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Permit .7 ,. �X 3RTr' City of Tigard, Oregon o 13125 SW Hall Blvd. O Tigard, OR 97223 i, w � -t t A t„„A 0# .%-i. _' Yi a CARD` June 16, 2008 H Mart Portland, Inc. 13600 SW Pacific Hwy Tigard, OR 97223 Attn: Yong Kim Re: Permit No. MEC2008 -00279 Dear Mr. Kim: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 13600 SW Pacific Hwy Project Name: H Mart Job No.: N/A Refund: ® Check #57794 in the amount of $10.00. n Credit card "return" receipt in the amount of $ . n Trust account "deposit" receipt in the amount of $ . Notes: Overpayment for mechanical permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, f' , f / > Dianna Howse Building Division Services Coordinator Enc. I: \Buil ding\ Refunds\ Administration \LtrRefund- Overpay.doc 01/16/07 Phone: 503.639.4171 o Fax: 503.684.7297 e www.tigard - or.gov o TTY Relay: 503.684.2772 Community Development • Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor p 'City Staff (check onc) REFUND OR Name: INVOICE TO: (Business or Individual) /V/f /L 77/17V6 Mailing Address: s A9 /7 City /State /Zip: / //5 O a 3 Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: /16C_22 7 9 Site Address or Parcel #: /3Z; 0 d gz) /2 (/ c S/ Project Name: /V/C Subdivision Name: Lot #: EXPLANATION: y V&" QAI C' ECK ' � � / // Signature: c _�a � • , i Date: y Print Name: ' re5.6 /C /9 /6 /G / Refund Policy 1. The Director or Building Official may authorize the refund of a) any fee which was erroneously paid or collected. b) not more than 80% of the and use application fcc when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fcc for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. c) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 \vecks for processing refunds. a � � # - � �� t 3 r r 1°t,r '�vr � � �` 'h'k w � �€� ''S�`' 1'F : 1 ,? of +u Y` '^a v ' � WE'r a i.rcrr tgai.�, a - „ ECi 'OFFICE'USE;ONLX. *M x -� ;,. '� M . �-s ,a: Rte to Sys Admin: Date By e r �� Rte to Bldg Admin: Date W /C, Bye r∎�► Refund Processed: Date /r' /7/(} ` B`� Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By Receipt # 0i — /9 /Q Date ( j � �f/Gl ,e" Method () e £ Amount $ 4 , c— I: Building \ Forms \ Re PcmzitAction.d c ev 1)7/26/07 City of Tigard TIGARD Tidemark Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Tidemark System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: H Mart Portland, Inc. DATE: 6/9/08 13600 SW Pacific Hwy Tigard, OR 97223 REQUESTED BY: Dianna Howse Attn: Yong Kim TRANSACTION INFORMATION: Receipt #: 2008 -1910 Case #: MEC2008 -00279 Date: 6/4/08 Address /Parcel: 13600 SW Pacific Hwy Pay Method: Check Project Name: H Mart EXPLANATION: Refund overpayment of permit fees. REFUND INFORMATION: Fee Description From Receipt Revenue Account No. Refund Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount JMECH] Permit Fee 245- 0000 - 431010 $10.00 TOTAL REFUND: $10.00 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager %� G C Y -6!8 If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY Case Refund Processed: I Date: I / c' By: I: \Building \Refunds \RefundRequest.doc 05 /23/07 r . , � CITY OF TIGARD 6/4/2008 13125 SAN Hall Blcci. 5:03 ,:tins.,: T ' Tigard, OR 97223 503.639.4171 «TIGARD It: Receipt #: 27200800000000001910 Date: 06/04/2008 Line Items: Case No Tran Code Description Revenue Account No Amount Paid MEC2008 - 00279 [MECI - 1] Permit Fee 245 0000 - 431010 10.00 Line Item Total: $10.00 Payments: Method Paver User ID Acct. /Check No. Approval No. How Received Amount Paid Check H MART PORTLAND INC DEB 1 155 In Person 10.00 Payment Total: $10.00 cR, Page 1 or I City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 TIGARD June 16, 2008 H Mart Portland, Inc. 13600 SW Pacific Hwy Tigard, OR 97223 Attn: Yong Kim Re: Permit No. MEC2008 -00279 Dear Mr. Kim: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 13600 SW Pacific Hwy Project Name: H Mart Job No.: N/A Refund: ® Check #57794 in the amount of $10.00. ❑ Credit card "return" receipt in the amount of $ ❑ Trust account "deposit" receipt in the amount of $ Notes: Overpayment for mechanical permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, 441 rte_ Dianna Howse Building Division Services Coordinator Enc. • I:\ Building\ Refunds \Administra tion \LtrRefund - Overpay.