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Permit v_AA t 1 a CCSUIlZ C,'E U l0 rle ' ' CITY OF TIGARD MECHANICAL PERMIT , , "�:' COMMUNITY DEVELOPMENT Permit #: MEC2009-00337 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/10/2009 Parcel: 1S136CA04600 Jurisdiction: Tigard Site address: 10990 SW 79TH AVE Subdivision: FRIENDLY ACRES Lot: 2 Project: Combs Project Description: Install (1) bath fan. Owner: FEES COMBS, TYLER Description Date Amount 20908 SW WINEMA CT Single Duct Exhaust (Bathrooms, Toilet, 07/10/2009 $6.80 TUALATIN, OR 97062 Utility Rooms) PHONE: 503 - 545 -4177 12% State Surcharge - Mechanical 07/10/2009 $8.70 Minimum Fee Adjustment - Mechanical 07/10/2009 $65.70 Contractor: OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Gas Pressue: Total $81.20 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: 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 MECHANICAL PERMIT • COMMUNITY DEVELOPMENT Permit #: MEC2009 -00337 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/10/2009 T i'G AAA Parcel: 1 S 136CA04600 Jurisdiction: Tigard Site address: 10990 SW 79TH AVE Subdivision: FRIENDLY ACRES Lot: 2 Project: Combs Project Description: Install (1) bath fan. Owner: FEES ROBERTSON, SANDON P AND Description Date Amount NOYES, PAMELA S, 10990 SW 79TH Single Duct Exhaust (Bathrooms, Toilet, 07/10/2009 $6.80 TIGARD, OR 97223 Utility Rooms) PHONE: • 12% State Surcharge - Mechanical 07/10/2009 $8.70 Minimum Fee Adjustment - Mechanical 07/10/2009 $65.70 Contractor: OWNER PHONE: FAX: Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Gas Pressue: Total $81.20 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: ('� au�() ( V n 1 Permittee Signature: QQ �l 7 Call 503.639.4175 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. MechanicahPermit Applicati °, FOR OFFICE USE ONLY `J + VI City of Tigard R eceived Permit No.: Date/By: � `tom / l 1) 13125 SW Hall Blvd., Tigard, OR 97223 J 1 2009 Plan Review r 46 Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: gin Inspection Line: 503.639.4175 Date ReadyBy: ]uris: ® See Page 2 for Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Trt C Supplemental Information BUILDING DIVISION TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST ❑ Addition /alteration/replacement Mechanical permit fees* are based on the value of the work ❑ New construction 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 Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling - 7 /� /� 4 Air conditioning or heat pump Job site address: /O I/ 0 51�/ / -1 ' " ` 4 ye. (requires site plan showing placement) 14.00 City /State /ZIP: 7 ©K 9 7 2,7 3 Furnace 100,000 BTU (ducts/vents) 14.00 / Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: (O, S Gas heat pump 14.00 Cross street/directions to job site: Duct work 10.00 A/64r2 774C K I• , y .1 6x tr U D b f - / 7 Hydronic hot water system 14.00 1" Residential boiler (radiator or er r ' & j �,1,� hydronic) 14.00 F'/'c Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Flue /vent for any of above 6.80 Subdivision: Lot no.: Other: 10.00 Tax map /parcel no.: I S 13 `PC, AO tt Other fuel appliances DESCRIPTION OF WORK Water heater 10.00 Gas fireplace 10.00 i401 d 1 � ) 041— e e,{ i t n q /I Flue vent for water heater or gas J fireplace 10.00 . Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 Chimney /liner /flue /vent 10.00 RI PROPERTY OWNER ❑ TENANT Other: 10.00 Name: ' CO vlb Environmental exhaust and ventilation Address: Z tl O� Sw w NC.Nt Q C1 . equipment hood/other kitchen equipp ment 10.00 City /State /ZIP: TV ALAI 1 Ni / 0 P. 7 0 6 Z Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (rj0' 5'1' — c-( / 77 Fax: ( ) toilet compartments, utility rooms) / 6.80 ❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: S5.40 for first four; 81.