Permit a CITY OF TIGARD MECHANICAL PERMIT
r COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00128
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/12/2008
PARCEL: 2S105BC -00900
SITE ADDRESS: 16406 SW O'NEILL CT • • SUBDIVISION: KERRON'S CREST LOT: 009 JURISDICTION: URB
PROJECT: CHONG
Project Description: Replacing furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: 1
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
SUN TAEK & KON RAE CHONG Description Date Amount
16406 SW O'NEILL CT
TIGARD, OR 97223 IMECHI Permit Fee 3112/200E $72.50
[TAX] 12% State Surch 3/12/200E $8.70
Total $81.20
Phone: 503 -579 -7876
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PR1 503- 557 -22
FAX 503 - 557 -0919
Reg #: LIC 72623
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �w / � Permittee Signature. //
Call 50 . • 9.4175 by 7:00 a.m. for inspections 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, Oregon o 13125 SW Hall Blvd. • Tigard, OR 97223
I.
•
April 14, 2008 — —
Tri County Temp Control
13150 S. Clackamas River Dr.
Oregon City, OR 97045
Re: Permit No. MEC2008 -00128
Dear Sir /Ms.:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 16406 SW O'Neill Court
Project Name: Chong
Job No.: N/A
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $81.20.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Permit issued in error for URB jurisdiction. Refund 100% of permit fees.
Permit must be reissued and inspected by Washington County.
If you have any questions please contact me at 503.718.2430.
Sincerely,
•
Dianna Howse
Building Division Services Coordinator
Enc.
•
I: \Build ng\ Refunds \Administra tion \LtrRefund- CancelPen.nit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
•
: 'City .Jy/� Ti ar-d, Oregon on o 13125 SW Hall Blvd. o Tigard, OR 97223
Y J g a F s , 11
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use_
April 14, 2008
Tri County Temp Control •
13150 S. Clackamas River Dr.
Oregon City, OR 97045 •
Re: Permit No. MEC2008 -00128
Dear Sir /Ms.:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 16406 SW O'Neill Court
•
Project Name: Chong
Job No.: N/A
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $81.20.
❑ Trust account "deposit" receipt in the amount of $ .
Notes: Permit issued in error for' URB jurisdiction. Refund 100% of permit fees.
Permit must be reissued and-inspected by Washington County.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
•
Enc.
1: \ Budding \ Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 e Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Pe77nitAction or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Tri County Temp Control DATE: 4/14/08
13150 S. Clackamas River Dr.
Oregon City, OR 97045 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 2008 -812 Case #: MEC2008 -00128
Date: 3/12/08 Address /Parcel: 16406 SW O'Neill Ct.
Pay Method: CreditCarcl Project Name: Chong
EXPLANATION: Permit created in error. URB jurisdiction. Refund 100% of permit fees.
REFUND ; : INFORMATION ;i:. '•:::: ;:: : :
Fee .Des&i Uon:From Rec:ei t :::; .:. .: Re : No•. Refund:"
1✓xarri l.e . L IL D.. P E am le:`'` `245 := b():00= - 260. : :
. . � � p 43 Ol0 $ :Aiiount'"
[MECH] Permit Fee 245 - 0000 - 431010 $72.50
FAX] 12% State Surcharge 100 - 0000 - 207020 8.70
TOTAL REFUND: $81.20
APPROVALS:
I f under $500 Professional Staff
If under $7,500 Division Manager
If under S22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
: 'k:3 ,:° M F,OR.T.IDF K :S.YSTE:Mi AD MINI:STRATIONUS .ONLY. < :.:: .:. : '-;. :.:
Case Refund Processed: I Date: I ''', .,/ ,,, •- I 13y: =:� +_= :-_
I: \Building \Refunds \RefundRequesr.doc 05/23/07
•
,_' CI TY OF TIGARD
4/14/2008 .�
e. ? - 13125 SW Hall Blvd. 3 :58:59PM .
_;,t!¢!a 1 Tigard, OR 97223 103.639.4171 - -
T�IGARD,1 .
Refund Receipt #: 27200800000000001232 ieE- 4'-= = -5/2 .
Date: 04/14/2008
Line Items: .
Case No • Tran Code Description . Revenue Account No Amount Paid
MEC2008 -00128 Reversal - [MECH }Permit Fee 245-0000-431010 (72.50)
MEC2008 -00128 Reversal - [TAXI 12% State Sur 100- 0000 - 207020 (8.70)
Line Item Total: ($81.20)
Refund:
Method Payer User ID. Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal , ALAN SANCI-IEZ/TRI COUNTY 05557D Fax (81.20)
. TEMP CONTROL
Refund Total: ($81.20)
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CITY OF TIGARD 3/13/2008. . -.
s . ricp"...,
131255 Hall Blvd. 2:34:13PV1
,, oii - T igard, OR 97223 503.639.4171
ITIGARD1
Receipt #: 27200800000000000812 • / / /c,it/4 z_ -
Date: 03 /12/2008
Line Items:
Case No Tran Code Description .Revenue Account No Amount Paid •
MEC2008 - 00128 [MECH] Permit Fee 245-0000-431010 72.50
MEC2008 -00I28 [TAX] 12`%, State Surcharge 100- 0000- 207020 . 8.70
•
Line Item Total: $81.20
• Pavements•
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard ALAN SANCHEZ / TRI COUNTY BTT 05557.D Fax 81.20
TEMP CONTROL
• Payment Total: $81.20
•
•
•
•
iRcccip.r1)■ I aage I or I .
