Permit • City of Tigard, Oregon 0 13125 SW Hall Blvd. ° Tigard, OR 97223
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•
1 i_.\ t.
November 6, 2009
Thermal Flo Inc.
7236 SW Durham Rd., Ste. 100
Portland, OR 97224
Attn: Yvette Cooksley
Re: Permit No. MEC2009 -00582
Dear Ms. Cooksley:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 7071 SW Barbara Ln.
Project Name: Jackson
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $100.80.
❑ Trust account "deposit" receipt in the amount of $
Notes: MEC permit created in error. Work added and fees paid under MST2009- 00148.
Refund 100% of fees paid under MEC.
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 - 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
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: Thermal Flo Inc. DATE: 11/5/09
7236 SW Durham Rd., Ste. 100
Portland, OR 97224 REQUESTED BY: Dianna Howse
Attn: Yvette Cooksley LS
TRANSACTION INFORMATION:
Receipt #: 175873 Case #: MEC2009 -00582
Date: 11/2/09 Address /Parcel: 7071 SW Barbara Ln.
Pay Method: CreditCard Project Name: Jackson
EXPLANATION: Created MEC2009 -00582 in error. Fees should have been added to MST2009- 00148.
Refund 100% of MEC permit fees and charge fees on MST.
. REFUND. INFO.RMATION::::' : ;. , . " •
' ee Description F om Receipt: Revenue Account No. •
- �� -Refund. .
Example: 245;0000
Mechanical permit fees 2300000 -43102 $90.00
12% State Surcharge 1003100 -24001 10.80
TOTAL REFUND: $100.80
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager 4; v '���
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
:` FOR ACCELA•:SYSTEM ADMINISTRATION USE,ONLY
Refund Request Reviewed: Date: y ; r By:
Case Refund Processed: Date: • By: ..,-,.?!.'•V V:=
l: \Building \Refunds \ReFundRequesc.doc 04/13/09
i C ° Community Development
TIGARD Request for Permit Action
TO: CITY OF TIGARD
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 CK City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Businessorindividual) - TN( ry)a\ V \0 ri e . / \nyliz -W A,, cce.
Mailing Address: 7 Z 3(.0 k j , 3 D AT ha rr- s 12(41 *) a/c.(.. 100
City/State /Zip: PO( AVkr\(k OK q 77 2 L I
Phone No.: 50 b • ?)3 a>
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( ✓):
CANCEL PERMIT APPLICATION. rlaQ„ zz OCq • (pc 5S Z
REFUND PERMIT FEES (attach receipt, if available). orvic' ZC y OC"i S 2-
R INVOICE FOR FEES DUE (attach case fee schedule and explain below).
REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: na Qz ooCt • 00..S112-
Site Address or Parcel #: 707 l )( be ca Lln •
Project Name: ` T O&(' s in
Subdivision Name: Lot #:
EXPLANATION: ril 7009 • 005E32 0 r enA' -er\ , n {,for.
e_ e-S ShamsIA hckve be_en acid -ed -- -n
nn s72009 . C50 I4 g . "Rec - e Y e Vuonc4 kr o%• OC - --eess
Signature: 6 Q L X Q Date: "• R. QQ
Print Name: Ldr01 Q Se_ \ Vex s
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 n• c e; By4,
Refund Processed: Date s / V l i 1:'; By r nvoice Processed: Date By
Permit Canceled: Date // / /c 5 By 40/ Parcel Tag Added: Date By
Receipt # 6'` '0 Date ;%� e f,• Method CC. Amount $
I:\ Building \Forms \RegPermitAction.doc Rev 07/26/07
• .L. CITY OF TIGARD RECEIPT
G C 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
lGAItI7.
, /J i
Receipt Number: 175873 - 11/02/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID .
