Permit CITY OF TIGARD MECHANICAL PERMIT
IL
I: COMMUNITY DEVELOPMENT Permit #: MEC2010 -00328
,TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2010
Parcel: 2S112CCO5000
Jurisdiction: Tigard
Site address: 8020 SW BOND ST
Subdivision: BOND PARK NO. 3 Lot: 78
Project: Hagan
Project Description: Install A/C. Unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
HAGAN, BETTY Description Date Amount
8020 SW BOND ST Air Conditioning 07/14/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 07/14/2010 $10.80
PHONE: 503 - 968 - 1340 Minimum Fee Adjustment - Mechanical 07/14/2010 $43.25
Contractor:
BLAIRCO INC
7609 MACARTHUR BLVD
VANCOUVER, WA 98664
PHONE: 360- 695 -1476
FAX: 360 - 699 -9310
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
issued By: '� / , -- PermltteeSignature: Q ,97 c ' - /� �
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This pemilt card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FROM , ,, ,„., (FR I ) JUL 8 2010 15: 57/$T. 15: 58/No. 7500000481 P 1
1
. f r i
Mechanical Permit Applicat ii ',,; ,.., .: 4'. ,- - ... - 1,0R 01 1.1( 1 1 sl (rsd )
ippir City of Tigard ' JUL 0 9 2010 9 / /
Received
Date/By: 0 ifr''''' Permit No gr --4/ a
--- . 13125 SW Hall Blvd., Tigard, Olt 97223 Plan Revic .
Phone; 503.639.4171 Fax: 503.598.1 9 !1 - 1 - NI " Dte/Ely
Other Premit:
:.: "I''' f i (--, a:
. inspection Line: 503.639,4175 -, , r 0,...: 4 . '... 7 t: ILI
I I t 1 A I I I Dat Rady/By: lir 81 ace Pap 2 for
Internet: vAvw.tigard-orgov BUiLUNC f:',%!: Notifted/Mcthod: Supplemental hdannocion
. ' '' . ::ff : `...; t fl i e.f.'4, ii4. ‘ r.040. 1 tRCIA 7 ; 14 ; ' .: '
Mechanical permit fees* arc based on the value of thc work
D New construction jaXdditiOn/alteratiOn/replaceMent performed. Indicate the value (rounded to thc nearest dollar) of all
El Demolition El Other: mechanical materials, equipment, labor, overhead, and profit. _
:: f , - .A- . -.— • - : -
, ' . i : . . 1 4F:O±rt 1.
jal- and 2-fiunily dwelling 0 Commercial/industrial ID Accessory building
For speci ..
al information use checklist
0 Multi-family 0 Master builder n Other: Description I—Q-ty. J Ea, 1 Total
P;- Ail.0.6144 Heatin : comb
Air conditioning or heat pump
Job site address: F020 4.,...) gi01114 'i ' (requires site plan showing placement) 1 14,00 I4 ---
City/State/71P: # 1 . 1 Sext, CA_ ci-ta4 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (duecriveol.) . 17,90
Suite/bldg./apt. no.: I Project name: Gus heat pump 14,00
Cross street/directions to job site: Duct work 10.00
Hydronic hot watcr system 14,00
/It be sc,..3 Ov 4 ‘.5C3 tra-(( git./J • Residential boiler (radiator Or
hydron ic) 14.00
Unit heaters (fuel-type, not electric).
in-widL suspended, etc. 14.00
Flue/vent for any of above 6.80
Subdivision: Lot Lot no.:
Other: 1 10,00
'lax map/parcel no.: Other fuel appliances
$;OVT6ii.0:40E1110 , Water healer 10.00 _ ,
Gas fireplace 10.00
I niz;u. t P lc_ ___ Flue vent for watcr heater or gas
fire /0 Iric
Log lighter (gas) 10.00
i am
......iinar
ZE i7/1/91 /tigss r Wood/pellet stove 10.00
/// y C/ L- CZ ,0) 6/971(7 Wood fireplace,/insert 10,00
Chimney/1 incr/flue/vent 10,00
„ ':;•:..4',:45k.110061 othcr; .
10.00
_
N am: I - h - e C4r) Environmental exhaust and ventilation
...
