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Permit R CITY OF TIGARD MECHANICAL PERMIT 2?• - COMMUNITY DEVELOPMENT Permit #: MEC2009 00126 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/25/2009 Parcel: 1S133CD15100 Jurisdiction: Tigard Site address: 11577 SW TALLWOOD DR Subdivision: Lot: 0 Project: Carpenter Project Description: Change -out gas furnace. Owner: FEES CARPENTER, PEGGY A & HAROLD P Description Date Amount 11577 SW TALLWOOD DR Furnaces < 100K BTU 03/25/2009 $14.00 TIGARD, OR 97223 12% State Surcharge - Mechanical 03/25/2009 $8.70 PHONE: 503 - 521 -1928 Minimum Fee Adjustment - Mechanical 03/25/2009 $58.50 Contractor: COLUMBIA HEATING & COOLING INC PO BOX 230397 TIGARD, OR 97223 PHONE: 503 - 624 -2704 FAX: 503- 598 -0270 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas 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, T se rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules Issued By: K ... _ iJ "MAP), J4 Permittee Signature: -----. Aariv. g. c C all 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 RECEIPT III 1: - . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 172967 - 03/25/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2009 -00126 Furnaces < 100K BTU 245 - 0000 - 431010 $14.00 MEC2009 -00126 • 12% State Surcharge - Mechanical 100- 0000 - 207020 $8.70 MEC2009 -00126 Minimum Fee Adjustment - Mechanical 245 - 0000 - 431010 $58.50 Total: $81.20 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 615202 LSELLERS 03/25/2009 $81.20 Payor: Columbia Heating & Cooling Total Payments: $81.20 Balance Due: $0.00 • • Page 1 of 1 CITY OF TIGARD RECEIPT q 2 . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD fr :tau Receipt Number: 175010 - 08/27/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2009 - 00126 $ - 64.96 Total: $ -64.96 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 615202 DHOWSE 08/27/2009 $ -64.96 Payor: Columbia Heating & Cooling Total Payments: $ - 64.96 Balance Due: $64.96 • Page 1 of 1 r City! of Tigard, Oregon ° 13125 SW Hall Blvd. o Tigard, OR 97223 • II I NI • mi . • August 27, 2009 - - . -. _ -. Columbia Heating & Cooling P.O. Box 230397 Tigard, OR 97281 Attn: Kathleen Clark Re: Permit No. MEC2009 -00126 Dear Ms. Clark: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 11577 SW Tallwood Dr. Project Name: Carpenter Job No.: 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 job 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- Cancell'ermit.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: Columbia Heating & Cooling DATE: 8/20/09 P.O. Box 230397 Tigard, OR 97281 REQUESTED BY: Dianna Howse Attn: Kathleen Clark TRANSACTION INFORMATION: Receipt #: 172967 Case #: MEC2009 -00126 Date: 3 /25/09 Address /Parcel: 11577 SW Tallwood Dr. Pay Method: CreditCard Project Name: Carpenter EXPLANATION: Per applicant's request as job was cancelled. Refund 80% of permit fees. REFUND INFORMATION: Fee Description •Fr Receipt Revenue Account No. Refiind IJxainple:.;.[BU1LD] Permit Fee Example: 245-0000-432000 $ Amount • Mechanical Permit 245- 0000 - 431010 $58.00 12% State Surcharge 100 - 0000 - 207020 6.96 TOTAL REFUND: $64.96 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager ' °U. 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 /4„- , • - Refund Request Reviewed: Date: :'� :; B - Case Refund Processed: Date: i%! 7��� : By: 1: \Building\ Refunds \RefundRequest.doc 04 /13/09 I . `a 11111 It • MAR t' Z 2009 Community Development 41 P..:.:1.: r :1 Request for Permit Action ; : ` , a__l. 1 IGARfl i.,.0 � _�lCtlstl 't<r\ 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: C] Ownet ( Applicant 0 Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Bus or tndisidual) `/1 Co /w Mailing Address: f () _ i( 3 9 i t City /State /Zip: `/7, �- CL -, Phone No.: .) 3- G,�q{-a PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( Er PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). INVOICE FOR FEES DUE (attach case fce schedule and explain below). REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). • Permit #: 1ii 6 o / — C.0 / a Site Address or Parcel #: // S- /7 7 4• j . i„ JJ ,Qr Project Name: L-c 01cI P C i4 AL r Subdivision Name: Lot #: si EXPLAN ATION: ez........ 44. Lr (64- ite.A-//j , ! &LI . Signature; J...