175 CI TV OF ['GARDate Ready/By: Avis: QI See Page 2 or
Internet: www.tigard-or.gov � l•SiNntified/method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE -USE CI{ECKLIST
-- Mechanical permit fees*arc based on the value of the work
®New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ 1c,ODO
CATEGORY OF CONS CRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling ®Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Q . I Ea. Total
' JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:13125 SW PACIFIC HWY-/lei!/ ./itxv-J3/l- ifochateFurnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:TIGARD OREGON 97223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name:SPECIALTY RETAILER Duct work - 23.32 -
Cross street/directions to job site:SCHOOL ST Hydronic hot water system 23.32
Residential boiler(radiator or
hvdronic) 23.32
-
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.:200 Other: 23.32
Other fuel appliances:
"Tax map/parcel no.:2S102CB00200 Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
- — Flue vent for water heater or gas
i�! .--eiiiiL,,e,96, /E - A/67itJ /Saes~ # ,e-CUL15/fJ& fireplace W 23.32
Log lighter(gas) 23,32
__ .................._... .-..................................._ Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/1iner/llue/vcnt 23.32
Other: 23.32
0 PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name:Leadership Circle Range hood/other kitchen
Address:P.O.Box 239 equipment 33,39
Clothes dryer exhaust _ 33.39
City/State/ZIP:Montrose,CO 81402 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
l Phone:(970)249-3398 Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT 0 CONTACT PERSON Other: 23.32
�_..w. �.....»». Fuel pi m
Business name: Ef Eis p P 1
snLt""(11� i $14.15 for first four;S4.03 for each additional
Contact name: 1�rn 115 C,Gf-
Furnace,etc.
�1 G��t
Address: 83 tic L.-emexic, ltzIAI-& 50'1 Ts_.._-sue Gas heat pump
Wall/suspended/unit heater ' -
City/State/ZII': L.j 4 i�k4. KS 66,2.1'f Water heater
Phone:(it �) )O(z 3 5 p'7 Fax::( ) Fireplace
E-mail: Range
Kc -YfAl- 5r E YY1(34 CM'e (4.E.(. call, . c owr Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:'I'BD-Out to Bid Other:Generator
MECHANICAL PERMIT FEES*
Address: Subtotal
permit fee
City/State/Z.iP: Minimum ($90.00)
Plan review(25%of permit fee) l.{ I(o-SS"
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie.: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
youriaire: ------.. days after it has been accepted as complete.
Authorized signature: 1„.1 , '' .,- • Fee methodology set by Tri-County Building industry Service Board
IPrint name:Kevin Stambach Date:06/01/16
Clnuilding\Permits 1MEC_PermitApp_040113,40c 440-461'IT(I I/02/COM/WEa)
jii