, ■ Runge hood/other kitchen
,...,
Address: -13 • ..,_.) c,,,, C ,cr . equipment 10.00
City/State/Z1P: 11 I cit. oa__ Chliq - Clothes dtycr exhaust .. 10.00
Single-duct exhaust (bathrooms,
Phone:51S) — 1..SI-b Fax: ( ) toilet corryartments, utility rooms) 6,80
' - • - ' ' ' • '-''' - ' ' " ' ' Attic/crawls e fans
P:'4:V.,g','''"'$$':Net7r9.tT40''''RFtRSf4■Nfl!g;':''''.t - ac
P 1000
Othcr; 10.00
Business name: e i ife3C . 6 1._A-- ire_co Fuel piping
Contact name: _gel i 'r\ ac,_ LArsofre-. 55.40 for first four: 51.00 for each additional
Furnace, etc.. I
Address: licrel IV \41..C- 1>Pre-Lr 12tal6C1 - Gas heat pump
City/Statc/ZIP: V't ca (),./1, etk (cL4 Wall/ausmtded/unit heater
Phone: 0, ( _11,4 7,,,,, I Fax: 3400) ( • Cal 0 Water heater
Fireplace
F-mail; . , Run --
; !;' , ','Z'' ' ‘'0 7 0 1 *.*0.0tC*?:^r41' ,- , ' " .. , 4. .;g:P37.'!Y.;::iT.:!: ;%:).. Barbecue
Clothes dryer (gas)
Business name: A 1-4-//2an
/ Other:
Address: : ::": FWgri!KEP1 i''.':
City/State/ZIP: Subtotal 34
Minimum permit fee (572.50)
P inv. ( ) ) .41) Fa x : ( ) • o
Plan review (25% f permit fix) ---'
1 CCI3 lic.: 4 E)(::) ?NI II State surcharge (12% of perrnit fee)
TOTAL PERMIT FEE
Authori This permit application expires if a permit i8 001 obtained wn 7 , A
md ig
srialure&I 1 ,, (t_i S • C . days after a has beep accepted 113 tomplete. /0 , U
Print name: ' 1 ),-'\ ,,,,_ %_ 41IL c C.-• Date: ali • Fee metbusluingy set by Tri-County Sailtling Industry Scryicc Board
i \authisuidet mitsVAK-VarmilApp d • , 1119/07 440-4617T (11/021C)M/WER) / '' 4> 0 - ) p - f P 67 JO )
II > rJ ir 1 i't el
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
q
TIGARD
February 23, 2010
Blairco, Inc.
Attn: Belinda Larson
7609 MacArthur Blvd.
Vancouver, WA 98664
Re: Permit No. MEC2010 -00328
Dear Ms. Larson:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 8020 SW Bond St.
Project Name: Hagan
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 as job was canceled. 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.
I: \Building\ Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
FROM NED) FEB 8 2011 8:12/ST. 8: 06/No.7500000075 P 1
gi
,` Community Development FEB 9 2011
I Request for Permit Action
TO: CITY OP TIGARD
Building Division Services Coordinator
13125 SW Hall Blvd, Tigard, OR 97223
Phone: 503.718.2430 Floc 503398.1960 wtvw.tigard- or.gov
PROM: ❑ Owner E Applicant 0 Contractor ❑ City Staff
(check one)
REFUND OR Name: Blairco, Inc.
INVOICE TO: °e
Mailing Address: 7609 MacArthur Blvd
City /State /Zip; Vancouver WA 98664 .
Phone No.: 360.695 -1476
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): O
0 •
CEL PERMIT APPLICATION. 0
FS ble
).
1.1 REFUND PERMIT FF (attach recut, if avtZtla 40-7///
• INVOICE FOR FEES DUE (attach case fee schedule and explain below).
0 REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). q#
Permit #: M EC20I0 -00328
Site Address or Parcel #: 8020 SW Bond St. T gr OR 97224 .
Project Name: Betty Hagan -
Subdivision Name: Lot #:
EXPLANATION: Customer cancelled job. No inspections performed
Signature: 4.5-1 j isk,.-..._ Date: 02/09/2011
Belinda Larson, Install. Coot.
Print Name:
aduatitalict
1. The Director or Ong Official nnay authotixe the refund of:
a) any fee which was erroneously paid or co Mecum .
b) not more than 80% of the land use application fee when an application is withdrawn or canceled Ware any review effort bra been expended
c) not more than 80% of the land use sppbatiost fee for issued permits
el) not more than 80% of the building plan review fee when an application is canceled before any plan review effort bas been expanded•
e) not more than 80% of the building permit fee for Waned pew prior to any Inspection request'.
2. Refunds vii be retuned to the owl Payer in the same method in wench payment was received. Please allow 1 -2 weep for proceaaing refunds.
