Permit i
a CITY OF TIGARD MECHANICAL PERMIT
v ° COMMUNITY DEVELOPMENT. PERMIT #: MEC2008 - 00422
',TIGARD: 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/13/2008
PARCEL: 25111 CD -02300
SITE ADDRESS: 09600 SW SUMMERFIELD DR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.7 LOT: 342 JURISDICTION: TIG
PROJECT: SPENCER
Project Description: Replace existing a/c unit in same location. .
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: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: •
WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS:
> 10000 cfm:
Owner:. • FEES
BARBARA SPENCER Description Date Amount
9600 SW SUMMERFIELD DR
TIGARD, OR 97224 [MECH] Permit Fee 8/13/200€ $72.50
[TAX] 12% State Surchai 8/13/200E $8.70
• Phone: 503-620-410] Total $81.20
Contractor:
•
COLUMBIA HEATING & COOLING INC
P.O. BOX 230397
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
•
Contact #: PRI 503- 624 -2704
FAX 503 -598 -0270
Reg #: LIC 76359
•
•
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 Permittee Signature: . J ( v---...____3
Call 503.639.4175 by 7:00 a.m. for inspections 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.
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: H Ecko - ppcia- REQUIRED ON GREEN INSPECTION CARD.
✓ Code I Inspection Description I PASS Date I By ✓ Code I Inspection Description I PASS Date 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 Ductwork
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 PLM - Plumbing Permit
910 Sprinkler rough -in
915 Fire alarm rough -in 305 Plumbing underslab
310 Crawl drain
920 Suppression trip test
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
I: \ Building \ Forms \InspCard- AOP- Blank.doc 02/02/07
Mechanical Permit Application uou OFFICE I'st: UNI.1
l s City Tigard {{�� f b Ra ' 2, D $ TI, Permit No.: MM�ea?oo8_oo i 13125 SW Hall Blvd., Tigard, OR 972��v 1, Datvay.
��pp
Phone: 503.639.4171 Fax: 503.598.19 �\\ 1 � a �,
T t G M, 1t D Other Permit
Inspection Line: 503.639 1 Rand Plan Revien Randy/By: r1eT III See Page 2 for
Internet: www.tigardor.gov '` • I
� ■ �`� Nolifind/Method � Supplemeoal
. - . .. TYPE OF .WORK ` ��1„ t u ri :. , • • ` COMMERCIpL E E! `CH
S E DULE USE CHECKLIST
•::.:':
❑New construction ❑ Additionlaltera itxtltacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest duller) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
. CATEGORY OF CONSTRUCTION: •• - Value: S
ST
❑ i - and 2- family dwelling [1] tn
Come_cial/industei ❑ al Accessory building 1tESLlE1'TIAI EQUIPMENT / SYSTEMS FEES'
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other:
Description 1 Qty. I F..2. 1 'Total •
... ..... .• : =:: ' JOB. SITE INFORMATION:A11 ;L.0CATION :.: > Heabng/coolirig
Job site address: ,,`, ) / �/// n Air conditioning or teat pump
fJ 5/ Cl ,-,57, / c � /+ LJ F/ P. 'd (requires site plan showing placement) / 14.00 ,
City /State/ZIP: Ci / /�` V IIGG Furnace 100,000 BTU (d,uts/ventr) , 14
.00
Furnace 100,000+ BTU (duets/vents) 17.90
SuiteibIdgJapt. no.; Project name:
Gas ; pry 14.00
Cross street/directions to job site: Duct work 14.00
-- 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. 10.00 '
Subdivision: , Lot no.: Flue'vrn: for any of above 10.00 `
Other:
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00 •
�_�{L Flue vent for water heater or gas '
.2 /� / /�J �/' fireplace 10.00
e-/4 4 e G 2e /vim ' " 7 f _ - Log lighter (gas) 10.00
•
Wood/pelle stove 10.00
Wood fireplace/insert 10.00 j
I •
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Cbimney/liner /fluefvcnt 10.00
.',K PROPERTY ,.:.: PROPERTY OWNER - [' T1! :1VANT...:::.::.'.;::_ :: %c.;
I :: •:: •. er 10.00
Name:
\),, Other: // e . -4 Af Environmental exhaust and veatilatloa
Address: l t1 _•/� v ) r Range hood/other kitchen
equipment 10.00
City / State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms, •
Phone: 4J 3) „epZ,d 4'7 Fax:( ) toilet comparattents,utility rooms) 6.80
❑ • APPLICANT: fr . . ' El CONTACI':PERSON.:` - " ;r:7. Atfic/crawlspaoe fans 10.00 ,
Other: 10.00
Business name: Fuel piping
Contact name R 1 b ! 55.40 for first four S1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/LIP: I Wall/suspended/unit heater
Phone: 03 )b3. Li 3 ," ?D t Fax :: 93)s 6 0 Water heater
- Fireplace
E -mail: Range
•
CONTRACTOR . : Barbecue
Business name: (2 Q l ” hi C ��G.a.JI i : te �// + �ytG Clothes dryer (gas)
1 �(Q� fir:
Address: ge 3 o X ) 3 0 3 91 MECHANICAL PER TT FFL$5
City/State/ZIP: ----5 a , J � „0 - Y ) /L Fax: 9 2 ) 4i/ , Subtotal
Z q - ' .3- /0 9 D i y Minimum permit fee (S72.50)
Phone: (
�/ o �d Plan review (25% of permit lee)
CCB lic.: 7 b 3 S 9 ' State surcharge (.12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: ■C;PAP t e ,��y
This permit application expires U a permit Is not obtained within 180
� _ days after it has been accepted n oompkk.