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 ° City of Tigard TIGARD Tidemark Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Tidemark System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: H Mart Portland, Inc. DATE: 6/9/08 13600 SW Pacific Hwy Tigard, OR 97223 REQUESTED BY: Dianna Howse Attn: Yong Kim TRANSACTION INFORMATION: Receipt #: 2008 -1910 Case #: MEC2008 -00279 Date: 6/4/08 Address /Parcel: 13600 SW Pacific Hwy Pay Method: Check Project Name: H Mart EXPLANATION: Refund overpayment of permit fees. REFUND INFORMATION: • - , . Fee Description From Receipt • : Revenue Account No . • Refund: Example: [BUILD] Permit • Fee ' . • txample: 245 - 0000 - 432000 $ Amount [MECH] Permit Fee 245- 0000 - 431010 $10.00 TOTAL REFUND: $10.00 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager 6 ° y' —O If under 22 500 Department Man $ p Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board •• • FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY • • Case Refund Processed: Date: (,// f/ [ By I / I: \Building \Refunds \RefundRequest.doc 05/23/07 `? CITY OF TIGARD 6/4/2008 • 13125 SW Flail Blvd. 5:03:09PM Tigard, OR 97223 503.639.4171 TIGARD Receipt #: 27200800000000001910 Date: 06/04/2008 Line Items: Case No Tran Code Description Revenue Account No Amount Paid MEC2008 - 00279 [MECH] Permit Fee 245 0000 - 431010 10.00 Line Item Total: $10.00 Payments: Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid Check H MART PORTLAND INC DEB 1 155 In Person 10.00 Payment Total: $10.00 • • elteeeipi.rpt Page I or I J 1,1 ° Community Development TIGARD Request for Permit Action TO: CITY OF TIGARD Building Division Services Coordinator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor 'City Staff (check one) > /t0 l < REFUND OR Name: INVOICE TO: (Business or Individual) /7 /V /927 ,O/g77-1,5 Q //VC— Mailing Address: /J oO £ c) A9- j / /7A-)7 City /State /Zip: / /92 6 � 02 97, a 3 Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: /`7EGo200 Do 7 9 Site Address or Parcel #: /3(0 0 0 5 ) f� Z 61 i Project Name: / / Subdivision Name: Lot #: EXPLANATION: l) , e Q V& 0 ,0 C' 9 ECK Signature: _ ignature: 4 -= X _ : 4 / , • A4i Date: 0/0, Print Name: .C3. /C /9 ,5 /G. / Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rte to Sys Admin: Date By Rte to Bldg Admin: Date By Refund Processed: Date 0/7/69. By Invoice Processed: Date By Permit Canceled: Date By Parcel Tag Added: Date By Receipt #QJ' — /9 /O Date 1p /D Method ( / Amount $ /g , 0-z) I: \Building \Forms \RegPemritAction.d c ev 07/26/07 CITY TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00279 T i e AR P, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/4/2008 PARCEL: 2S102CC -00500 SITE ADDRESS: 13600 SW PACIFIC HWY ZONING: C -G SUBDIVISION: TIGARD MARKETPLACE LOT: JURISDICTION: TIG PROJECT: H MART Project Description: Connection of (17) gas kitchen appliances, (1) 2- burner range, (5) deep fryer, (4) 4- burner ranges, (1) (1) 4- burner grill, (3) stock burners, (1) 2- burner grill & (1) 6- burner wok. Project Value: $15,000 CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: OCCUPANCY GRP: M VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: NAT 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: 17 Owner: FEES 13500 PACIFIC CORP Description Date Amount BY CAP ADVISORS 38345 W TEN MILE RD, STE 170 [MECH] Permit Fee 6/4/2008 $299.00 FARMINGTON HILLS, MI 48335 [TAX] 12% State Surch 6/4/2008 $35.88 Phone: Total $334.88 Contractor: RELIABLE GAS SYSTEMS LLC 810 COLUMBIA DR MOLALLA, OR 97038 REQUIRED ITEMS AND REPORTS Contact #: PRI 503- 679 -4529 Reg #: LIC 179399 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct que 'ons to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued di r / Permittee Signaturek Call 503.639.4175 by 7:00 a.m. for inspections that business day. 