Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00565
T IGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/13/2008
PARCEL: 2S103BB - 10700
SITE ADDRESS: 12110 SW 123RD CT ZONING: R - 4.5
SUBDIVISION: YE OLDE WINDMILL LOT: 027 JURISDICTION: TIG
PROJECT: LEE
Project Description: Heat pump installation.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
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:
Owner: FEES
MARTIN & CAROL LEE Description Date Amount
12110 SW 123RD CT
TIGARD, OR 97223 [MECH] Permit Fee 11/13/200 $72.50
[TAX] 12% State Surch 11/13/20C $8.70
Total $81.20
Phone: 503 -590 -7341
Contractor:
AAA HEATING & COOLING
5017 NE GRAND AVE
PORTLAND, OR 97211 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -284 -2173
FAX 503- 284 -1552
Reg #: LIC 222
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By Permittee Signature: /'�� Gil /
iii
CaII s .639.4175 by 7:00 a.m. for inspections that busines 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.
From: 11/13/2008 09:20 11534 P.001/003
Mechanical Permit Applicatio Cti� 10 OFE ('1: US I+ 0NL1
' . :„ City of Tigard Received
n O D Date/By: os Permit No.: e,.
IN
° 13125 SW Hall Blvd., Tigard, OR 97223 1 3 - ,,
. ® N Phone: 503.639.4171 Fax: 503.598.1960 �J 1 Plan Review
T I t A I t Inspection Line: 503.639.4175 O C �oA(Z� o Date/By: Other Permit: in .
. ,. � Internet: www.tigard-or.gov ' ed/Meth r S See Page l Inform
COI °I 0 S� " otified/M °tbod: 6 Supplemental Information
1 i . N °r T55*.0 A. ;4:'ct%Ya '6 >. t '01 ; ' t., ; � a ., C ,:.:,-..
Mechanical pemvt fees* based on the value of the work
❑ New construction gr Addition/alteration/replacement
El Demolition ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
.L 4 r
�� mechanical materials, equipment, labor, overhead, and profit.
Y . z ' ',. f 's?' � w . ° cs '� . r . Value: $
CAT1 < �!
r 'n!BI F 1'^y
K1 and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ' �' ' ° > �- �c
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist.
j a Description Qty. I Ea. I Total
a 1' ., '.t : _`JQH'1, O' .,. .I I s ::, s 1t� F r'
. , Hea
r �.. _ � • fit -;i��� t�s.
Job site address: ~y � Air conditioning or heat pump ,' f 211 D S1,� Z ,a G� 1 1'T
City/State/ZIP: [ l� (1` (requires site plan showing placement) { 14.00
J a 2 Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: 1 Project name: L ___e_ r_. Furnace 100,000+ BTU (ducts/vents) 17.90
Gas beat 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
ra,i,:ri > '' a ; a;,"°4t . e „ t „ 0 Ki a t , ti ; r� t. Water heater 10.00
.�:. = ✓4���
t t e r3 e s k e i I — Gas fireplace _ 10.0
k 'l \ - � � � Flue vent for water heater or gas
- fireplace _10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fu eplace/insert 10.00
. ' ::1 .!.. .1s.., il,Q ua � , .�'a1 t :��X , ..ti { {• . _ ' .. " ot y/liner /flue/vent 10.00
aY
Name: 4 AC d- I� � t 1--
` other: 10.00
Environmental exhaust and ventilation
Address: I111 �-2 1, y7 � �� equipm ood/otherkitchen
4-� e^ equipment ,
City/State/Z1P: T \ cL■`4 CI 12. _Clothes dryer exhaust - 10.00
Phone: (rj ) �7 °t b �1 Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 6.80
' + ' 3? .......- Y 1 mod F 4 .�
�, f lF+ M t t i o l co 4e " ,',
Attic /crawlspace fans , 1 0.00
Business name: Other: 10.00 _
Fuel piping
Contact name: ,. J L4 SQ_'22,Pr $5.40 for first four; $1.00 for each additional
Address: Furnace etc.
Gas heat pump
City/State/Z1P:
Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
E -mail: Fireplace •
. ' ' a.,Bd;m ,r t; ? r Range _
,.n
rr :. ' ` '; ,1',. Barbecue
Business name: rtIN lke a-t 1ti0 % '4-
C.Ot> \lei Clothes dryer (gas)
Address: a I 1 VVe (2► ic..$4 Other:
�ex-ti ,^7 °°1 Zl \ r Subtotal i 4
Z-,( 1 3 ( 2.2/4— (t pie'-. Minimum ( ) `Z'z b
Phone:
Z Fax: permit fee $72.50
_
Z .� Plan review (25% of permit fee)
CCB lie.: v State surcharge (12% of permit fee) 3'c�7 [L
TOTAL PERMIT FEE g, `
Authorized signature: Tbls permit appllcadon expires if a permit Is not obtained wlthIu 180
_ days after It has been accepted as complete.
Print name: V 1� trig Date: I t-11,-.D ce • Fee methodology set by Tri -County Building Industry Service Boar
IaBuildingtPetmiu/MEC- PermitApp . doc 01/19 /07 440 -4617T (1 UO21COM/WEB)
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: AAA Heating & Cooling DATE: 11/26/08
5017 NE Grand Ave.
Portland, OR 97211 REQUESTED BY: Dianna Howse
Attn: Victoria Allen
TRANSACTION INFORMATION:
Receipt #: 2008 -3867 Case #: MEC2008 -00565
Date: 11/13/08 Address /Parcel: 12110 S\V 123rd Ct.
