Permit FROM (MON)FEB 9 2009 14: 19/ST. 14: 17 /NO. 7600000310 p 1
: N . ■ is Community Development
Request for Permit Action
T 14...`.1
TO: CITY OF TIGARD
Building Division Services Coordinator fi
13125 SW Hall Blvd., Tigard, OR 97223 .
Phone: 503.718,2430 Fax: 503.598.1960 www.tigatd- or.gov .
FROM: ❑ Owner 15d Applicant 0. Contractor 0 City Staff
(check one) '
r
REFUND OR Name:
INVOICE TO: ( &"i"°' or Individ 1 &l t `& } `VI —
*Mailing Address: _ / 7 - _ Q 2-2:, •
A _ e /J e% O q-7
-m l,----
il No.: u 4 2B -- , 93 •
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓): r
j0` . CANCEL PERMIT APPLICATION_ 0.
REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PER.MI'I' (do not cancel permit).
Permit #: IrYL e C. 1Q oOC E )
Site Address ox Parcel #: 1 44 7_.5 k
Project Name: i—
Subdivision Name: I Lot #:
EXPLANATION: .i C3
Signature: � ate: 7—/) /i�
aa'� , J � • Sd
*Print Name: ., -0/2y /.1 ,1'O/f�
Rio 7o .5
BslZolict
t. 'lhe Din ctor or Building Official may authorize the refund of. ! a / -57-0
a) any fee which was erroneously paid or collected.
b) not conic than 80% of the land ure application fee when r application is withdrawn or canceled before any review effort has been cxpendal.
c) not more than fi0% of the land use application fee for Issued permits. F
d mre
) not o than 80°/ review of the building plan revi fee when an application ea canceled before any plan review effort has been expended. 0 • 76
c) not more than ItflY0 of the buildingpertut fee fnriauedpermits prior to any in.:pectioo maprcus.
2. Refund• will be returned to the original Payer in the same payment method in which paent wM received please allow 1.2 weeks for parcctains refundtr o� 0 ! 1p 4
1:014. U[ I(:I': t'�1� O \I.l Al / /
Rtc to S s Admin; Date IMIIIII Rte to Bld Admits: Date ril'Qt Z✓w
Refund Processed: Date ff ao a Invoice Processed: Dat .4. /d U'a'
Permit Canceled: Date _►r, Doc B _ / .
Receipt # Date Method Amount $ Cl /
!: \)3uadine \porms\RoeremitAcdon.d a Rev 07/26/1)7 /
/Nr/die� yTr .u6.._
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
March 26, 2010 , .n
'.f•' -t �1 c
Bell Heating,
�) '.
ting Inc.
15550 SE Piazza Ave.
Clackamas, OR 97015
Attn: Gary Garrison
Re: Permit No.: MEC2010 -00053
Site Address: 11425 SW 87 Ave.
Project: Sang
Dear Mr. Garrison:
The City of Tigard has received your request to cancel a permit and process a refund for the
above referenced permit. The City's Building Division policy is to return 80% of permit fees
paid for canceled permits however we are unable to do so as the check for payment of the permit
fees on this permit was returned as "Not Sufficient Funds ".
We have voided the permit, and enclose an invoice for fees due as follows:
•
20% of permit fees retained as Administration Fee: $16.24
Returned Check Fee: $25.00
Total Fees Due (payable upon receipt of invoice): $41.24
Please reimburse the City for fees due at your earliest convenience by one of the options below:
1) Visit the Permit Center and make payment in person with cash, cashier's check,
debit or credit card, Tuesday through Friday, 7:00 am to 4:30 pm.
2) By mail, submit a cashier's check or complete and return Payment Authorization
Form along with a copy of the invoice in the enclosed return envelope.
Please note that the City will not accept personal checks for payment of fees due.
If you have any questions, please call me at 503- 718 -2430.
Sincerely,
Dianna L. Howse
Building. Division Services Supervisor
Encs.
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
q CITY OF TIGARD
Building Division
TIGARD 13125 SW Hall Blvd.,Tigard, OR 97223 503 -639 -4171
INVOICE
TO: Bell Heating, Inc. Customer ID: 447
15550 SE Piazza Ave. Invoice No.: INV2010 -00005
Clackamas, OR 97015 Invoice Date: 03/26/2010
Attn: Gary Garrison Date Due: Upon Receipt
Case No :. " . Site Address . , Subdivision - Lot #.or Project.Name • Amount Due
MEC2010 -00053 14425 SW 87th Ave. Sang
Project cancelled by applicant
and check was returned as NSF
20% Administration Fee: $16.24
Returned Check Fee: $25.00
Note: Payment must be made
in the form of cash, cashier's
check, debit card or credit card.
Invoice Total: $41.24
❑ Please see attached fee schedule for description of fees due.
(Detach and return this portion with payment.)
Case No.: MEC2010 -00053 Customer ID: 447
Site Address: 14425 SW 87t Ave. Invoice No.: INV2010 -00005
Project: Sang Invoice Date: 02/16/2010
Date Due: Upon Receipt
• Invoice Total: $41.24
Amount Paid: $
Office Note: Payment must be in the form of cash, cashier's check, debit card or credit card.