Print name: ,j' f /' y I Date: rie5/ ' Fee enetbodo!ogy set by Tri County Building Industy Service Board
Z / 0LZ0 869 ONILV3H VI8Wl100 B9 l:80 80 Zl 6nV
Aug 12 08 08:16a COLUMBIA HEATING 503-598-0270 p.3
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City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 •
• ...
TIGARD
October 7, 2008
Columbia Heating
P.O. Box 230397
Tigard, OR 97281
Attn: P. A. Dalby
Re: Permit No. MEC2008 -00422
Dear Ms. Dalby:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 9600 SW Summerfield Dr.
Project Name: Spencer
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $64.96.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as customer cancelled job. 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 \Administ ration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
•
City of Tigard
T I G A R D 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: Columbia Heating DATE: October 6, 2008
P.O. Box 230397
Tigard, OR 97281 REQUESTED BY: Dianna Howse
Attn: P. A. Dalby
TRANSACTION INFORMATION:
Receipt #: 2008 -2883 Case #: MEC2008 -00422
Date: 8/13/08 Address /Parcel: 9600 SW Summerfield Dr.
Pay Method: CreditCard Project Name: Spencer
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% 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 $58.00
[TAX] 12% State Surcharge 100- 0000 - 207020 6.96
TOTAL REFUND: $64.96
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager 5 /WI>.
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
• FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: I Date: I /e /Ve.),' I B : '
I: \Building \Refunds \RefundRequest.doc 05/23/07
M 1 CITY OF T'IGARD 1ti/6,200S •
°" 1332; S\\ 11111 tti,c I I :4 3:04AM
itit ..4:7 Ti r: I. OR 97223 5113- 639.4 t71
Refund Receipt #: 27200800000000003467 / ., ` l: C-.
Date: 10/06/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MEC200$ -00422 Reversal - [MECH] Permit fee 245-0000-43101 0 (58.00)
MEC2008 -00 -122 Reversal - [TAX] 12 %, State Sur I00- 0000 - 207020 (6.96)
Line Item Total: ($64.96)
Refund:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal COLUMBIA HEATING & 013144 Fax (64.96)
rnnni I Mc:
Refund Total: ($64.96)
}
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•
`J CITY OF TIGARD 9/24/2008
,ti 111rSWy Hall Blvd. 10:09:
L ! L Tigard. OR 97213 503.639.1171
Receipt #: 27200800000000002883 0/-2/.6 - -
Date: 08/13/2008
Line Items:
Case No 'Tau Code Description Revenue Account !No Amount Paid
MEC2008 - 00422 [MECH Permit Fee 245 - 00(10- 131010 72.50
MEC2008 -00422 [TAXI I2'4 State Surcharge I00- 0000 - 207020 8.7(1
•
Line Item Total: $8120
Payments:
Niel Payer User ID Acct. /Check No Approval No. How Received Amount Paid
CrcditCard COLUMBIA HEATING & DEB (113144 Fax 81.20
COOLING
Payment Total: $81.20
•
Community Development REC
Request for Permit Action s c p 2 4200B
TIGARD
CITY OF T D
TO: CITY OF TIGARD VI WING DIVISION
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: (Buss nccs or Individual) G O / fiL , .6 / G A /_ i ft/
Mailing Address: PD 43 o d ' l> 3 7 `7 •
V 0 1 ® City/State/Zip: D� 0 2�
•
id
/%t Phone No.: - - .D 3 lP .Z �� o
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
Y Y Z 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 #: /1 e 0 O 7 — D U zi
n
Site Address or Parcel #: 9 G 0 0 - t 6plc [/Iq
Project Name:
Subdivision Name: Lot #:
EXPLANATION:
c.
Signature: Q Date: q //a
Print Name: /. A )9,41/1)
Refund pov�-
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.
.l)
not more than 80% of the bolding plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 8fP /0 of the building permit fee for issued permits prior to any inspection reque,ts.
2 Refunds will be returned to the original Payer in the same method in which payment was received Please allow 1-2 wculea for processing refunds.
= d .
FOR OFFICE USE ONLY
Rte to Sys Admin: Date • LF7 g ortg_MI Rte to Bid Admire Date ' B - t
Refund Processed: Date /B b 0. By ,04:14 Invoice Processed: Date By
Permit Canceled: Date / _ , B. ,,?4,1 Parcel Tageided: Date B
Recei Alffig Date _ 0.0i Method I Amount $
1:\ Building \ Form: \RoyPcnnnitAction.d. R. • 07/26;07
vd 0LZ0 ONI1V3H `d18Wl1OO e0S:60 80 17Z deS