Permit City of Tigard, Oregon ° 13125 SW Hall Blvd. e Tigard, OR 97223
® , t ®
711ETARD
September 11, 2009
HVAC, Inc.
5188 SE International Way
Milwaukie, OR 97222 •
Attn: Jody DePew
Re: Permit No. ELR2008 -00190
Dear Sir /Ms.:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 16037 SW Upper Boones Ferry Rd., #200
Project Name: Oregon State Bar -Fanno Creek
Job No.: N/A
Refund: ® Check #100545 in the amount of $67.20.
❑ Credit card "return" receipt in the amount of $
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as wiring for thermostat not used on fan powered box.
Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
" C191
Dianna Howse
Building Division Services Supervisor
Enc.
1: \ Building \ Refunds \ Administration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 . o www.tigard - or.gov e TTY Relay: 503.684.2772
J : , CITY OF TI GA D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00190
TICARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/3/2008
g PARCEL: 2S113AB -00300
SITE ADDRESS: 16037 SW UPPER BOONES FERRY RD 200 ZONING: I - L
SUBDIVISION: FANNO CREEK PLACE LOT: JURISDICTION: TIG
PROJECT: OREGON STATE BAR
Project Description: Low voltage for t -state wiring.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK:. MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
OPUS NORTHWEST HVAC INC
1500 SW FIRST AVE STE 1100 5188 SE INTERNATIONAL WAY
PORTLAND, OR 97201 MILWAUKIE, OR 97222
Phone: Contact #: PRI 503- 462 -4822
FAX 503 -462 -6555
Reg #: ELE 26-571CLE
FEES LIC 50897
Description Date Amount SUP 605LEA
[ELPRMT] ELR Permit 7/3/2008 $75.00
• . [TAX] 12% State Surch 7/3/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 by the Oregon
Utility Notifi ' n Ue - . Tho - rules are set forth in OAR 952 - 001 -0010 through O • r , 52001 -0100. You may obtain copies of these
rules or d' ect questions t• ' N I - 503.246.6699 or 1.800.332.2344.
Issued �� �J V/ /, , Permittee Si• ature: , ii gr •
-
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
L.WNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
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.
''° Electrical Permit Application I OR OFFICE ISF, ()NI .N
tY of Ti g ved 7 y Ok I.l Permit No.: E./4.449 8 41/941 Ci and
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review i, a ... Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 �' Date/B .
. .
Inspection Line: 503.639.4175 ,w. ' I � Date Ready/By. tug: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
' TYPE OF WORK - . - . - • . PLAN REVIEW • - - - .
❑ New construction ❑ Addition/alteration/replacement Please check all that apply: .
❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ['Building over three stories El Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ['Egress/lighting plan RV park
Job no.: (f'� Job site address: / - 3 ' Q c,_, n Q ❑Health - care facility ❑Other:
t� �lQ 7 So U/ ✓ uYIS / K c� Submit 2 sets of plans with any of the above.
City/ State/ZIP:
Tin
� The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: 0 Pr ect name:6, S 1� FEE* SCHEDULE .
�- {i• �� Description I Qtr. I Fee. I T°111 I '•
Cross street/directions to job site: � New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
L 011) V l � W ? —
(AV" 4 1 f 2C dwelling service and/or feeder 90.90 2
I
Services or feeders installation, alteration, and/or relocation
200 amps or Tess 80.30 2
R PERTY OWNS l ❑ TENANT 201 amps to 400 amps 106.85 2
� � m -1c 401 amps to 600 amps 160.60 2
Name: L(S l C�a '� JG !7 601 amps to 1,000 amps 240.60 2
Address: /500 e e.0 d 2j kiE, w //00 Over 1,000 amps or volts 454.65 2
n Reconnect only 66.85 2
City /State/ZIP: D2 ( )2 7 p 77,6,/ Temporary services or feeders installation, alteration, and/or
i
Phone: ( ) Fax: ( ) relocation
. 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder oot included)
Phone: Pump or irrigation circle 53.40 2
( ) Fax::( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
� extension. Describe: / Page 2 2
Business name:
Address: Si �� 5c / IL) 4\/ Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: M v Lto G. t_ . ,Q l / Ye C7•,1 Investigation per hour (1 hr min) 62.50
,
Phone: t' Fax Industrial plant per hour _ 73.75
S�) � y g� ' 1 ti 3 ) `�D . ELECTRICAL PERMIT FEES* _ = !r:
CCB Lic.: 50g4 Electnca Lic (p _5 7!CL. Suprv. Lic.: 605 LEA Subtotal
Suprv. Electrician signature, required: t'Xe F,, Plan review (25 %ofpermit fee)
Print name: A....( SCa� atZ I Date: State surcharge (8 %ofperntit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it bas been accepted as complete
Print name: I Date: • Fee methodology set by TO- County Building Industry Service Board
•' Number of inspections per permit allowed
1:\ Bwlding \PennitsELC- PamitApp.doc 12/03 44046 t5T(IMD2/COMAVEB
CITY OF TIGARD • RECEIPT
II : 1 3125 SW Hall Blvd., Tigard OR 97223
503.639.4171
T1GAFtD
Receipt Number: 175180 - 09/11/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
ELR2008 - 00190 $ - 67.20
Total: S -67.20
PAYMENT METHOD CHECK # CC AUTH. CODE AC CT ID CASHIER ID RECEIPT DATE RECEIPT AMT
• Check 100545 DHOWSE 09/11/2009 $ - 20
Payor. HVAC Inc.