-.) ( Date: (,,1.7/z1 — Print Name: /l f I) d 4k--(e____ rte fund rolist 1. The Director or 1'1616n OFRciil Piny authorize the refund of a) any fee which was errrsuou.ly paid or collected. 1)) oat more Phan 80% of the land use application fcc when en application it withdrawn or canceled befnrc any review cfftm has : expended. e) not more than 80% cif the land lac application (cc far issued permit'. (1) not more than NM of the building/Ilan review Fee when an application is canceled bc-fore any plan review effort by been expended. e) not more than 8114b of the baildine permi fce rot kneel permit, prior en ony inapecd;.n rcquar+. 2. Refunds will be returned m ehc original wryer in the sane method in which payment was received. incase allow 1.2 weeks for prnerecbcp reftrrtd,. FOR ( 1(:F: t N 1•: t 1N1 Rtc co Sys Admire: Date Rte to $I. Admire: Date Refund Processed: Date , " rat: / 1 B° Permit Canceled: paw Aw1i % s. I nvo i ce P tncessed: Date B • a ¢S¢• Parcel' fag Added: Date g, Receipt # Dote .' Method Amoruot $ 1:taue7ctng \Forms \Rcpt nnjtAetinn.ebx Rev 07 /2fr /07 Z' OLZ0 96G €OS ONI1.d3H VI8Wf11O0 d8Z:10 60 LZ .ieW Mar 24 09 11 :42a COLUMBIA HEA 503 598 -0270 p.2 El . k. Mechanical Permit Application • - FOR O FFICE ,I SGONI Ni:,. ° ' ... MAR 2 4 2009 Received r .. Permit ' Cit of Tig Deceive: 0 a4 d9 y j J- erg /a 4 1 3125 SW Hall Blvd , Tigard, OR 97223 Plan Review Other Permit: 'l Phone: 503,639.4171 Fax: 503.598 1960 CITY OF TIGAR • ', Date/By: inspection Line: 503.639 4175 B UILDING DIVISI a xeaayr3y'. ions S See Page 2 for I • TFGAFl4 ' IVotificd Method: Supplemental Information Internet: c�ww tigard- or.gov / /��• TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE Mechanical permit fees* are based on the value of the work [] New constructiondditionlalteration /replacem performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT ;SYSTEMS FEES* Q"i"- and 2- family dwelling ❑ ConunereiaUindustrial ❑ Accessory building For special information use checklist. II ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. i Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling / Air conditioning or heat pump Job site address: J 577 se 9 4. JO"- - (requires site plan showing placement) _ 14.00 . Furnace 100,000 BTU (duc ,*---- 14.00 City/State /ZIP: - -T 9— j 17.90 I � Furnace 100,000-f BTU (ducts/vents) Suite/bldg./apt. no.: Project name: Gas heat pump _ 14.00 — Duct work 14.00 Cross street /directions to job site: 1400 Hydronic hot water system , 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: Lot no.: Other 10.60 _ Tax map/parcel no.: Other fuel appliances Water heater 1 10.00 DESCRIPTION OF WORK Gas fire. lace I 10.00 Flue vent fee water heater or gas • /3L /. fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplacelinsert 10.00 Chimney/liner/flue/vent 10.00 PROPERTY OWNER I 0 TENANT Other: I 10.00 Name• Environmeatat exhaust and ventilation � �� t.:2„./c., 1� Range hood /other kitchen Address: HS / 15 7-9#0,0-0,140-- equipment _ ^ 10.00 Clothes dryer exhaust 10.00 . City/State/ZIP: +� 0 4 "77_7_3 Single -duct exhaust (bathrooms, toilet com,artments, u tility rooms) 6.80 Phone: C.S�, j) STL j -f 5 ,. z _ so . Nos. ( ) . _ ❑ APPLICANT El CONTACT PERSON Attic/crawlspace fans I 10.00 j Other: 10.00 Business name: b Fuel piping m Contact nae( '' R 1 b / S5.40 for First four; SI.00 for each additional 1 Furnace, etc. Address: Gas heat pump City /State/ZIP: W al Ususpended/unit heater Water heater Phone: ) �r J - 7DCr f Fax:: 93 )S .- 6 c:'--: � (� � Fireplace E -mail: Range CONTRACTOR • Barbecue 1 L ? l Clothes drier (gas) I Bus ness name: (2. l (fJ ' b / c.,.._, 1 r✓l / nom, 5 L.(7 C7 r �? j Other: L._. Cf/? r o Address: l X )...3 D I MECHANICAL PERMIT FEES* ��/ - 1 Subtota City/State/UP: �a � r=1., r=1., I � � r 7 Phone; (1 v �) 6 , ti J � " �0 I/ l F ( } 0 � Minimum permit fee ($?2($72.50) 6} p r — Plan review (25% of permit fee) m State surcharge (12% of permit fee) CCB tic.: ? '� TOTAL PERMIT FEE . Th permi application expires if a permit is aot obtained within 180 JIFF Authorized signature: i1:04... drys after it has been accepted as complete. �w Date: 3l2 0 I • ' Fee methodology set by Tn Ccuaty Building Industry Service Board I Print name: Won �•�.�' 1 ,`,BuildingTermitstMEC•Pe`mit APP do: (15 /05105 440 -2517T (I 1 /172/CObL EB)