Permit T IGARD
City of Tigard
March 28, 2013
Able Heating & Cooling
Attn: Kelly Wilhite
16285 SW 85 Ave., Suite 105
Tigard, OR 97224
Re: Permit No. MEC2013 -00116
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13044 SW Raptor P1
Project Name: Zunk
Job No.: N/A
Refund Method: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $100.80.
Note: Please allow 2 -5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account "deposit" receipt in the amount of $
Comment(s): Per applicant's request as work was canceled due to placement location
of heat pump unit on site plan that was accepted at submittal. Refund 100% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard- or.gov
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request forPermit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Able Heating & Cooling DATE: 3/28/2013
16285 SW 85 Ave., Suite 105
Tigard, OR 97224 REQUESTED BY: Dianna Howse
Attn: Kelly White
TRANSACTION INFORMATION:
Receipt #: 190400 Case #: lvIEC2013 -00116
Date: 2/26/2013 Address /Parcel: 13044 SW Raptor P1
Pay Method: CreditCard Project Name: Zunk
EXPLANATION: Per applicant's request as work was cancelled due to city error in accepting application
with placement location of unit in error on site plan. Refund 100% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000 -43104 $ Amount
Mechanical permit fee 230 - 0000 - 43102 $90.00
12% State Surcharge 100- 0000 -24001 10.80
TOTAL REFUND: $100.80
APPROVALS: SIGNATURES DATE:
If under $5,000 Professional Staff ' '
If under $12,500 Division Manager
If under $25,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: I Date: I .3/�/�C3 By: 1 425/—
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T 1 6285 SW 85
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iftt Heating 4 2013 Phone: 503 - 579 -2250
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Mechanical Permit A ppRE IVED ' T FOR OFFICE I.i$L ONL1
City of Tigard Received
IN C " 13125 SW Hall Blvd, Tigard, 0123 4 2013 Date/By: Permit No.:
Phone: 503.718.2439 Fax: 503 960 Plan Review
T I C A R D Inspection Line: 503.639.417
Date/By: Other Permit:
Internet: www.tigard or.gov ITY OF TIGARD Pate Ready /By; 1aris: El See Page 2 for
NotirtediMethod: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction ®Addition/elteratioa /replacemtxlt
performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials. equipment, labor, overhead and profit
•
CATEGORY OF CONSTRUCTION Value: S
RESIDENTIAL EQUIPMENT / SYSTEMS FEES
El 1- and 2- family dwelling ❑ CotmnerciaL'industrial 0 Accessory building For spedal iaformadoa use checklist.
❑ Multi- family ❑ Master builder
❑ Other. Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heatinp/coo0ng:
Air conditioning
lob site address: 13044 SW RAPTOR PLACE (requires site plan showing placement) 46.75
City /State/ZIP: TIGARD, OR. 97223 Furnace 100,000 BTU (ducts vt nls) 46.75
Furnace 100,000E BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: ZU\7C Heat pump
Cross street/directions to job site: (requires site plan showing placement) 1 61.06 61.06
Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
•
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue /vent for any of above 23.32
Tax map /parcel no.: Other 23.32
Other fuel 0ppllsoces:
DESCRIPTION • OF WORK Water heater 2332
INSTALL NEW DUCTLESS HEAT PUMP SYSTEM Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 2332
Log lighter (gas) 23.32
Wood/pellet stove 33.39
•
Wood f7replacrlinsert 23.32
® PROPERTY OWNER I O TENANT Chimney/liner /flue/vent 23.32
Name: LESLIE ZUNI{ Other: 23.32
Environmental exhaust and ventilation:
Address: 13044 SW RAPTOR PLACE Range hood/other kitchen
equipment 3339
City/State/ZIP: TIGARD, OR. 97223 Clothes dryer exhaust 33.39
Phone: (503)521-8843 Fax: ( ) Single duo exhaust (bathrooms,
❑ APPLICANT toilet compartments, utility rooms) 23.32
❑ CONTACT PERSON , Attic!crawlspace fans 23.32
. Business name: Other. , 23.32
Contact name: S14.15 piping:
514.15 for first four SUB f or cads a dditional
Address:
F ce, etc.
City/State/ZIP:
as heat m
Wall/suspended/unit heater
Phone: ( Fax:: ( ) W heater .
