Permit C ITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00731
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/17/2007
PARCEL: 2 S 104CA -04200
SITE ADDRESS: 13589 SW MICHELLE CT ZONING: R -7
SUBDIVISION: HILLSHIRE LOT: 042 JURISDICTION: TIG
PROJECT: SCHLOSS
Project Description: Gas furnace replacement, duct work, vent.
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:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 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:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
JIM SCHLOSS Description Date Amount
13589 SW MICHELLE CT
TIGARD, OR 97223 [MECH] Permit Fee 12/17/20C $72.50
[TAX] 8% State Surcha 12/17/20C $5.80
Total $78.30
Phone: 503 -524 -6765
Contractor: •
SPECIALTY HEATING & COOLING
7500 SW TECH CENTER DR #130
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact #: FAX 503 - 598 -0718
PRI 503- 620 -5643
Reg #: LIC 66578
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: , I Permittee Signature: _ cZ, j ,D� ! A.01 . / . L
Call 503.639.4175 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.
• . IDI±C /14 /2007 /FRI 04:50 PM FAX No, P. 001 /002
Mechanical Permit A 1 r FOR OFFICE 11SE ONI.
City of Tigard ED 1.2 0-7 7 $ • Permit xa��t � 7� ao 73
13125 SW Hall Blvd., Tigard, OR • .
A Plan Review
Phone: 503.639.4171 Fax: 503.598.19 r ...;, . , . ,. , Other Permit:
Inspection Line: 503.639.4175 DEC 1 4 200 a 1 i . Date Ready/By: '
I nternet www.ci.tigard.or.us �.L NadflecVIeth : Suppleme Information
GITY OF Supplemental
F -Try:,,,, i-:r:, r� , _ 1 l,.Al: l , i ( ,-tr1 � Si J151;it I'` ,�I'' F�kGI]fi[1
! „ rte - is. i , H, 1.:s _ �_ � ,.__1,,..., ... .. __c i = ".1 a �, ^, r i1 .. J i • u _ rif ..1 .jf L_4: �<5�.. 1 ._-1 ! 1x_
Q New construction U Addition/alteration/replacement
Mechanical permit fees* are bayed on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
t }I V r, , Y r; � -T". -• 3 .-. - c Y -T- c7 p,-^? �r a $
E-, V ._..._ .� .. 1 ., o. -= L.It�- ,�'I_) ` , - ii. ii10 _8 A \f.. ,.l 'e, i . r 4 _, ... - - , • a slr.. a .r.. ' �. .. ; - -fa•.. ...... .,.. : :. 7 r, J r V 1 ':3
i -
t a,��. litl J \J + [ = lsa1 , , ,
�. � (. , { v : J D �. � � , :-' :fir., '
1- and 2- family dwelling ❑ Commercial/industrial (] Accessory building
❑ Multi - family El Master builder El Other: For special tnnforntattar use checklist.
_ Description 1 Qty. I Ea I Total
�:y - 75? {Y[ {Y! 1 a4rry - r - ^
' ` -b:7,1�'^'1 = s�='.J" _= ",r.01- ' ` : .'i � A
J •. 1 . a , 'Ifnl�rn tl �. >7 ; 7I J�• l;) f l ni) 5 I��rS�l i(U p ..... yyt r � :P tlnl;/cooling
I' • "..... ? Air conditioning or heat pump
Job site address:
I (requires site plan shoartegaeat) 14.00 -
City/StatetZIP: 7'a.d 0}12.,, 6 /7 0 1a. Furnace 100,000 BTU ( ducts/vents) , 14.00 /y ,
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: Gas heat pump 14,00
Cross street/directions to job site: Ductwork 1 14.00 ) 14
Hydronic hot water stem 14.00
Residential boiler (radiator or
- hydronic) 14.00
Unit heaters (fuel -type, not electric),
In -wall, in -duct, suspended. etc. 10.00
Subdivision: Lot no.: Flue/vent for any of above I 10.00 10
Other. 10.00
Tax map/parvel no.: Other fuel appliances
�
�1 w, i '.
