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Permit CITY OF TIGARD MECHANICAL PERMIT 3! COMMUNITY DEVELOPMENT Permit #: MEC2009 -00088 Date Issued: 03/27/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S136DC04500 Jurisdiction: Site address: 7501 SW DARTMOUTH ST Subdivision: Lot: 0 Project: WINCO Project Description: Bakery Department - TI Owner: FEES WAREMART INC Description Date Amount BY BURKE + NICKEL, 3336 E 32ND ST #217 Permit Fee 03/27/2009 $326.00 TULSA, OK 74135 Plan Review 03/27/2009 $81.50 PHONE: 12% State Surcharge 03/27/2009 $39.12 Contractor: SOURCE REFRIGERATION 5506 SE INTERNATIONAL WAY MILWAUKIE, OR 97222 PHONE: 503 - 652 -0754 FAX: 503 - 652 -0449 Type of Use: COM Class of Work: ALT Type of Const: IIB Occupancy Grp: M Occupancy Load: Stories: 1 Fuel Air Handlers Fuel Types: Units < 10000 cfm: Gas Pressue Units > 10000 cfm: Furnaces Boilers & Compressors Furnaces < 100K BTU: 0 -3 HP: Furnaces >= 100K BTU: 3 -15 HP: Floor Furnaces: 15 -30 HP: Unit Heaters: 30 -50 HP: Vents w/o Appliances: 50 or Greater HP: Air Conditioning: Heat Pump: Appliances Vent Fans: Vent Systems: Total $446.62 Hoods: Comm Incinerators: Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions) Clothes Dryers: Other Mech Units: Gas Outlets: Other Desc: Install freezer Duct Work: cases and Fire /Smoke Dampers: 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 Issued By: I 'I� (� 'V.N Permittee Signatur \ll 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. • Mech Pen i = p 11�c iii., FOR OFFICE USE ONLY ' Rec' ived O 4 2 Permit No,: City of Tigard ������pp Da /B : DP <� M �c,.��� - 13125 SW Hall Blvd., Tigard, OR1y992P3 ` � Revi '"" TS� 414 p Phone: 503.639.417 Fax: 503.598.1960 /� a rut , . " "°I) ■'" ✓•te/By . �r/ ' Other Permit: r/�O - 000`9 Inspection Line: 503.639.4175 CITY OF TIGARD . i, j. x•1_11.- `l ate Ready By: ra See Page 2 for Internet: www.ci.tigard.or- uspDILDI1vG DI H ISIO Notified/Method:10 • 25. // t Supplemental Information .... . -.,.r ..,. :.w- ;4.:., ,.,- :a +�,,,c, - r• � , ;:< G " " "' '' `R °* "''a ",''', �`�izs' za:as & m r a , .. :: - 1° :<, < ; A 6 r AivitittAVAW `CkIEI1CJf tISE�CHreiar " :: . .,. -P; :, t :; �1!I'E, C?)(' �.URK A,,:. , > M1., - :•.,a .,,, Et , ,:,,s �:.R ,• a� �`"°..,.«`*.: i.=',.' };s;:ati:>a`-:`i:. "... >r�ao- ",= �.H9ta %a':+ma -<:,v, Mechanical permit fees* are based on the value of the work ❑ New construction El. Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: .mechanical materials, equipment, labor, overhead, and profit. ��: ; M;,,,.:,.: ��A ,:�- 3: „ >,,,,,:,��,:,� =w�.,;�`;; ," - -� �;�><F _����� Vlue: $ 1,7 �� ".: '' � :: . , :.. ,.,gin - ,,,.,,,,, �. <,� :CATS �G(1RY O . �,CO,N ., . r�'�:.� .... �� �.',, � . :. t ', <:..,.. �.:, :;,.:; , .,..� - =`fi AL.E k i III'MHitin TE111S°.I E,ES. ,.,. �`�:, : �;, �$ IDEN�TIn, �. .� <..r °.���:s:•: - >:��ssu :- zau.,.K,.�;x� -�,., ❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑Mast er builder ❑ — Other: Description Qty. I Ea. 1 Total ar€ °. ;,;b- :.,,�a,.