Total Payments: $ - 67.20
Balance Due: $67.20
Page 1 of 1
ri'.r'l CITY OF TICARD _17,2009
:i :,2 i 13125 S \ \' Hall Blvd. 9' I6
�� P � i
i., Tigard, OR 17223 af13.(3)A171
;T
Receipt #: 27200800000000002369
Date: 07/03/2008
•
Line Items:
Case No Trait Code Description Revenue Account No Amount Paid
MEC2008- 00348 [MECH] Permit Fee 245-0000-431010 . 95 50
MEC2008 -00348 [MECPLN] Plan Rcv 245- 0000 - 433050 23 88
MEC2008 -00348 [TAX] I2'% State Surcharge 100- 0000 - 207020 11.46
ELR2008 -00190 [ELPRMT] ELR Permit 220-0000-431510 .1; 9. T;") 75 00
ELR2008 -00190 [TAX] 12% State'Surcharge 100- 0000 - 207020 •? 9 00
Line Item Total: r .. .. $214.84
Payments: - - • _
Method Payer User ID - Acct. /Check,No. Approval No. 1 Received Amount Paid
Check HVAC INC DEB 5554 In Person 214 84
Payment Total: $214.84
•
CRctcipl ipl Page I of I
.11 q
City of Tigard
TIGARD Accela 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 Accela System Administrator by Friday at
5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: HVAC, Inc. DATE: 7/16/09
5188 SE International Way
Milwaukie, OR 97222 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 2008 -2369 Case #: ELR2008 -00190
Date: 7/3/08 Address /Parcel: 16037 SW Upper Boones Ferry
Rd, #200
Pay Method: Check Project Name: Oregon State Bar
• EXPLANATION: Per applicant's request as wiring for termostat not used on fan powered box. Refund
80% of permit fees.
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[ELPRMT] ELR Permit 220 - 0000 - 431510 $60.00
FAX] 12% State Surcharge 100 - 0000 - 207020 7.20
TOTAL REFUND: $67.20
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager I��L
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 L Contract Review Board
' "'�' � � *:� } ��� `; "� "."r�°.'�`'� - °. 1 ' - . jL�` %1'_1l:' � ��'!< �- � !+' "� i I v r r y � p,�.. FFi - '�1_ ;;�":�;ht'� {�Y("rt 3S.:f�.�r+'}
k''=,t '67:Ra,!..�:r..mz 1 :rr_^a_ 1gO.,. _ C , LA S ST!E 40 ITN�IS,50A- '.ON IVON�I:Y.
Refund Request Reviewed: Date: 2 �G t+;' By:
Case Refund Processed: Date: � s � ' / / //e _' By:
1• \Building \ Refunds \RefundRequesr doc 04/13/09
'02/17/2009 09:12 FAX 503 462 6555 HVAC INC 11002
1 II
' Community Development RECENED
Request for Permit Action
TIGARD RD FEB 11 2009
CT
TO: CITY OF TIGARD gU1S 1.D NGDi IO N
Building Division Services Coordinator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: El Owner ❑Applicant ® Contractor ❑ C ity Staff
(check one)
REFUND OR Name: HVAC, Inc.
INVOICE TO: (Business or Individual)
Mailing Address: 5188 SE International Way
City /State /Zip: Milwaukie, OR 97222
Phone No.: 503- 462 -4822
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 #: e1r2008 -00190
Site Address or Parcel #: 16037 SW Upper Boones Ferry Rd. #200
Project Name: Oregon State Bar -Fanno Creek
Subdivision Name: Lot #:
EXPLANATION: wiring for thermostat not used on fan powered box
•
: 1 1 i ,
Signature: Date: 2/17/09
. - � � .. /
Nib eP - rolect Assistant
Print Name:
Refund Policy
I. 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 ts 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.
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 weeks for processing refunds.
FOR 01 [Cl l SF, ONLY _
Rte to S s Admin: Date I] Q D " _.'/ Rte to Bl.: Admin: Date y0 B . ig." °
Refund Processed: Date ' // D - B' - A alill Invoice Processed: Date B
Permit Canceled: Date 9 // ey B ?i ' ' rcel T:: Added: Date B
Receipt # Date Method Amount $
I:\ Building \Foams \RcgPermitAction.doc Rev 07/26/07
•
.,02/17/2009 09:12 FAX 503 462 6555 HVAC INC 1 001
TWENTIETH '.
up 2006
® ANNIV6i 9 4R'
OR CCB# 50897 WA L8I# HVACI"125J6 CA 863290
HVAC FAx # (503) 462 -6555
DATE: 2/17/2009 FROM: JODY DEPEW
To: BLDG DIVISION SERVICES COORDINATOR
COMPANY: CITY OF TIGARD
SUBJECT: REQUEST FOR REFUND OF PERMIT FEES
FAx #: (503) 598 -1960 No. OF PAGES: 2
(INCLUDING THIS SHEET)
ENCLOSED IS REQUEST FOR REFUND OF PERMIT FEES FOR OREGON STATE
BAR -FANNO CREEK LOW- VOLTAGE ELECTRICAL WORK . .?
PERMIT # ELR2008 -00190
IF ANY QUESTIONS PLEASE CONTACT ME DIRECTLY 503- 462 -6575
THANK YOU,
i`.
SINCERELY
JODY DEPEW
HVAC, INC.
•
PROJECT ASSISTANT
•
•
IF ALL PAGES ARE NOT RECEIVED, PLEASE CALL US AT (503) 462 -4822
5188 SE INTERNATIONAL WAY, MILWAUKIE, OR 97222 -4602