`,7J -.• .i. - ; :.,. , eq Water heater 10.00
;: .�� : i.,.. '� f �_� ID ��)?.- � j0) ( 1. ' Bf C _.,. � r r „
a � : ' _ •� . Z4 _ 9 1. ? �- , J - L 1 r fireplace 10.00
" / i / Ira•$ l L.f_.. VIIL 44.1 -('il- conk UC Gas 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
Zr r , t c : ;z.. - :; Chimney/linedflue/vcnt 10.00
I , �`dt:I L1 iu1 �l asr4tiT'. " :... '`'+ " i'" -,,,- ' L�t � 1 j j :
.- 4_ L'._♦�..
. - ;,�. Other. 10.00
Name: a r f Environmental exhaust and ventilation
Address: I i cl r' u L a P Range hood/other kitchen 10.00
City/State/ZIP: Or_ ' -2 • . Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (5 3) 1 • - (,Z b - Fax: ( ) toilet compartments, utility rooms) 6.80
A j �( l ' .n1 ' l T �,'It r, .. • 1 -- / r '.
[:,.);:j.',:' : nViC, t41, 3 11i Z 1{_r y , :;, as 1, els. T r ,i , j Attidcrawlspacehns 10.00
Other: I0.00
Fdel piping
Contact name 35.40 for first Ibur; $1.00 for each additional
Address: Furnace, etc.
• 4 • �� I Gas heat pump ,
• , ,
Wall/suspended/unit heater _
Phone: ( ) • - Water heater
5 ""11 : Fireplace
E -mail:
_ Range
f �l . . ,, = fi '7;',"i:-','-:;',, r - 1 1 '..17:-.,'.7'.7'-.,.,1-; '. (l'S Yt: ��L� �T , I r t . { 1 ;fi Barbecue
Clothes dryer (gas)
Business name: '
•
_ New - . i
Business _
-
Other.
Address:
e • I `_ a .., - 'S :1 � !'�+, r S 7z"{ 4 - ji4 1 i I ' -
- r' r r' .� Y r j •`
City /State/ZIP: • , •
OR. q 7 y~ Subtotal
Minimum permit fee ($72.50) 7,, • g
Phone: 663) _ • • Fax: b , • • - • / Z (' Plara review (25% of permit fee)
State surcharge (8% of permit fbe) rs.. `i-L)
TOTAL PERMIT 'j
• Authorized sig iature I/ This permit application expires if a permit h not t obtained within hin 180 180 4/ ova arta it has been accepted AS eompieoe.
Print name: 514 e L Date; 0. 14 1 7 ' Fee methodology set by Tr4 County Building Industry Service Board
ilerutirmgleanmt ,MEC•Permiapp.doc 1 7/07 440.46 I7r(a1ro2/coM/WEa)
• City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
a
• T I GARD
January 15, 2008
Specialty Heating
7500 SW Tech Center Dr., Ste. 130
Tigard, OR 97223
Attn: Sheri Matheis
Re: Permit No. MEC2007 -00731
Dear Sheri:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 13589 SW Michelle Ct.
Project Name: Schloss
Job No.: N/A
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $62.64.
❑ 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,
A' •
Dianna Howse
Building Division Services Coordinator
Enc.
1:\ Building \ Refunds \ Administration \LtrRefund- CancelPetmitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
JAN /U2 /2UU0 /WED 04:34 PM FAX No, P. 001 /001 irliECEIVED)
Building Division JAN ) 2 i!uu8
Request for Permit Action or Refund
CITY0i° 611;ak1 �
City of Tigard BUIMINGOIVISI(P'
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960
FROM: ❑ Owner [i Applicant ❑ Contractor ❑ City Staff
(check one)
Name: ��) � ..{
(Business or Individual) Speethat aq
®/ q t: r4.t.L
' ! � 0 1 D Mailing Address: %5 ) / e ee Je Or. Sic 13 v
Aj ef e City /State/Zip: i y�, q 1e2.23
Phone No.: 563 c lo -x50
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
CANCEL PERMIT APPLICATION.
