Permit n CITY OF TIGARD MECHANICAL PERMIT
74 sa -',. COMMUNITY DEVELOPMENT Permit #: MEC2009 -00597
T [ G AR o 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 11/10/2009
Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11535 SW DURHAM RD C -1
Subdivision: Lot: 0
Project: Liberty Tax
Project Description: Relocate (2) restroom exhaust fans.
Owner: FEES
HIP WILLOWBROOK LLC Description Date Amount
BY TAX DEPARTMENT, PO BOX 2708 permit Fee 11/10/2009 $69.06
PORTLAND, OR 97208 12% State Surcharge - Mechanical 11/10/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 11/10/2009 $20.94
Contractor:
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123
PHONE: 503 - 628 -6841
FAX: 503- 848 -2597
Type of Use: COM
•
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories:
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressue: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: 2 Vent Systems: Total $100.80
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: n,' nk j UAL Permittee Signature: 11144_6, j
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rfrO
�'� Call 503.639.4175 by 7:00 a.m. for an inspection 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.
ii RECEIVED
Mechanical Permit Application FOR OFFICE USE ONLY
t City of Tigard NOV 1 0 2009 Received
Permit No.. ��
II ,ki - Phone: 503.639.4171 Fax: 503.598.1 ° 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review (�y t n q .co
QTY OF TIGARD
Date/By: Other Petmit `�
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready /By: NI ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — 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: $ 50®, 0 C9
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. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 11535 SW Durham Rd Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: Tigard OR Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg./apt. no.: C -1 Project name: raiiv#0 Li ( T O`x Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
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
"fax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Relocate 2 restroom exhaust to accommodate new layout Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
❑ PROPERTY OWNER Chimney /liner /flue /vent 23.32
❑ TENANT Other: 23.32
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: Same as below
Fuel piping
Contact name: S14.15 for first four; S4.03 for each additional
Furnace, etc.
Address:
Gas heat pump
City /State /ZIP: Wall /suspended /unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Willamette HVAC
Clothes dryer (gas)
Other:
Address: 3075 SW 234 Ave Ste 206 MECIIANICAL PERMIT FEES*
City /State /ZIP: Hillsboro OR 97123 Subtotal
Phone: (503) 628.6841 Fax: (503) 848.2597 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: 56951 State surcharge (12% of permit fee)
• 1 TOTAL PERMIT FEE
Authorized signature: + This permit application expires a p is not within 180
days after it has been if accepted ermit as complet e.
Print name: Michael Malstrom Date: 11/9/09 " Fee methodology set by "Fri- County Building Industry Service Board
I.\Buil din0ermits\MEC- PermitApp.doc 10/01/09 440 -4617T (11 /02 /COM /WEB)
City of Tigard, Oregon o 13125 SW Hall Blvd. o
9 Tigard, ® R 97223 'cA ; r
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December 11, 2009
Willamette HVAC
3075 SW 234t Ave., Ste. 206
Hillsboro, OR 97123
Attn: Michael Malstrom
Re: Permit No. MEC2009 -00597
Dear Mr. Malstrom:
The City of Tigard has processed a refund for fees on the above referenced permit(s) for the
following:
Site Address: 11535 SW Durham Rd., C -1
Project Name: Liberty Tax
Job No.:
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $23.45.
❑ Trust account "deposit" receipt in the amount of $
Notes: Over charge on permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
l: \Building\ Refunds\ Administration \Ltr1Zefund- Refundonly.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772
•
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I " Community Development
Request for Permit Action
r
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 rct City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) r n . l n 1, Q . 6 - S . l Q 1 .
Mailing Address: ?�Cj) 5 31,0 D31h Ave �l� '34 e 2 06
City/State /Zip: kkV, 0 1 0'e_ • 7123
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 #: mi 2 004' . 00 SCr7
Site Address or Parcel #: l i S 35 J.r hn 2G e-
Project Name: (._:( y3-e( q q.