�,:.; s: =.: �uv -w =• � -:� : 3 �:..°: ��:e -. � rs a°,':- • �z "�`'s,,, ; s b i r d- i - , ..,'A t ` Heating /cooling 4 ,,,,e z kkt ' T(?I3 ^:S , AN , r�„:,, . ° N: �.��.��� ° =o. =_, x; °'��rti�:” �- ��s,< �'' s� ° °`"�` s�. � ,`" : �' "- .. ,. Air conditioning or heat pump Job site address: -1t() v"(\ �� vv S \, (requires site plan showing placement) 14.00 , City /State /ZIP: vvv ` Furnace 100,000 BTU (ducts /vents) 14.00 \�(J V 1� �� Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: I Project name: \\ nC4 Gas heat pump 14.00 Cross street/directions to job site: (',4 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 Flue /vent for any of above 10.00 _ Subdivision: I Lot no.: Other: 10.00 Tax map /parcel no.: Other fuel appliances ,;. ' :� „.vg Water heater 10.00 e ,axis '° . 13E GRIP O W < I2 .% �: , f ; .,.,> , ,,,., ,� `': ,t. Yom: -�m;. ,� °-- ..s,:,.,,.,�:,_- �,. .. � e �,,,* Gas fireplace 10.00 N O1/4,1((_ o CAA (A LS Wti& N9 x )3 eCAu.S f \ IN SOlvu{ , Flue vent for water heater or gas `-- r fireplace 10.00 %'‘13/ t \ ^ l C\31-% W1 \( gyh-k 01 cAM5 • Log lighter (gas) 10.00 • Wood /pellet stove 10.00 Wood fireplace /insert 10.00. • %a,•, `. > :,: i „ ° ^_ :,,:� -. ; -.s.; :, K Chimney /liner /flue /vent 10.00 :; ,gam; : p >.: r,re1.. `n >: 1 �, °�E A• VZ ,. r: ,,; °; �� „ rt : Y,,, _.`: ;u ,RFJPERTY: U:1' ..,40 .. �„ ". " - 4-;W -giii..- L,,, >x-,�r 10.00 -' ^ �° ',�+�£. , .: €��:x .,�,�f,::;.;�,� Other: Name: Vvnc Environmental exhaust and ventilation U �� Range hood /other kitchen Address:7501 )ti\ \ `ty,,A.\\ 4 equipment 10.00 City /State /ZIP: I ( R Clothes dryer exhaust 10.00 V ” Single -duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80 - ;- ,_,,;,;,,7,...., �,� ,._, ,, ii ire .,, .. < , r 3rM,, 4,. Attic /crawlspace fans 10.00 �,���..,;����: >;�,., 'a� X,, "„'° ...� =,.� E -� ��=' =:�„.. � >,. C®IVTAGT�° � I+a . S'01 , �: ��... <. ; i; , , t s �`; - L1GAN I`.• �eUM I .:c , 0- -M.::, a ,;,,,,-,NA ;,�P aa., ..::: "•- - ,..._. �N.,F, „, `> .. S �;:- ,. <. O ther: 10.00 Business name: t:> C (, �Z - &(1c - � eYv Fuel piping Contact name: CC C CI) thSCM $5.40 for first four; $1.00 for each additional t �q�� Furnace, etc. Address:r t . S� t OV ` "_ Gas heat pump City /State /ZIP: I\` y\\I. v ll. t �,2z,2• Wall /suspended/unit heater ( Phone: (s L )�_ Ck'ZC41 I Fax: : (SO3 ) (gS Z "(� I� Water heatcr Fireplace E -mail: \ CStjV,{ Cr f as ^ (1, co,,,,, Range = ,ter, ° .. =r' <a "'`tRi "." f Barbecue Cloth , , , .-r,� ,;w .,s :;r C'ON`I` I'U,R': a,,, .,' n ; :., Clothes dryer (gas) Business name: , rL� ' -k( eat (pkc ('\ Other: Address: ��� �J:� �(r� v�er� � Cll�fe� V�iQw� ,,, d,, G I P RM E S e,,t; . v : ��i' , Vie,,^ > r ��.�. asi „:m•:, City /State /ZIP: r 2. 2 7 Subtotal �\yJGM� 1 �” n C Mi nimum permit fe ($72.50) Phone: (C--. ) .., �� .