Permit CITY OF TIGARD MECHANICAL PERMIT
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:Vs - COMMUNITY DEVELOPMENT Permit #: MEC2010 -00117
Date Issued: 03/19/2010
f GARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S104ACO2700
Jurisdiction: Tigard
Site address: 12550 SW 134TH AVE
Subdivision: MORNING HILL NO. 8 Lot: 171
Project: Wilde
Project Description: Install bath fan and dryer exhaust.
Owner: FEES
WILDE, ERIN DANIELLE Description Date Amount
12550 SW 134TH
TIGARD, OR 97223 Clothes Dryer Exhaust 03/19/2010 $33.39
Single Duct Exhaust (Bathrooms, Toilet, 03/19/2010 $23.32
PHONE: Utility Rooms)
12% State Surcharge - Mechanical 03/19/2010 $10.80
Contractor: Minimum Fee Adjustment - Mechanical 03/19/2010 $33.29
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
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. X
Issued By: Permittee Signature: (
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.
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
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January 5, 2011 '
(1 4 4y :. .
•
Erin Wilde •
12550 SW 134` Ave.
Tigard, OR 97223
Re: Permit No. MEC2010 -00117 •
Dear Erin Wilde:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12550 SW 134 Ave. •
Project Name: Wilde •
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $80.64.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request and project was cancelled. Refund 80% of 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\ Administration \LtrRefund- CancelPermitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
1111111 p a City of Tigard
T> G A R D Accela Refund Request
This form is used for refund requests of land use, development engineering and building application
fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached
to this request. Refund requests are due to Accela System Administrator by Wednesday at
5:00 PM for processing by the following Wednesday. Accounts Payable will route refund
checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing.
PAYABLE TO: Erin Wilde DATE: 12/28/2010
12550 SW 134t Ave.
Tigard, OR 97223 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 177275 Case #: MEC2010 -00117
Date: 03/19/2010 Address /Parcel: 12550 SW 134th Ave.
Pay Method: CreditCard Project Name:
EXPLANATION: Per applicant's request due to lack of funds to complete project.
REFUND; INFORMATION:'
•Fee.DescripfioriFrom..Receipt `. . . Revenue Account No. . Refund
• Example: . : B udiiig.Perrnit Fee - .. . -Example:. 2300000 -43104 - ;'$ Amount
Mech Permit Fee 2300000 -43102 $72.00
12% State Surcharge 1003100 -24001 8.64
TOTAL REFUND: $80.64 IV
APPROVALS:
If under $5,000 Professional Staff
If under $12,500 Division Manager ,
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
.: . FOR TIDEMARK SYSTEM ADMINISTRATION USE ON��I .
Case Refund Processed: I Date: I /S:/// I By:
I: \Building \Refunds \RefundRequest.doc x 09/01/2010
RECEIPT
114 V CITY OF TIGARD
9 13 125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
— tl N-ao
Receipt Number: 180964 - 01/05/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2010-00117 5-80.64
Total: $ -80.64
•
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT _
Credit Card 619154 DHOWSE 01/05/2011 $ -80.64
Payor. Erin Wilde
Total Payments: $ -80.64
Balance Due: $80.64
•
7 Tidemark
S ystem Administration
i . ^','' Finance Department Request ,
Date: / /.5 /// •
To: I.iz Lutz •
Angela McCoy
From: Dianna Howse/
•
Re: Receipt #: /77 /ea 96 `/
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:
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Page 1 of 1
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1111 CITY OF TIGARD RECEIPT
a
• 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGA.RLD
Receipt Number: 177275 - 03/19/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2010 -00117 Clothes Dryer Exhaust 2300000 -43102 $33.39
MEC2010 -00117 Single Duct Exhaust (Bathrooms, Toilet, 2300000 -43102 $23.32
Utility Rooms)
MEC2010 -00117 12% State Surcharge - Mechanical 1003100 -24001 $10.80
MEC2010 -00117 Minimum Fee Adjustment - Mechanical 2300000 -43102 $33.29
Total: $100.80
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 619154 LSELLERS 03/19/2010 $100.80
Payor: Erin Wilde •
Total Payments: $100.80
• Balance Due: $0.00
•
•
Page 1 of 1
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11/30/2010 14:40 5035981960
CITY OF TIGARD PAGE 02/02
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CITY OF TIGARD
Iluilding Division Services !
13125 OR 97223 Phone: 503.718.2430 Pax: 503.598,1960 www.dpsd
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MAR 19 2013 Eiew Permit No.
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13125 SW Hall BlvdTigard, OR 97223 D C . Phone: 503.639.4171 Fax: 503.598.1960. nq
CI � ; "r' r 1r`t V DateBy: Other Permit:
Inspection Line: 503 ;,; a �;.' 4
I I c A R D, g g i �ti l Date Ready/By: hin Ea See Page 2 for
Internet: www.ti ard -or. ov ti +1
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`•4, 6�a;j�;� Di �.�. 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: $
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES*
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description 1 Qty. 1 Ea. I Total
, . ; JOB SITE INFORMATION AND LOCATION Heating/cooling
-^ - .. Air conditioning
t Job site aililress:' L i �U 5I , '
t (requires site plan showing placement) 46.75
City/State/ZIP: / 7 „ / �� Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: /'0 A � / 4 Project name: / v / Heat pump 61.06
Cross street/directions to job site: '� ' i 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
Flue /vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
cDESGRH!TION,'OFWORK� Water heater 23.32
� Gas fireplace 33.39
Fa 4t (,t `.\ 01 f t' ) tO 0-6).7 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
Chimney /liner /flue /vent 23.32
F CISPROPERTV ,OWNER ❑ TENANT
Other 23.32
Name: it'U I) ' V Ike / 1 kj ( (j___,...__- Environmental exhaust and ventilation
Address: l ) 3 ) l ��--� ! z Range hood /other kitchen ect equipment .33.39
City /State /ZIP: / ! ( o/ ! c) ye_ f j� y 9 , Clothes dryer exhaust 33.39
�/ 1Single- duct•exhaust- (bathrooms,
Phone: 0Z) -9 3L / Fax: ( j q_ 2.. toilet.eoriipartinents,- utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSO • Attic /crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: `, $14.15 for first four; $4.03 for each additional
Address: .r�r. �� c V Fumace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
Other:
Address: nu3v\i(--- MECHAN ICAL PERMI T FEES*
City /State /ZIP: Subtotal
Minimum permitfee,($90.00)1
Phone: ( ) Fax:( )
Plan review (25% of permit fee)
CCB lic.: State surcharge•(12 %of permit
4 TOTAL PERMIT FEE ( .aO
r 1 This permit application expires if a permit is not obtained within 180
c - Authorized:signature: ' days after it has been accepted as complete.
Print name: • 3 / b u 1 / / ,) h Date: (7 JO * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Permits\MEC- PermitApp.doc 10/01/09 440- 4617T(1102/COMM/WEB)
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi- Family Fee Schedule:
Total Valuation: Permit Fee:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01, to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
$10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and _
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
fraction thereof.
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Note: All new commercial buildings require 2 sets of plans.
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1:\ Building \Permits \MEC- PermitApp.doc 10/01/09 2