MEC2009 -00582 Heat Pump 2300000 -43102 $61.06
MEC2009 -00582 12% State Surcharge - Mechanical 1003100 -24001 $10.80
MEC2009 -00582 Minimum Fee Adjustment - Mechanical 2300000 -43102 $28.9
Total: $100.80
•
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 083970 STREAT 11/02/2009 $100.80
Payor: Kenneth A Coe
Total Payments: $100.80
Balance Due: $0.00
•
CITY 11 25 S B6HAL L PBLVT 5
D
TIGARD, OR. 97223
TERMINAL I.D.: 00173400008883138658
MERCHANT H: 8083130658
VISA
$$$$$$$$$$$$3629
SALE
RECORD : HOU 02, 09 INV: TIME: 8 12 19
BATCH: 402 AUTH: 083970
AUSs RESPONSE: 2
CUIJZ RESPONSE: P
5 l!I6IT ZIP MATCHES, ADDRESS DOES HOT
TOTAL $100.80
I A6REE TO PAY ABOVE TOTAL AMOUNT
ACCORDIH6 TO CARD ISSUER AGREEMENT
(MERCHANT AGREEMENT IF CREDIT VOUCHER)
CUSTOMER COPY Page 1 of 1
• CITY OF TIGARD RECEIPT
3 ; 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
TIGARD
•
Receipt Number: 175948 - 11/06/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2009 -00582 $- 100.80
• Total: $- 100.80
•
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 083970 DHOWSE 11/06/2009 $- 100.80
Payor: Kenneth A Coe
Total Payments: $- 100.80
Balance Due: $100.80
IL Tidemark
System Administration
Finance Department Request
Date: /WO 9 ~
To: Liz Lutz
Angela McCoy
From: Dianna Howse/
Re: Receipt #: /7' f7 7 /255c/ p
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:
Thank you!
I: \ Building \ Forms \RteSlip- FinanceReq.doc
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Page 1 of 1
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1 . .
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• ' Mechanical Permit Application .. ,......._, ,„..:i ONO' . . '; : •. ..,
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City of Tigard . t
bileiBY:
IZZEIMEntin -
1
1 1 " 13125 SW Hall Blvd.. Tigard. OR 97223
, '
I . Phone: 503.639.4171 Fax: 503.598.1960 plan Re
Other Permit:
• Date/By:
TIGA.F.0 Inspection Line: 503.639.4175 ' Da
Inteinct WWW.tig.ard-Or.gliv ze Ready/By J
' • Notified/Method: • • unr Page 2 for
0 See
Supplemental Information
.. .: 7, : - - 11 =F ::: .: 2 ;k 7 :‘ 7 7 . ^.:-: . :; 1.,,..;,kg i3ailtb_Vit:=41SE
Mechanical permit tees* are based on the value of the work
0 New construction Xf Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other mechanical materials. e. ui • ment. labor, overhead, and myth
i' 04j±514 ....................................................... ... Value: $
_ ........._........,,,,..,.........._,..,........ ........ ......._.... .... . - -.......- ,,.. - • - niti " o u lf;.*0 - .4 .: /-i sys . reifs , 5 t. m
For special information use checklist.
. 2 „.. 7., .. ::.t.
I - and 2-family dwelling 0 Commercial/industrial D Accessory building " ' - - -- :• ' • ••
g
—
Multi-family CI Master builder 0 Other. i
Description f OrY- Ea. Taal
......:.;.::,:
4eiii:iiitiiiiifOliMA' Fmsli 71',1KA Heating/cooling •
An conditioning
lob site address: lb/ i a vy' a LA, (requiTes site plan showing piacement) . _ _ 46.75
•
City/State/ZIP: Tijareti 0.4 q121. Furnace 100,000 BTU (ductslvems) - 46.75 •
• - - - -
Furnace 100.000-- BTU (duets/nom) 54.91
Suitc/bldgJapt.no.: Project name: /J'• 10 . Heat pump A CIA. —40 .1". J 61.06 (Oh DO
Cross streeUdirechons /0 job site: Duct work 23.32 -
I.Iydronic hot water system 23.32
A - 6 Residential boiler (radiator or
NiMi 0 eLb tti• - 0 bo- ey hydronic)
Unit heaters (fuel not electric), 11.32
. . in-wall, in-duct, suspended. etc. 46.75
Flue/vent for any of above 23.32
Subdivision: A I A I . • Ik 1 J r " 4111F Other j 23.32
' I . I AIII
Tax map/parcel i i P1 i ArrkfifiltIP 2 Other fuel appliances
• ."- - - -- -inr.:---- - -1.-2::"L"•:=.::•:=Ez.z.v-7w.