\ I Fax: (C3 ) V) - Z-Q, tAtic Plan review (25% of permit fee) CCB lie.: '`l�oa(o State surcharge (8% of permit fee) TOTAL PERMIT FEE l-�-I4 p , L 2, �I > 1 s (1 I rIP►.tJl� This permit application expires if a permit is not obtained within - 180 Authorized signature: J ^�l `wJ// (( days after it t has been accepted as s complete. mplete. Print name: W\\ e \ W Vie \\ I Date:' 5'QG I * Fee methodology set by Tri County Building Industry Service Board � i:\ Building \Permits \MEC- PermitApp.due 12/03 440 -4617T (11 /02 /COM/WEB) "R ""iJRr`.t �T City ® Tigard, u� •regon 0 13125 SW 'all Blvd. o Tigard, OR 97223 ; KW 4 44 1 0 7-- q11 t a.- FAR Troy _` 1'.' September 11, 2009 s Duane Amyx 316 E. Main St. Emmett, ID 83617 Re: Permit No. MEC2008 -00088 Dear Mr. Amyx: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 7501 SW Dartmouth St. Project Name: Winco Foods Job No.: N/A Refund: ® Check #100498 in the amount of $310.24. n Credit card "return" receipt in the amount of $ . n Trust account "deposit" receipt in the amount of $ . Notes: Per applicant's request as scope of work changed and was completed under another permit (MEC2008- 00210). Retain plan review fees for plan review already completed; refund permit fee less $62.50 (hourly rate) for one inspection completed. If you have any questions please contact me at 503.718.2430. Sincerely, I., O Dianna Howse Building Division Services Supervisor Enc. I.A Building \ Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07 Phone: 503.639.4171 0 Fax: 503.684.7297 ® www.tigard- or.gov © TTY Relay: 503.684.2772 CITY OF TIGARD RECEIPT r 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 175182 - 09/11/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2008-00088 $- 310.24 Total: $- 310.24 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 100498 DHOWSE 09/11/2009 $- 310.24 Payor: Duane Amyx Total Payments: $- 310.24 Balance Due: $310.24 Page 1 of 1 . ,. 11 mms;r17p — frffifzli. L,ITY OF TIGARD 1/14/2009 3 2 K ` I 15 SW HA Blvd. 9:14128ANI . "hoard OR 97223 503.639.4171 :r..10'4,kliDi Receipt #: 27200800000000001243 Date: 04/15/2008 Line Items: Case No Tran Code Description Revenue Account No Amount Paid M EC2008-00088 [MECH] Permit Fee 245-0000-431010 339.50 MEC2008-00088 [MECPLN] Plan Rev 245-0000-433050 84.88 MEC2008-00088 [TAX] 12% State Surcharge 100-0000-207020 40.74 Line Item Total: $465.12 Payments: Method Payer User ID Acct./Check No. Approval No. How Received Amount Paid CreditCard DUANE AMYX CONST / BTT 015525 In Person 465.1 DUANCE AMYX Payment Total: $465.12 ; 9, ,,- , ::: .7 '7 .‘ .. ., , CReeelpi I pt Page I or I 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: Duane Amyx DATE: 8/20/09 316 E Main St. Emmett, ID 83617 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: at, -'.� Receipt #: 2008-1243 ;;.;; ' �° Case #: MEC2008 -00088 Date: 4/15/08 , } • Address /Parcel: 7501 SW Dartmouth St. Pay Method: Cre it.e d Project Name: Winco Foods EXPLANATION: Per applicant's request as scope of work changed and was completed under another permit (MEC2008- 00210). Retain plan review fees for plan review completed; refund permit fee less $62.50 (hourly rate) for one inspection completed. REFUNDINFO Fee�Description From Receipt Revenue Account,No Refu nd ;; Exam le UILD. Permit.Eee';•: ":n ; = 4 .:.