I t)1; t)1 1 ICI I "I t)♦I l
Rte to S s Admin: Date B Rte to Bl. _ Admin: Date a :23 l+
Refund Processed: Date a201 B ,,,%/ Invoice Processed: Date B
Permit Canceled: B'!�-.,,��MIlE3fl iffil Parcel T+ T. Added: Date B
Receipt # Date. Met od Amount $
ilig q
Q City of Tigard
T I GA RD 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: Blairco, Inc. DATE: 2/18/2011
7609 MacArthur Blvd.
Vancouver, WA 98664 REQUESTED BY: Dianna Howse
Atm: Belinda Larson
TRANSACTION INFORMATION:
Receipt #: 178664 Case #: MEC2010 -00328
Date: 7/14/2010 Address /Parcel: 8020 SW Bond St.
Pay Method: CreditCard Project Name: Hagan
EXPLANATION: Per applicant's request as job was canceled. Refund 80% of permit fees.
REFUND INFORMATION:
.Fee Description From Receipt . Revenue Account No. Refund.
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Mechanical Permit Fee 2300000 -43102 $72.00
12% State Surcharge 1003100 -24001 8.64
TOTAL REFUND: $80.64
APPROVALS:
If under $5,000 Professional Staff ++�` n
If under $12,500 Division Manager 4,y , 0_0 a a,/,
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM AD INISTRATION USE ONLY • .
Case Refund Processed: I Date: 1 02` 3 // I By: I ;!I &,
L\ Building \ Refunds \RcfundRcyucst.doc x 09/01/2010
CITY OF TIGARD RECEIPT
q
m . _ 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
/ZGt A/4
Receipt Number: 181589 - 02/23/2011
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2010-00328 $ -80.64
Total: $40.64
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 027172 DHOWSE 02/23/2011 $ -80.64
Payor: Joseph Blair - Blairco, Inc.
Total Payments: $ -80.64
Balance Due: $80.64
khty G
111 Tidemark
• System Administration
Finance Department Request
Date: •G /a A/ •
To: Liz Lutz
Angela McCoy
From: Dianna Howse/
- Re: Receipt #: 0/5 f9 /7f'e 6 y
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 h ave been
reversed on Revenue Account Re ort .
Other /Explanation:
,2E1/ 9 , Th2 7
Thank you!
I: \Buildin \Forms \Rtesio_FinanceReq.doc
Page 1 of 1
1111 CITY OF TIGARD RECEIPT
E g . 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
/ 1cm!
Receipt Number: 178664 - 07/14/2010
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2010 -00328 Mechanical Permit - RES 2300000 -43102 $18.00
MEC2010 -00328 12% State Surcharge - Mechanical 1003100 -24001 $2.16
Total: $20.16
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 027172 DHOWSE 07/14/2010 $100.80
Payor: Joseph Blair, Blairco, Inc.
Total Payments: $100.80
Balance Due: $0.00
Page 1 of 1
FROM (WED)FEB 8 2011 8:12/ST. 8:08 /No.7500000075 P 2
CITY OF TIGARD • • RECEIPT
13125 SW HoII Blvd., TiQard OR 97223 -
503.639,4171
TI( . \ r:
Receipt Number: 178664 - 07/14/2010
CASE NO, FEE DESCRIPTION REVENUE ACCOUNT NUMBER ELOS
MEC2010-00328 Air Conditioning 2300000-43102 $48.75
MEC2O10.00320 12% State Surcharge - Mechanical 1003100 -24001 $10.80
MEC2010.00328 Minimum Fee Adjustment - Mechanical 2300000. 43102 $43.25
Total: $100.80
PAYMENT METHOD CHECK N CC AUTH. CODE ACCT ID CASHIER ID RECEIP3.D6TE NECEIPT AMT
Credit Card 027172 OHOWSE 07/1412010 $100.80
Payor: Joseph Blair, Blairco, Inc.
Total Payments: $100.80
Balance Due: $0.00
37, Yo
ag. 40
cFD , 6 j
Page 1 of 1
FROM {WED) JUL 14 2010 8 :02 /ST. 8: 02//No.75500000517 P 1
.....)\:t4 5- - I q (=°
Awn •. j cLF\c1/4_. -
RE CEME , o '�� c� �l d�
'JUL 14 2010
CITY OF i IGARD
BUILDING DIVISION
r+- w r -
1 - '1\11\ l
t
C . „..,,- - - c
, , \ - - - - - - - - s'\ . ; ,
I „„ r
1 ,
1 .,
\-- - t... .----1.‘
1 0 s
_
14
1