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. Mechanical Permit Application a"� � . � y FOR OFFICE'US t ONcv 's � ' ^'-,. s, C r r City of Tigard Received (j © Og Permit No.: e 7 11 14 a. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review j ll Phone: 503.639.4171 Fax: 503.598.1960 Other Permit: Date/By: ' T I G A R n Inspection Line: 503.639.4175 Date Ready /By: Ell ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental Information - - TYPE OF WORK COMMERCIAL. FEE* SCHEDULE L USE. CHECKLIST' ❑ New construction ❑ Addition /alteration /replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ l RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ' - ❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. 1 Ea. Total JOB SITE INFORMATION AND LOCATION. Heating/cooling Job site address: D 1 1 I Air conditioning or heat pump l �Lo00� ( j� C • 1 w / (requires site plan showing placement) 14.00 City /State /ZIP: -- fj (32 97�� -"j Furnace 100,000 BTU (ducts /vents) 14.00 , / — A l7 n �� Furnace 100,000+ BTU (ducts /vents) 17.90 (-4 I — l Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: Lot no.: Flue /vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances DESCRIP'T'ION OF WORK Water heater 10.00 �) , Gas fireplace 10.00 TL3 4-0 ' eb--"t■4_,Q_A ( 1 re. -,.L �o O. Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 '.PROPERTY OWNER ❑ TENANT' Chimney/liner/flue/vent 10.00 Other: 10.00 Name: L 3 V Pi -c t r(c, CoEP. 6y 00P ADJ s o25 Environmental exhaust and ventilation 1 � o Range hood/other kitchen Address: g g '�c j 1 .t� , j� � �, equipment 10.00 City /State /ZIP: F MD `o ..,J 4 /mss i 4f$ 3 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 • ❑ APPLICANT ❑ CONTACT` PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: $5.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range 5' • CO ' Barbecue Business name: L /..„ 6 QzJ �' a � f -,,,, 1e , �i Clothes dryer (gas) r v � Other: / 2 - Address: 210 t.0 M P 4 / --D /L . MECHANICAL PERMIT FEES* ' City /State /ZIP: D L LL - C 2 9 - 20 3 9 Subtotal 1 ) 0 O. 3) Lp 49..? Fax: ( ) Minimum permit fee ($72.50) ON • Phone: ( et Plan review (25% of permit fee) CCB lic.: 1 71 5? 9? State surcharge (12% of permit fee) • ag TOTAL PERMIT FEE [ , This permit application expires if a permit is not obtaine wi m 80 Authorized signature: days after it has been accepted as complete. Print name: 0,ve . /44 Date: Z /4/ * Fee methodology set by Tri- County Building Industry Service Board I:\Building\Permits\M C- PermitAppdoc 01/19/07 440- 4617T(11/02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: :Total Valuations Permit'Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. 1:\ Building \Permits\MEC - PermitApp.doc 01/19/07 2 CITY ��wn n m�'w� N;���m���� BUILDING DIVISION PERMIT #: M[C2008 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6J4/20()6 ` Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 6/5/2008 TIME: 7:O0AM PAGE: 39 SITE ADDRESS: 13GO8 PACIFIC HW/ CLASS OF WORK: SUBDIVISION: TIGARD MARKETPLACE LOT #: TYPE OF USE: PROJECT NAME: H&1ART DESCRIPTION: Connection of(17) gas kitchen appliances, \2-burner range, (5 ) deep fryer, (4) /nux ranges, O\ broiler, (1)4-burner grill, (3) stock burners, (1) 2-burner grill & (1) 6'hummarvxuk. Project Value: OWNER: 1350O PACIFIC CORP, PHONE #: CONTRACTOR: RELIABLE: GAS SYSTEMS LLC PHONE #: 503-679-4529 Inspection Request Scheduled For: Date: EJ5/3008 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 070917'01 505'630.6120 N Corrections/Comments/Instructions: - NIAAT|AL APPRO\AL CANCEL ri NO ACCESS [7 FAIL r CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: Date Phone #: (503) 718'd�~���r~ ` ' `^ '