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: 6e)/d Cl othes dryer (gas) Other: Address: MECHANICAL PERMIT FEES* City/State /ZIP: Subtotal 6 , U Minimum permit fee ($72.50) "72.S G Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fee) e , 7 G TOTAL PERMIT FEE A1.2 n This permit application expires if a permit is not obtaine within 180 Authorized signature: C (/J 6/441,5 days after it has been accepted as complete. Print name: 17 C /t/Li? S Date: ft./ L. y iv /061 . Fee methodology set by Tri -County Building Industry Service Board :\ Building \Permits\MEC- PermitApp.doc 01/19/07 440 -4617T (11 /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: Total Valuation: Permit Fee: $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC- PermitApp.doc 01/19/07 2 • 1 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.055 (4)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or \(//: 1 will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. j . coi Print N of Permit Applicant L � Signs rare of Permit Applicant Date 4 1 _2C'CC. L S ` ( Permit #: P b ':e c" ' b • ((, . F Address: 1( )P 1 1 qi n .,a:j;a' r< mit /ice • ck Issued by: _. <_ ) Date: / d r t ( ( This Copy for Permit Offices Plect-Oo3,3 9- City of Tigard, Oregon 0 13125 SW Hall Blvd. 0 Tigard, OR 97223 w � � tt 1 t September 11, 2009 y �`I' , Tyler Combs 20908 SW Winema Ct. Tualatin, OR 97062 Re: Permit No. ELC2009- 00336, MEC2009- 00337, PLM2009 -00183 Dear Mr. Combs: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 10990 SW 79 Ave. • Project Name: Combs Job No.: N/A Refund: ® Check #100517 in the amount of $177.86. n Credit card "return" receipt in the amount of $ . ❑ Trust account "deposit" receipt in the amount of $ . Notes: Per applicant's request as 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. I: \Building\ Refunds\ Administration \LtrRefund- CancelPermitdoc 01/16/07 Phone: 503.639.4171 o Fax: 503.684.7297 0 www.tigard- or.gov 0 TTY Relay: 503.684.2772 • CITY OF TIGARD RECEIPT e 2 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 T f.GA:1.i J); Receipt Number: 174307 - 07/10/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2009 -00337 Single Duct Exhaust (Bathrooms, Toilet, 2300000 -43102 . 5,.: , . „ $6.80 Utility Rooms) MEC2009 -00337 12% State Surcharge - Mechanical 1003100 -24001 $8 MEC2009 -00337 Minimum Fee Adjustment - Mechanical 2300000 -43102 $65.70 —•' Total: $81.20 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 1003 LSELLERS 07/10/2009 $81.20 Payor: Tyler Combs Total Payments: $81.20 Balance Due: $0.00 Page 1 of 1 1 IR Community Development TIGARD : ... Re uest for Permit Actio ' • 4 2009 TO: CITY OF TIGARD CITY OF TIGARD Building Division Services Coordinator BUILDING DIVISION 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: t Owner 4. Applicant n Contractor n City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) Ty le, j COW d Mailing Address: D 0 8 5 ti/ W 2 l „,, ", C-t City /State /Zip: (1/0L (0l'j / 1 Og /7061 Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL PERMIT APPLICATION. F , REFUND PERMIT FEES (attach receipt, if available). INVOICE FOR FEES DUE (attach case fee schedule and explain below). n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). I/ �^ Permit #: r l & L2o0 °( " 0 Site Address or Parcel #: /5/ 3 4 c A? o i6 00 /Q 990 2 7 Project Name: Subdivision Name: Lot #: EXPLANATION: Wl& VCto( i fr�$ eq' ' 'UK,. n s ce Signature: 6/4/1° Date: Vifi/el Print Name: 7 ,/ev ( d w 5 Refund Policy 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. FOR OFFICE USE ONLY Rte to Sys Admin: Date , By Rte to Bldg Admin: Date 9/i /e/9 By Refund Processed: Date 1j/ n 9 By Invoice Processed: Date By Permit Canceled: Date ��j,o y By / ': Parcel Tag Added: Date By Receipt # Date Method Amount $ I:\ Building \Forms \RegPemvtAction.doc Rev 07/26/07 City of Tigard, Oregon 13125 SW Hall Blvd. 0 Tigard, OR 97223 • 11 • .{ • September 11, 2009 Tyler Combs 20908 SW Winema Ct. Tualatin, OR 97062 Re: Permit No. ELC2009- 00336, MEC2009- 00337, PLM2009 -00183 Dear Mr. Combs: - The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 10990 SW 79 Ave. Project Name: Combs Job No.: N/A Refund: ® Check #100517 in the amount of $177.86. ❑ Credit card "return" receipt in the amount of $ ❑ Trust account "deposit" receipt in the amount of $ Notes: Per applicant's request as 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. I: \Building\ Refunds \Administrat ion \LtrRefund- CancelPerrnit.doc 01/16/07 Phone: 503.639.4171 • Fax: 503.684.7297 • • www.tigard - or.gov • TTY Relay: 503.684.2772 7111 q City of Tigard T I G n R D 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: Tyler Combs DATE: 7/16/09 20908 SW Winema Ct. Tualatin, OR 97062 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt #: 174306, 174307, 174308 Case #: ELC2009- 00336, '/ MEC2009 -00337 • PLM2009 -00183 • Date: 7/10/09 Address /Parcel: 10990 SW 79th Ave. Pay Method: Check Project Name: Combs EXPLANATION: Per applicant's request as project was cancelled. Refund 80% of permit fees. - �, '1' �- - ��: ,'PI.4 .. �.. . �"', :? 