Subdivision Name: Lot #:
EXPLANATION: e !r d ar%e d 014 M Q.r Q it b
Gv f 6 „e& S r -gin/ 7//'9L / n/s - 7-&-_--9-2) (`D / 1/1 t- s<. e ("51.-
Signature: mZ Q y& Date: (,l . to - 0 9
Print Name: In { Qt y at v s
. 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.
r
t i iY =t g '` �` F, O CE U SE i'ONLY ry ti': '
_.? � � ,- rP -�A�.. fit s IS, __ii It .�. _ -.. OR �. FFI., _. — TEL �.i O F F r., _I. _._ ._ tiY.: .J_'
Rte to S s Admin: Date B Rte to Bld: Admin: Date1;2AWS B i ®gN
Refund Processed: Date B i A A Invoice Processed: Date B
Permit Canceled: Date �`a C sil Parcel Ta . Added: Date B
Recei.t # Date Method Amount $
1: \Building \ Forms \RegPermitAction.doc Rev 07/26/07
City of 7 Zgard, Oregon 0 13125 SW Hall Blvd. 0 Tigard, OR 97223
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Anleg D
December 11, 2009
Willamette HVAC
3075 SW 234 Ave., Ste. 206
Hillsboro, OR 97123
Attn: Michael Malstrom
Re: Permit No. MEC2009 -00597
Dear Mr. Malstrom:
The City of Tigard has processed a refund for fees on the above referenced permit(s) for the
following:
Site Address: 11535 SW Durham Rd., C -1
Project Name: Liberty Tax
Job No.:
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $23.45.
❑ Trust account "deposit" receipt in the amount of $
Notes: Over charge on permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
1 \Building\ Refunds \ Administra tion \LtrRefund- RefundOnly.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772
° Community Development
T I G A R D 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)
REFUND OR Name:
INVOICE TO: (Business or Individual) r M i c - Q . 0 yyn q ` a rc
Mailing Address: 3 Cri S j D3L'Ih A e 2 06
City/State /Zip: l\K, ( 0t2..
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 #: r `L2 c o C l ` . c c Sq - 7
Site Address or Parcel #: 53S C"
Project Name: L( tP ir - cc
Subdivision Name: Lot #:
EXPLANATION: 6v Q &\a YCE d 6 rn Q . r- n 3 ,
/f�J /c' &- h de ��S i ,� J // / A: S C'�1� C C`c� o Nr [ ,1
Signature: . � ��� Date: Lk • l U • 09
Print Name: 1_ -1( Oil rd Uiv
• 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/2 / // 9 By
Refund Processed: Date / . ., 7 Invoice Processed: Date By
Permit Canceled: Date i''� `Y. By'c ' Parcel Tag Added: Date By
Receipt # Date Method Amount $
I: \Building \Forms \RegPemutAction.doc Rev 07/26/07
•
CITY OF TIGARD RECEIPT
g • 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TFGARD
Receipt Number: 175966 - 11/10/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2009- 00597 $ -20.94
Total: $ -20.94
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 74226b LSELLERS 11/10/2009 $ -20.94
Payor: Michael J Malstrom
Total Payments: $ -20.94
Balance Due: ($2.51)
Page 1 of 1
' CITY OF TIGARD 'rl �i krk RECEIPT
i a . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
•
TIGARD
Receipt Number: 175967 - 11/10/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2009 -00597 $ -2.51
Total: $ -2.51
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 74226b LSELLERS 11/10/2009 $ -2.51
Payor: Michael J Malstrom
Total Payments: $ -2.51
Balance Due: $0.00
•
Tidemark
S ystem Administration
"'\I " Finance Department Request
Date: it • 10. O9
To: Liz Lutz
Angela McCoy
From: Dianna Howse /
Re: Receipt #: 159( 6(0
Please process this request as follows:
Journal Entry (route copy of JE to
Dianna Howse). •
•
Reversal (fees have been reversed on
• Revenue Account Report).
Credit Card Return (fees have been
reversed on Revenue Account Report).
Other /Explanation:
Thank you!
1: \ Building \ Forms \ RteSlip•FinanceReq.doc Page 1 of 1
•
CITY OF TIGARD RECEIPT
s 13125 SW Hall Blvd., Tigard OR 97223 C i t St InqA
503.639.4171
TIGARD
Receipt Number: 175965 - 11/10/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2009 -00597 Permit Fee 2300000 -43102 $69.06
MEC2009 -00597 12% State Surcharge - Mechanical 1003100 -24001 $10.80
MEC2009 -00597 Minimum Fee Adjustment - Mechanical 2300000 -43102 $20.94
Total: $100.80
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 100.80 LSELLERS 11/10/2009 $100.80
Payor: Michael J Malstrom
Total Payments: $100.80
Balance Due: $0.00
Page 1 of 1