Permit ' npl! CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00138
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/18/2008
PARCEL: 1 S 125BD -02507
SITE ADDRESS: 08950 SW 80TH AVE - , -
SUBDIVISION: LOT: JURISDI - ION: WAC
PROJECT: WILLIAMS
Project Description: Installing A/C.
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: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
RICHARD & KARON WILLIAMS Description Date Amount
8950 SW 80TH AVE
PORTLAND, OR 97223 [MECH] Permit Fee 3/18/200€ $72.50
[TAX] 12% State Surch 3/18/200€ $8.70
Phone: 503 - 452 - 4148
Total $81.20
Contractor:
FOUR SEASONS HEATING & A/C INC.
1005 INDUSTRIAL PARKWAY
NEWBERG, OR 97132 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -538 -1950
FAX 503 -538 -0165
Reg #: LIC 97152
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 Permittee Signature: �� ,C,35,•/) ck-1/
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.
City of Tigard, Oregon 0 13125 SW Hall Blvd. m Tigard, OR 97223 •
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April 14, 2008
Four Seasons Heating & A/C Inc.
1005 Industrial Way
Newberg, OR 97132
Re: Permit No. MEC2008 -00138
Dear Sir /Ms.:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 8950 SW 80th
. Project Name: Williams
Job No.:
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 created in error. WAC 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: \Building\ Refunds \Administra tion \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 e Fax: 503.684.7297 • www.tigard or.gov • 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 Permit Action orRefund 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: Four Seasons Heating & A/C Inc. DATE: 4/14/08
1005 Industrial Pkwy
Newberg, OR 97132 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 2008 8 .. r "mo Case #: MEC2008 -00138
Date: 3/18/08 Address /Parcel: 8950 SW 80th
Pay Method: CreditCard Project Name: Williams
EXPLANATION: Permit created in error. WAC jurisdiction. Refund l00% of permit fees.
REFUND. INFORMATION: ,;. , ..
Fee Description From Receipt •.;;
Revenue= Accciunf
'24$:
:Exain le:: UILD PermitFee : `
P �•�: ].: " .... � Ezarnple: ' $
[MECH] Permit Fee 245 - 0000 - 431010 $72.50
[TAX] 12% State Surcharge 100- 0000 - 207020 8.70
TOTAL REFUND: $81.20
APPROVALS: •
7
If under $500 Professional Staff
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
; FOIE; TIDEMARK _SYSTEMADMINI'S.TRATI.ON iJSEONLy
Case Refund Processed: I Date: I By: I •
r: \Building \Refunds \RefundRequesi.doc 05/23/07
City of Tigard, Oregon o 13125 SW Hall Blvd. ° Tigard, OR 97223
•
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April ] 4 2008 r l 1: l: j
• A
P 14, - -�'
Four Seasons Heating & A/C Inc.
1005 Industrial Way
Newberg, OR 97132
Re: Permit No. MEC2008 -00138
Dear Sir /Ms.:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following: .
Site Address: 8950 SW 80th'
Project Name: Williams
Job No.:
Refund: n 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 created in error. WAC 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.
l: \Building\ Refunds\ Administration \LtrRefund- canceiPermit.doc 01/16/07
Phone: 503.639.4171 o 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 Permit Action 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: Four Seasons Heating & A/C Inc. DATE: 4/14/08
1005 Industrial Pkwy
Newberg, OR 97132 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 2008- 82T E T's'r . Case #: MEC2008 -00138
Date: 3/18/08 Address /Parcel: 8950 SW 80th
Pay Method: CreditCard Project Name: Williams
EXPLANATION: Permit created in error. VAC jurisdiction. Refund 100% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 $ Amount
FMECH] Permit Fee 245- 0000 - 431010 $72.50
ITA_X] 12% State Surcharge 100- 0000 - 207020 8.70
•
TOTAL REFUND: $81.20
APPROVALS:
If under $500 Professional Staff v(
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: I Date:; *,'% ?�f' I By: I ,,
I: \Building \Refunds \RefundRequcst.doc 05/23/07
i ` CITY O '11GAR® 4/14/2008 •
m � . 13125 SW Han It1vd. 4.01:40PM
' Tigard. OR 97723 503.639.4171
i14,2�1tiir.S"I
•
Refund Receipt #: 27200800000000001233 ./« � r ' z—_
Date: 04/14/2008
Line Items: •
Case No Tran Code Description Revenue Account No Amount Paid
MEC2008 -00I38 Reversal - [MECH] Permit Fee 245-0000-431010 (72.50)
MEC2008 -00138 Reversal - [TAX] 12% State Sur 100- 0000 - 207020 (8.70)
Line Item Total: ($81.20)
Refund:
Method Payer User ID Acct. /Check No. Approval No. I - low Received Amount Paid
Credit Reversal FOUR SEASONS /ED 1- IAI-IN 099051 Fax (81.20)
Refund Total: ($81.20)
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;.. CITY OF T @CARD 3/28/2008
, 111
Si 1, e 1112] SW Ilan Blvd. 5: I J:3 }ANI
: .'s ;Y£. Tigard. OR 97223 501.619.4171
•
T4G'AR�D`
Receipt #: 27200800000000000882 6 A i ►'' /A... /g /I_
Date: 03/18/2008
Line Items:
Case No "Tan Code Description Revenue Account No Amount Paid
MEC2008 -00135 [M ECH] Permit Fee . 245 -0000- 431010 72.50
MEC2008 -0013$ [TAX] I 2% State Surcharge I 00- 0000 - 207020 8.70
Line Item Total: $81.20
Payments:
Method Payer User ID Acct. /Check No. Approval No. I - low Received Amount Paid
CreditCard FOUR SEASONS / ED HAHN BTT 099051 Fax 81.20
Payment Total: 581.20
•
cRcccipLrpi Page 1 ► 1
7 111 . 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 N - City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) ", ,. �I,.. -.I 4 � A ' + ( C.