'i!' -'. t;.':•... • '.t +,� :ew•t c �R: ,-.. I�f xs}���('1'y /, ,• „� N,:- f•. ••.F._�. _i'�''; -. •"_ '�l3 :�:Y• �:':,;;`� -'•' F..� s.� 'r �,'. ::�. } .{. ' _ ._5.... � C� 11• ���I�OL..ut�f :��Oi'.,?. • 'ii, b R �'1!��:'�` Ji'. .!(.A./ • 14-` R�I�.r r r�.. . •�. f�.'�.' "- 1'XA�. .� � J�ii�. ': : . : �;p�s -'Aw'!jf$'+ :° y r( �Y 7 ^ -;.•- :u•, !s• ` . •-ti - .-- ,?'vi ,�;• _ a � : ; ;'.:-'.p` -- f_. 'e a g' ' :: .Vi:,.: . :'.R ciqunt . 'y, ^,- ` r# faL in. i .4, 1 }': rt . :. ;; , ..•S .,.rl ,.i. ;1'.. i fl.'1� : f: f}L'� ' L,�. � ,'i. =�+ ?_1 '�. 'r�.;+:: r_.1� . { » >._7 :f�.' ', _ .;::1 � - .�.i;.:5. ' -F��. t':,. ;, ;: . . : •' y_ _ . ,: . .$. _Ar m'aju ' ��: � � �,`- 7 .�]� I ?. � mit Fee ;: ��- �. ,�:;:?.. ,.. � Ex at�i pl e : 24 5` =' 0.0 0.0 • :._32Q00•`' : • • ., �,. :. ....,..... 0A Electrical Permit Fee 2200000 -43103 ✓ $42.80 ✓ 12% State Surcharge 1003100 -24001 ✓ 5.14 Mechanical Permit Fee 2300000 -43102 ✓ 58.00 12% State Surcharge 1003100 -24001 ✓ 6.96 •- Plumbing Permit Fee 2300000 -43101 $58.00 •• 12% State Surcharge 1003100 - 24001 ✓ 6.96 TOTAL REFUND: $177.86 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager , I len .. If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board ONLY: . _. •;, , ;- ' �'` � �:' t:;.' °F•OR ACGEI:A'SYST•EM ADMINISTRATION: L�S :;' -:; , . .. , • . . Refund Request Reviewed: Date: 2 //C By: ` Case Refund Processed: Date: / ,d.Gd' By: _ e i - ' I: \Building \Refunds \RefundRequest.doc 04/13/09 CITY OF TIGARD RECEIPT 1 111 ! gt . 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD fJ J (Avg) Receipt Number: 175175 - 09/11/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID ELC2009 - 00336 $ - 47.94 Total: $ -47.94 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 100517 DHOWSE 09/11/2009 $ - 47.94 Payor: Tyler Combs Total Payments: $ Balance Due: $47.94 • • Page 1 of 1 CITY OF TIGARD RECEIPT p III g . 13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD A i r &'d1 /6 Receipt Number: 175176 - 09/11/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2009 - 00337 $ - 64 . 96 Total: $ -64.96 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 100517 DHOWSE 09/11/2009 $ -64.96 Payor: Tyler Combs Total Payments: $ - 64.96 Balance Due: $64.96 Page 1 of 1 CITY OF TIGARD RECEIPT i l l ill It : 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Tr GARI) 6 0C-7 fir` Receipt Number: 174307 - 07/10/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2009 -00337 Single Duct Exhaust (Bathrooms, Toilet, 2300000 -43102 r •,. $6.80 Utility Rooms) ` MEC2009 -00337 12% State Surcharge - Mechanical 1003100 -24001 $8.70 MEC2009 -00337 Minimum Fee Adjustment - Mechanical 2300000 -43102 $65.70'' Total: ^ • $81.20 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 1003 LSELLERS 07/10/2009 $81.20 Payor: Tyler Combs Total Payments: $81.20 Balance Due: $0.00 • Page 1 of 1 1,111 CITY OF TIGARD RECEIPT q 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 175178 - 09/11/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2009 -00183 $ -64.96 Total: $ -64.96 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 100517 DROWSE 09/11/2009 $ - 64.96 Payor: Tyler Combs Total Payments: $ -64.96 Balance Due: $64.96 Page 1 of 1 III CITY OF TIGARD RECEIPT i " :: 13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TF (�ARO Receipt Number: 174308 - 07/10/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2009 -00183 Lavatories 2300000 -43101 - $16.60 PLM2009 -00183 Water Closet 2300000 -43101 --.')c2 J $16.60-: PLM2009 -00183 12% State Surcharge - Plumbing 1003100 -24001 ;: `••' ;, : - $8.70 PLM2009 -00183 Minimum Fee Adjustment - Plumbing 2300000 -43101 $39.304-• Total: :: L! $81.20 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 1003 LSELLERS 07/10/2009 $81.20 Payor: Tyler Combs Total Payments: $81.20 Balance Due: $0.00 • • • Page 1 of 1