[� REFUND PERMIT FEES.
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: Y►Zi,C',C2O0Z -- 6073 /
•
Site Address or Parcel #: / 35 9 S LJ YVZ r t' tl i lk
Project Name: 5e,h / dS 5
Subdivision Name: 1 / /.,S h l eg, Lot #:
EXPLANATION: ('J5 l 7Y1 Cr (lam e (0,11-e a( &t lit. L! S
Signature: • . � j 4_41.0 Date: l /a /6
Print Name: S h e , )
Refund Policy
1. The Building Official may authorize the refund of:
a) any fee which was a roneously paid or collected.
b) not more than 80 percent of the permit fee for issued permits prior to any inspection requests.
c) not more than 80 percent of plan review fee when an application is canceled before any plan review effort has been expended.
2. Refunds will be returned to the original Payer in the same method in which payment was received. AA
t_ii'' I( 1Is : QNl
Rte to Sys Admit': Date / R 0 : % Rte to Bldg Admin: Date / /s Af B. - v■
Refund Processed: Date f/r5 /cr By t" Invoice Processed: Date By
Permit Canceled: Date 5h OcF B . Parcel Tag Added: Date By
7 Syr,
Receipt # L' .Date 44 �o 7 Method C. L Amount $ 2e, D G Z- 6Y
\BuildineFormslRegPermitAotion- l doe Rev 10/17/05
. ; : . 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 Permit A ction orRO4nd 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: Specialty Heating DATE: 1/15/08
7500 SW Tech Center Dr., Ste. 130
Tigard, OR 97223 REQUESTED BY: Dianna Howse
Attn: Sheri Matheis
TRANSACTION INFORMATION:
Receipt # : 2007 -5472 Case # : MEC2007 -00731
Date: 12/17/07 Address /Parcel: 13589 SW Michelle Ct.
Pay Method: CreditCard Project Name: Schloss
EXPLANATION: Per applicant's request as job was cancelled.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount
[MECH] Permit Fee 245 - 0000 - 431010 58.00
[TAX] 8% State Surcharge 100- 0000 - 207020 4.64
TOTAL REFUND: $62.64
APPROVALS:
If under $500 Professional Staff : /i
If under $7,500 Division Manager 1
If under $22,500 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: ; ;f >' .. By.
I:\ Building \Refunds \RefundRequesc.doc 05/23/07
ir CITY OF TIGARD 1/15/2008
13125 SW Han Blvd. 3:01:03PM
Tigard, OR 97223 503.639.4171
TIGARD
Refund Receipt #: 27200800000000000163 /crG/E`.Si9 _
Date: 01/15/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
• MEC2007 - 00731 Reversal - [MECH] Permit Fee 245- 0000 - 431010 (58.00)
MEC2007 -00731 Reversal - [TAX] 8% State Surc 100- 0000 - 207020 (4.64)
Line Item Total: ($62.64)
Refund:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal SPECIALTY HEATING 097091 Fax (62.64)
Refund Total: ($62.64)
1
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CITY OF TIGARD 1/3/2008
_ _ 13125 SW Hall Blvd. 8:11:54AM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200700000000005472 e ts /'Y
Date: 12/17/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MEC2007 -00730 [MECH] Permit Fee 245- 0000 - 431010 72.50
MEC2007 -00730 [TAX] 8% State Surcharge 100- 0000 - 207020 5.80
MEC2007 -00731 [MECH] Permit Fee 245- 0000 - 431010 72.50
—� MEC2007 -00731 [TAX] 8% State Surcharge 100- 0000 - 207020 5.80
Line Item Total: $156.60
Payments:
Method Payer User ID Acct. /Check No. Approval No. H ow Received Amount Paid
CreditCard SPECIALTY HEATING BB 097091 Fax 156.60
Payment Total: $156.60
cReccipt.II Page I of
City of Tigard, Oregon . • "13125 SW Hall Blvd. • Tigard, OR 97223
I ( 7 )
TIGARD
January 15, 2008 fyi
Specialty Heating
7500 SW Tech Center. Dr., Ste. 130
Tigard, OR 97223
Attn: Sheri Matheis
Re: Permit No. MEC2007 -00731
Dear Sheri:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 13589 SW Michelle Ct.