Please mail payment to:
City of Tigard, Building Division
13125 SW Hall Blvd.
Tigard, OR 97223
Attn: Dianna Howse
�: \Budding \Accounting \Invoice.doc 04/06
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Mechanical Permit App liellrec ..,,...,.;-.?.-.;:-.: ..,- -.....-: ',, . FOR OFFICE OiNiy,..
City of Tigard Received ' '
Date/By ,g-ts/ie e
13125 SW Hall Blvd., Tigard, OR 97223.: s B 3 20 i
Plan Review
Phone: 503.639 4171 Fax 503.55 .'!.. . ..,v , i'qi A Date/By• q Other P errrutfry91:2 0 c (i a ao
Inspection Line: 503.639A175( ' C 'Ii - ., IG, A4:1::.1 I I.'-
Date Ready/By Juns ' 127 See Page 2 for
Internet: wwv. ci tig us oi '‘‘) •: . , '41 ..
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Nottlied/lvlethod
. . . ::7) " Supplemental Information •
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,.,... !,. u ,. - 7 :5 1 °CUE s •ICLIST
Mechanical permit fees* are based on the value of the work
ID New construction - 5(j'Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition El Other: mechanical materials, equipment, labor, overhead, and profit
tigraik114:01.1ffliMatat4iikkagialinfikAtrjall"-X:1-:: .:.), ' V a I u e* $
OSTEINIS-FEES*
[54 and 2 dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist
0 Multi 0 Master builder 0 Other:
Description 1 Qty I Ea I Total
Altatill.V.K.flfAA07.,W,4--.14,0-1:47.:**0,21:):::E,:g.,:tig.,*,,..-44y.iti-1,-wg-.. Heating/cooling
Job site address: / 9/2.__r r7-of 0_7:
O
Air conditioning or heat pump
(requires sac plan showing placement) / .1 q 4, ,IS
City/State/ZIP 77 -g Mbe 02, el72-2/ Fumace 100,000 BTU (ducts/vents) / WO 4 1/ii TS
Furnace 100,000+ BTU (ducts/vents) L7 90 • .
Suite/bldg./apt. no.: 1 Project name:
Gas heat pump . . . • 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
" Fluehient for any of above 10.00
Subdivision: Lot no.:
— , Other: 10 00
• Tax map/parcel no.: Other fuel appliances
afgaM ''' I ''''" 1 '41.2.tA;ViArtifalffickgaTiroVISMNR 4 14 5 4V,V461).40P.116: 1 3t.Iite-ttiMei!i Water heater 10 00
P#' . hirlifWr •AK....d.V.,:ce;,,,,,‘ ...,,, ,.jf... Pkikilfsfirs'.1:/1N-'w..'5%
Gas fireplace 10 00
/yti 4 i/ ilL ",1 Flue vent for water heater or gas
1 A. er'it-Tr.• fireplace 10.00
Log lighter (gas) 10.00 _
Wood/pellet stove - 10.00
1 Wood fireElace/insert 10 00
-- .,r,1 :i,..'.4...., 'f.,',Mi..,-V.0, i v ;;; Isa i i I Chi mnev/lf e r/ flue/ v en t W 00
Name: ..7/0741 J i49 )(16 Environmental exhaust and ventilation
Range hood/other kitchen
Address:
lefata equipment / 1$110 I V. 59
City/State/ZIP: Clothes dryer exhaust I .LO 33,_19
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 2_ .kilfr
,
esx/xiarhosa#4 i 7. .r..p.:!...:`,cr):1141..‘ :•: ,s11.e.-;41,1S, gl-rk",:il.:',;;;-,4r;;:ii..ii,.rt Atli C/C rawlspace fans 10.00
Y.f011, :.-Y 7'‘':v0:1;...e- i
Other I I 10.00 I
Business name: •
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Furnace, etc
Address:
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax : ( ) Water heater
Fireplace
E-mail: Range
"40,1 '','.. ;.. Barbecue
- :.;:c' „.... .....-- , ,-. -,....., ., • , ' . - ! .' 1 4t;.;; , :,. i Ie.: .' . - ,- ', 1
Business name: ' / Clothes drr (gas)
Other I
Address. isTrar lit y4th.A0 Ais- , Tff - t•- -- - - 2 , -. - -i — T - ) iFE-yr,616e,i)iii - pf , .-
13 .,.• ie,, • f, s - . IS, IT/014ES
City/State/ZIP: , (( 4.. °i.e Subtotal ,•1414 e
. ph...: (s ig. ) c _ /ev Fax ( 3 ) (g ... zik--0 Minimum permit fee ($72 50) 7 f.. „St'
Plan review (23% of permit fee)
f -;;
11F CCI3 tic • ___ Sta
te surchalgeiZa o. permit fee) ..5
0 Cliti —
• Pw 1 TOTAL PERMIT FEE SO 1 ,,,,,•._
.000% , _ This permit application expires if a permit is not obtaiiseltin ISO
Authorized sic/nature / days after It has beer. accepted as complete.
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Prin: name • ev 04 iti(rio") 1 Da,....„2./) A., •1 Fee file l 11 CI do l 0 g y set by T 6 -C OU n ty B 11 i i d 1 ng industry Service
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: \BuddolgTermos'.ht F.C- net/pa doc 12103 44o-1617T •:■ 1 '
. SITE PLAN
*INDICATE NORTH FOR INSPECTOR*
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