.•,:; WMer heater
-"..e&D''''.47-."'4. ____A I 2332
Gas fireplace • 3339
v •
Flue vent for water heater or gas
fireplace 23.32
.. ) 'II i. '11 1' li ( ivi I eK -
Log lOtcr (gas) 23.32
4f.4 WA/2- /He& ref Vent/ Dr,ye?'", Wood/pellet stove 33.39
• 4/1v-ti 1-671i • Wood firep)ace/insert 23.32
- - . • - • - - - -.--.,,....,.., Chimney/liner/flue/vent 23.32
Ak4" r 1 -W 6 44 - 5 1 t 4 t li .....4. - #.0 .,i ft:4 ' .• 7 #;X# 1.: 4 13: P. 1 :Z 7 :4 P. oth,, 23,32
Name: ' , cra.,6 I PL..." Environmental exhaust and ventilation
Range hood/other kitchen
Address. - equipment 33.39 .
City/State/ZIP: (5 • Clothes dryer exhaust 33.39 i
....... -
Single-duct exhaust (bathrooms, I
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) - 23.32 ...•
" • "--- --"" - • ''.: ''' Attickrawlspace fans
•2: s iiiffitidif±eltg- - Ptifi: .: - g IyT.,1010i36qi:"::F...77A 2332 •
Business name: Thffird d 4a itie,,...
tler: 23.32
Contact name: gy 410M -
6 , O Fue t i p ipin_g
S14.15 for first four: $4.03 for each additional
•
Addr 1 25W' A
04 oblta41 tr. 00
7 Furnace. etc.
Gas heat pumn
City/State/ZIP: 1 ' 91121- Wall/suspended/unit heater
Phone:t/ ' 410-; , Ae „ Fax:AV) 5qg-4,144 Water heater
•
Fireplace
E-mail: 44 Th 410141 / IPM&• eNtie■ Ranee •
.,:,- Barbecue
Business name: Clothes dryer (gas)
Other:
_,...--..?1-1?-1•.., . „ .... . . . .
Address: --- 6 9 Y/
a' & ei_
City/State/ZIP: Subtotal ' i/31..t042
Minimum permit fee (590.00)
Phone; ( ) Fax: ( ) .
Plan review (25% of permit fee)
CCB 1ic.: 16: i 04-7 State surcharge (12% of permit fee) 1940 733
TOTAL PERMIT FEE lfrif*
• This permit application expires if a permit is not obtained within 180 ..e
Authorized signatur - / e
days after It bas been accepted as complete_ ■
' IX
Print name: ,a0 it Date: /0 - '; /I —D7 • Fee methodology set by Tri-County Building Industry Scrvic4; Board
..r. .e 1 TV i ■ I Ire, f rruallIMIR% 6%.39
Z00/00d evin# O1d1VP183H1 917L9869C09 8Z:90 600Z/Z0/1.1
City of Tigard, Oregon a 13125 SW Hall Blvd. e Tigard, OR 97223 : :�
jig ca
F SV+' 4.
'i tt ('� of Sf:; E Z' °.
November 6, 2009
Thermal Flo Inc.
7236 SW Durham Rd., Ste. 100
Portland, OR 97224
Attn: Yvette Cooksley
Re: Permit No. MEC2009 -00582
Dear Ms. Cooksley:
The City of Tigard has canceled the above referenced perinit(s) and enclose a refund for the
following:
Site Address: 7071 SW Barbara Ln.
Project Name: Jackson
Job No.: N/A
Refund: n Check # in the amount of $
® Credit card "return" receipt in the amount of $100.80.
❑ Trust account "deposit" receipt in the amount of $
Notes: MEC permit created in error. Work added and fees paid under MST2009- 00148.
Refund 100% of fees paid under MEC.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
1:A Building \ Refunds\ Administration \LtrRefund- CancelPernut.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 www.tigard- or.gov o TTY Relay: 503.684.2772