Pay Method: CreditCard Project Name: Lee
EXPLANATION: Duplicate permit created in error. Refund 100% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount
[MECH] Permit Fee 245- 0000 - 431010 $72.50
[TAX] 12% State Surcharge 100- 0000 - 207020 8.70
TOTAL REFUND: $81.20
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager
If under $22,500 Department Manager r
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: , .. / 4;/ 1 B I -
l: \Building \Refunds \RefundRequest.doc 05/23/07
From: 11/18/2008 09:30 11553 P.001/002
RECEIVED
°
Community Development
NOV 18 2008
Request for Permit Action
CITY OF TIGARD
BUILDING DIVISION
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) f \ I ke_ f , e - (`ODLA-Ai
.- 111 Mailing Address: ij D l�l �E C-� (Ct w 4Q A L 4
' 444— / City /State /Zip: po'( � LLV�.aQ �- et 'j
// n2G� /etr Phone No.: 0
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
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 #: ‘A.,2, - /0oi? ` - bO r7Le
Site Address or Parcel #: 12_1‘ &.
Project Name:
Subdivision Name: Lot #:
EXPLANATION: C -e,& 1
t , \�S �1 Z Q.2 .� I} 1�
G C t •
SCU -... L j(5\1) . /iiuvL / 'Z-' �i •
SEE /i e avO? �4OS5?
Signature: Date:
Print Name: V + 1TY L� lll, t
Refund Polity
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.
Rte to S s Admin: Date 1 R� «�J►I1 Rte to Bld: Admin: Date B
Refund Processed: Date ' e, B Invoice Processed: Date B •
Permit Canceled: Date /i - 7‘9 . Z E M B 46,17,11 Parcel Tat Added: Date B
Recei . t # /� -.� 6 Date frjn. Method Amount $
I:\ Building \Forts \RegPermitAction.oc • ev 07/26/07
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 •
•
T I GARD
December 1, 2008
•
AAA Heating & Cooling
5017 NE Grand Ave.
Portland, OR 97211
Attn: Victoria Allen
Re: Permit No. MEC2008 -00565
Dear Ms. Allen:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12110 SW 123r Ct.
Project Name: Lee
Job No.: N/A
Refund: ❑ Check # in the amount of $
Credit card "return" receipt in the amount of $81.20.
•
❑ Trust account "deposit" receipt in the amount of $
Notes: Duplicate permit created in error. Refund 100% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
/
Dianna Howse
Building Division Services Supervisor
Enc.
I: \Building\ Refunds\ Administration \LtrRefund- CancelPemiit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
I - CITY OF TIGARD 12/1/2008-
13125 SW Hall Blvd. 6:51:52AM
Tigard, OR 97223 503.639.4171
T1
Refund Receipt #: 27200800000000003981 , 7:1 f- 5-1/ =- 4 - S-1.9-6---
• Date: 12/01/2008
Line Items:
Case No Trait Code Description Revenue Account No Amount Paid
MEC2008 -00565 Reversal - [MECH] Permit Fee 245-0000-431010 (72
MEC2008 -00565 Reversal - [TAX] 12% State Sur 100- 0000 - 207020 (8
Line Item Total: ($81.20)
•
Refund:
Method Payer User ID Acct. /Check No. Approval No. Flow Received Amount Paid
Credit Reversal AAA HEATING & COOLING 006683 Fax (81.20)
Refund Total: ($81.20)
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CITY OF TIGARD 1 1/18/2008' • Ir 13125 SW Hall Blvd. 1:09:33PM . Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200800000000003867 c :.1 /.? . - / Af ir ` --
Date: 11/13/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MEC2008 -00565 [MECH] Permit Fee 245- 0000 - 431010 72.50
MEC2008 -00565 [TAX] 12% State Surcharge 100- 0000 - 207020 8.70
Line Item Total: $81.20
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard AAA HEATING & COOLING BTT 006683 Fax 81.20
•
Payment Total: $81.20
cltcceipl.rpi Page I of I
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: f- ,)y.' -t ( REQUIRED ON GREEN INSPECTION CARD.
✓ Code I Inspection Description • . .1 PASS Date I By ✓ Code I Inspection Description I PASS Date I By
BUP - Building Permit ' ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG - Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post /beam structural 150 Hot tub /spa /pool
•
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG- Structure set -up MEC - Mechanical Permit
- 280 Insulation 605 Post /beam mechanical
285 Drywall nailing 610 Gas line
287 ' Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
•
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood •
695 Misc. inspection:
_ 699 Mechanical final
BUP - Fire Protection System Permit
•
905 Sprinkler underfloor /slab
910 Sprinkler rough -in PLM - Plumbing Permit
915 Fire alarm rough -in 305 Plumbing underslab
920 Suppression trip test 310 Crawl drain
995 Misc. inspection: 315 Post /beam plumbing
998 Alarm final 320 Plumbing rough -in
999 Sprinkler final 322 Shower pan
330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer •
405 Excavation 345 Culvert /catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
1: \Building \Forms \InspCard- AOP- Blank.doc 02/02/07
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° AAA Heating and Cooling Inc, I Alrconditioning OHeatpump Site Plan 4/
Portland, Oregon 97211
603-284.2173
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