•
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 City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) • • — 44 / ' ```
0 1 ;Ma ilin g A ddress: /3/ 5) ,S. G/a c ki as 2i
r// 'fr , /State /Zip: Or-e (�/ p/ O/1/ C, , 7/ cJ 1704/S
Phone No.: J� �S-5`7 — ad
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: / adU ` CXU ) d
Site Address or Parcel #: / G � L /Qi
Project Name: �� 1
Subdivision Name: Lp 7J4/,S Cr°f f Lot #: (�
EXPLANATION: C�*:= fr /ti co'vcs C( (ASS
)7 ,4/ '7A1 Il JC KL_C i C-, t c1 )_
Signature: Date: f, 0r
Print Name: ___ -I\J r
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°..'o 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'So of the land use application fee for issued permits.
d) not more than 80° o of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80° o 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 By
• By 4W
Refund Processed: Date //y ee By • Invoice Processed: Date // By
Permit Canceled: Date ri A --- By -s Parcel Tag Added: Date By
Receipt #f-f/ a_ Date /Mkt Method CL' _ Amount $ p/, .R
I: \ Building \Forms \Regl ermitAction.d.e 1 cv07/ 6/07
0
MAR -12 - 2008 07:39A FROM: N ED TO:5035981960 P.1
Mechanical Permit A utk -.:'i f $..
' ^ R eceived
T /.. City Tigard q 2008 D ateBy: l g .7`— Permit No :�y� -C _ w lag
• 13125 SW W 1 96
Hall Blvd., Tigard,OR y , . Plan Review
• Phone: 503.639.4171 Fax: 503.5 :.0 Other Petmn
Date/Br
T 1 � : n I:1 ) Inspection Line: 503.639.4175 OF 11Gp►R Data Ready/By. rails ® Sec Page 2 for
Internet: www.tigard- or.gov 01 • G p n1190 Notified/lvtethod /08 Supplemental Information
VA LVj d a tf iy drvrrt 51nvi.L) ic l c --
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* arc based on the value of the work
❑ New construction X Addition / alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: $
1 - and 2 d wellin RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist.
6
y g ❑ C Master builder i ld er ustrial ❑ Accessory building
Multi - family ❑Master builder ❑ Other: Description Qty, Ga. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 4,406 e Y 10t Nk( L, co W 1 I Air conditioning or heat pump
(requires site plan showing placement) 14.00
City /State /ZIP: 18 11722 i Furnace 100,000 BTU (ducts/vents) l 14.00 I I, crt)
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
i Cross street/directions to job site: Duct work 10.00
i Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
I- --- -• - - -- Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.:
Flue /vent for any of above I 6.80 i ( -kv
Other. 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK _ Water heater 10.00 !
I n /gyp pl a y t R Gas fireplace 10.00
Kitt 1 it taff ., Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
PROPERTY OWNER ❑ TENANT Chimney /liner /line /vent 10.00
Other: 10.00
Name: OVn, J (� Environmental exhaust and ventilation
Is i V o.iv p ` t i cy Range hood/other kitchen
Address: �V b 1 ��[��� Ll3af
JJ 1 t `')'7 it m equipment 10.00
City /State /ZIP: i 0 WO N trio O 1 Clothes dryer exhaust 10 00
t� Fax: Single -duct exhaust (bathrooms,
Phone:
�3) 5 [ ' B '7w ( ) toilet compartments, utility rooms) 6.80
%APPLICANT ❑ CONTACT. PERSON Attic /crowtspace fans 10.00 -
Business name: Other: 1 10.00 i
Fuel piping
Contact name: liar, MQ��1 $5.40 for first four; 51.00 for each additional
Address: Furnace, etc
Gas heat pump
City /State /7_IP: Wall /suspended/unit heater
Phone: ( ) 1 F x:: ( ) Water heater
I Fireplace
E -mail:
Range
CONTRACTOR Barbecue I
Business name:Tri C Clothes dryer (gas) I
Address: 13 [50 rno kip' `i Na Other:
a MECHANICAL PERMIT FEES*
City/State /ZIP: 0rm , 1� O Subtotal
Phone: ( Fax: ( 657 Q Minimum permit fee ($72.50) 7� i
5 5 I Platt review ( 25% of permit fee)
CCB lie.: / 8.10 1 /2.422, r State surcharge (12% of permit fee) q �, r I
� a TOTAL PERMIT FEE y` 'J • (/
Authorized signature: This perm application expires if o permit is not obtained within ISO
j A d ays a i t has been accepted as complete.
Print name: 'U T 1 at, NI Qw� _ [ Date: 3i1gcp I • Fee methodology set by Trt- County Building industry Service Board
I\ Bwlding'lPermits'MEC- PermiiApp. doe 01/19/07 440 -4617T (I1 /02 /COM/WP.B)