� P �;.`: .. ]� .. _ :.._ J✓xainple 245, 0000 = 432000,_ : , , �, ,$ Amount ;,t [MECH] Permit Fee 245- 0000 - 431010 $277.00 TAX] 12% State Surcharge 100- 0000 - 207020 33.24 TOTAL REFUND: $310.24 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager ■41, • , ;�. 6J 1 � If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board FOR ?A`CCEIjA: SYSTEM` t1I)NIIIVISTRATION .L1SE; O NLY Refund Request Reviewed: Date: .° � By: y; Case Refund Processed: Date: �E By: y tF' L \Building \Refunds \RefundRequest.doc 04/13/09 ' 02/13/2009 15:25 5036520449 k✓ 11 SOURCE PDX PAGE 01/02 / Requeni0fl , ,,,. , ''IEGENED ., , C TIGARD � n VISION TO: CITY 4 111 niN ) E CEV'J $uilBuilding Division Services CoQI�#ivatax 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718. 430 Fax: 503.598.1960 wozw,tigar d- ox.gov / i 4 ON FROM: ❑ Owntia ❑ Applicant Is i Contractor ❑ Cit staff OF TIGARD (check ono) vt t►t-nfNG DIVISION REFUND OR Name: INVOICE O: (13"'i"a nr ;ndioidu4 VI/ NC 0 r0 V S _ 61'T T ki + ! brvl G ! 7TG� Mailing Address: 1 B .5 S6. City /State /Zi l: 13015C � T D $3705- 57s (O • Phone No.: 2 0$ — 2/(0 - 76 0 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): r4 CANCEL PERMIT APPLICATION. i REFUND PERMIT FEES (attach receipt, if available). 0 INVOICE FOR FEES DUE (attach case fee schedule and explain below). REMOTE CONTRACTOR FROM PERMIT (do rot cancel permit). Permit #: Al EC 2 OC)F — aeon / Site Address or Faxed #: 750i 5 IV DA-RI - 51 7(4eD 0 ie 97 .7,2 3 Project Name: VI/ AK c) Foo Subdivision Name: / • " is-__ 0/ Lot #; l w y —1.5,0g._ c4.rJ7 se_-- -- kV 8•-e9 ) EXPLANATION: 0' 1C N 4c P7R1 i t wv CrorTV P r uq P , . -' . . OF ME4 ' ' r = ..4. _ e1G .i • 011 Rer44-C ` aietGfnlr4G . Ala - ' oofTD . At>1 PMtrNJ ;),,► +Fay /S c e ( Sigmlztute: - _ . "� Datc: / — 1 3" D4 - _ _, Print Name: AP. C L14 &n A1nsl Pafiev 1. The Directot or Building Official trity authorize the reboil r C a) any Cr c which was eaoneoualy paid of collected 19 not innate than Ws of the land use applicadon fcc when an application is withdrawn or canteltd before any retie* effort hag been expended. c) not more than BM of Shr land est applieauon Fee Cos .issued' pc mios. d) not molt than Br" CI en bsldingplan r,r iew Fee when an arrGaation is canceled before any plan review effort has been cxpendad e) nor, mme ihm+ all% of the building permit fee Ca issued permits prior to any inspection requests. 2. RcEand: Trill be returned to the 0%iEental Parr in the At mer3tod in which payment was received ?lease shot 1 -2 weeks for processing rcfuorir. t R1 (ft l(, l l :` :t)'NFt) ' Rt to . a , t; .: ?at ; ' El D' ' 0011114,4 7tte to Bid Manisa: Date ,` /,1 F •� '� �"" Invoice Processed: Date B Refund Processed: Date „���i�. , ��' /a reel TA rl.dde ct Date B Permit Canceled: Dace ;�� � %�� �� Receipt # Date Mood IIEMEMENOMMINIMMI ;l: Vi3uildinp,\Form \Regkcm:itAction.doc Rev 07 26/07 ‘ es. Pr 41 RCOS "VA4/3