E -r�aiL /' F' lace •
R
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Business name: ABLE HEATING & COOLING LLC Clothes dryer (gas)
Address: 16285 SW 85" AVE. SUITE 105 Other:
MECHANICAL PERMIT FEES*
City/State/ZIP: TIGARD, OR. 97224 Subtotal 61.06
Phone: (503) 579 -2250 I Fax: (503) 620 -3980 Minimum permit fee ($90.00) 90.00
Plan review (25% of permit fee)
CCB lic.: 184392 State surcharge e )
ge (12% of permit fee 10.80
TOTAL ermit k PERMIT FEE I00.60
��
Authorized Si etttre (// permit application expires if a permit is not obtained within 180
days after it bas been accepted as complete.
Print name: KELLY
I Date: 02 - i • Fee methodology set by Tri- County Building Industry Service Board
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Mechanical Permit Application RECEIVE I ,:o,z()l'1 OFFICE (tieo 1,
r City of Tigard Received
13125 SW Hall Blv Ti FEB 2 5 2013 Da / B Y n""
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PeNo.: ' o`�� 3 . DOi►
d , Bard, OR 97223
Phone: 503.718.2439 Fax 503.598.1960 Plan m ew
DatdBy: Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TIG " ' 1 Date Ready/By: rur;,
Internet: www.tigard.or.gov
Ea Sec Page 2 for
BUILDING DNISII Notified/method: �(� Supplemental Information
TYPE OF WORK 1�1 COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
D New construction Mechanical permit fees* are based on the value of the work
0 ® Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
Demolition 0 Other: mechanical materials, equipment. labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES*
® l- and 2- family dwelling ❑ Commercial/industrial Q Accessory building For
• El Multi- family ❑ Master builder � �
❑Other: D escription I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 13044 SW RAPTOR PLACE Air (requirea it site plan res showing placement) 46.75
City/State/ZIP: TIGARD, OR. 97223 . Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (duca/ven t° 54.91
Suite/bldgJapt. no.: 1 Project name: ZUNK Heat pump
(requites site plan showing placement) 1 61.06 61.06
Cross street/directions to job site: Duct work
-
23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: , Flue/vent for any of above 23.32
Tax map/parcel no.:
- Other: 23.32
Other fuel appliances:
DESCRIPTION OF WORK Water heater ' 23.32
INSTALL NEW DUCTLESS HEAT PUMP SYSTEM Gas fireplace/insert 33.39
CPUMP
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas)
23.32
Wood/pellet stove 33.39
Wood fireplace/insert 2332
® PROPERTY OWNER El TENANT Chimney/liner/flue/vent y3 32
Name: LESLIE ZUNK Other: 23.32 I
Environmental exhaust and ventilation:
Address: 13044 SW RAPTOR PLACE • Range hood/other kitchen
equipment 3339
City/State/ZIP: TIGARD, OR. 97223 Clothes tt yer exhaust 33.39
Phone: (503 )521 -8843 I Fax: ( ) Single duct exhaust (bathrooms, •
❑ APPLICANT r toilet compartments, utility rooms) 23.32
i 0 CONTACT PERSON Attieferawlspace fans 23.32
Business name: Other: 23.32 ;
Contact name:
Fuel piping:
$14.15 for first four, $4.03 for each additional
Address: Furnace, a tc.
City /StatefZlP: Gas heat pump
Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water beater
. E-mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: ABLE HEATING & COOLING LLC • Clothes dryer (gas)
Address: 16285 SW 85 AVE. SUITE 105 Other:
MECHANICAL PERMIT FEES"
City/State/ZIP: TIGARD, OR. 97224 (I Subtotal 61.06
Phone: (503) 579 -2250 I Fax: (503) 620-3980 Minimum permit fee ($90.00) 90.00
1 Plan review (25% % of permit fee)
CCB lie.: 184392 State surcharge (12% of
permit fee) 10.80
I TOTAL PERMIT FEE I 100.80
Authorized signature: / • This permit appt cxpirxy a mit's obtained within 180
days otter it has teen if accepted as rent completobtaines
I Print name: KELLY R' 111 ! Data 02 -25-13 f • Fee methodoloeyset by IA-County Building !Mindy Service Board
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