Project Name: Schloss
Job No.: N/A
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $62.64.
❑ 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 Coordinator
Enc. •
•
1:\ Building \ Refunds \Administration \LtrRefund- CancelPernvt.doc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
JAN /02 /2008 /WED 04:34 PM FAX No. P. 001 /001
;411t)„, Division Building Divl�sion JAN 0 2 tUUB
Request for Permit Action or Refund CITYOF fIGiAE3D
City of Tigard BUItOIN30I11ISIOIt'
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960
FROM: ❑ Owner Ef Applicant ❑ Contractor ❑ City Staff
(check one)
Name: ��))1 ' C� /
(Business or Individual) S peel - CL I q ,L
V 0 1 0 Mailing Address: #1,5bO 50 /e.&h eerie Or. Sic 43'
/0," City/State/Zip: 7 t gczr , 9 7.x.,
Phone No.: 56 3 - 6 ap -510 43
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (
CANCEL PERMIT APPLICATION.
g REFUND PERMIT FEES.
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: 1' e..aOTZ — vo73 I
Site Address or Parcel #: 1 35 R 9 5 L) t , eite l /,'; (
Project Name: Se, f / ) 5 5
Subdivision Name: / / h ! rP. Lot #: Oil- (-1
EXPLANATION: ("/j j l (Tyn e r (!,L, e P,1 e [� Lt)t _ f�1 L�( .S
Signature: 4! • i 44 Date: 11 c / D
Print Name: S (0..i2.4
Refund Polley
1. The Building Official may authorize the refund of
a) any fee which was erroneously paid or collected.
b) not more than 80 percent of the permit fee for issued permits prior to any inspection requests.
c) not more than 80 percent of plan review fee when an application is canceled before any plan review effort has been expended.
2. Refunds will be returned to the original Payer in the same method in which payment was received.
Fov usl•: Uvl:l
Rte to Sys Admin: Date / R oS % Rte to Bldg Admin: Date / /$ ij B. = � d c
Refund Processed: Date //S 0r By Invoice Processed: Date By y
Permit Canceled: Date I/ /Oc B - - Parcel Tag Added: Date By =�
Receipt # B7- S3 4/i 7 Method Ca Amount $ 7e, O 6 . C y
L• 1Building\Forms\RegPermitActi 1 doc Rev 10/17/05 ' _
� — —mss—
MI
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 Perak A ction 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: Specialty Heating DATE: 1/15/08
7500 SW Tech Center Dr., Ste. 130
Tigard, OR 97223 REQUESTED BY: Dianna Howse
Attn: Sheri Matheis
TRANSACTION INFORMATION:
Receipt # : 2007 -5472 Case # : MEC2007 -00731
Date: 12/17/07 Address /Parcel: 13589 SW Michelle Ct.
Pay Method: CreditCard Project Name: Schloss
EXPLANATION: Per applicant's request as job was cancelled.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245 - 0000 - 432000 $ Amount
[MEd-I] Permit Fee 245 - 0000 - 431010 58.00
[TAX] 8% State Surcharge 100- 0000 - 207020 4.64
TOTAL REFUND: $62.64
APPROVALS:
If under $500 Professional Staff f,(�
If under $7,500 Division Manager )
If under $22,500 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: Date: By I
I:\ Building \Refunds \RefundRequest.doc 05/23/07