Mailing Address: (005 iG•• I (464.1/
0 7A, � City/State/Zip: / -Ll �Je�Jo � 02 � 7 / Phone No.: S O -- 5 3 $"— i 45e)
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
El INVOICE FOR FEES DUE (attach case fee schedule and explain below).
. ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). •
Permit #: P2F C r%) g ( � 8"
Site Address or Parcel #: c c s-- J.
Project Name: 660 /1 QKY) S
Subdivision Name: Lot #:
EXPLANATION: C ((` e pe f7 y,► -1- 1 / tl crro r. A ✓'t,S S
i 'v (a S1), fV Curl) Cc dy ( JL.►r t i C)N_
Signature: / a Date: 3,4jA,
AMP 4b.
Print Name: BirkAtcArili TC`55°`
Refund Policy (f
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% 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% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% 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 y / or By 4;
Refund Processed: Date 7/y By Invoice Processed: Date By
Permit Canceled: Date 50y/ By Parcel Tag Added: Date By
Receipt #Q, — 3' �/,p t Date p,F-- Method Cc_ Amount $ ?/ ggQ
I:\ Building \forms \RegPermitAction.doc R v 07/26/07 y
. Mechanical Permit Applicatrk 1 i 1 , w ( )1 1 1( 1 I H 1,NI ,
city of Tigard UM VE II' RtmliBi'vc,' J i / I ;
Permini.-pwc._ , . - do
I N ,..- 13125 SW Hall Blvd., Tigard, OR 97223 Phs ReVie■V
• 6: Phone: 503.639.4171 Fax: 503.598.1960MA R 1 7 Z008 Dateray: Other Pamir.
Inspection Line: 503.639.4175
Date Ready/By: bric 111 See Page 2 for
Internet www.tigard-or.gov CITY OF TIGARD ' supelemeeiii hifereordoe
BurtnironnwisioN
TYPE (If WO : - '.:.:.:'.::::'..:' ;;'.-," ,-;:.' : :if ;:7L' :::•:::::.:::.; ,:: f - :, i : . 6 ! . • ;:/11.E`. SCHEIRRE - tigacusaaAsT:
o New construction 0 Addition/alteration/replacement Mechanical permit Sets* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
O Demolition El Other: mechanical materials, equipmuo, labor, overhead, and profit_
- , " ' ' " ' Value: $ A a c, (,) 6
PATMOtY Or 000150.107. °:'' :: ': . :::!::::.::':: ,„ . i —, - 4 - 7
::;f )40010.1ThW...14W
1- and 2-thmily dwelling 0 Commercialfuidugrial 0 Accessary building .
: i 4*01rgig# ‘gralcs
IMulti 0 Master bonder D other For spacial brformatian use checklist
, Description Qty. I Ea._ j Total
*Ai SITE INFORWMPI *itArii"C::*.14.* Heathen/cooling
...,_.....
Job site address: t a fb • li 44.. Air conditioning or heat pump
(requires sibs elan showing platesser I 14.00 ILL -
City/State/ZIP: InnageliMr D._____.
Furnace 100.000 BTU (duets/vents) 14.00
SuitedbldgJapt. no.: Project name: .‘
inot. Furnace 100.000+ BTU (cleadvents)
Gas hcat pump 17.90
14.00
Cross street/directions to job site: Ductwork 10.00
Hydronie hot water syston 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit Imam (fuel-type, not electric),
in-wall, in-duet, suspended. etc. 14.00
— "
Subdivision Lot no.: Flue/vent for any of above 6.80
: i
Other. 10.00
.._
Tax map/pared no.: Other fuel amdlanees
77-7'""="--77:-...."-IFTIF:,;jaill'"'',..' • ::•:7 rrt: : .'7:`.:•: - Water heater 10.00
,. . Gas fireplace 10.00
ltgllrnIIIIMIMI 6 Ora--1_ nut veal fer water heater or gas
fireplace 10_00
_10.00
—.---- Log lighter (ma)
Wood/pellet stove 10.00
--------
Wood fireplace/insert 10.047
• .... ......:' - • , . • :_ ..„. Chinmayflineriflue/vont , 1000
Mfifili0BifTY Q/4 : :: . :.• : ' % . ,'T •
Name: os° i.\ I 1_, / 't Z cktioct EnvIncimeatai exhaust and ventilation
.. Runge hood/other kitchen I
Address: -...;-0 ,,„) : Li._ equipment 10.00
City/SU/C/7 . s 1 l ^.. 0 f L C) ( D--,-3 clothes dryer exhaust 10.00
Single-duet exhaust (bathrooms,
• • . 1
I
PhOn _50 LILS ._ - I a S --- toilet cornpartmenta, utility rooms) 6.80
0 U T . :.:.4- 10.00
Other 10 00
Business name: aja Fuel piping
Contaci INC. N Lug for first four; $1.00 for each additional
Address: 1005 INDUSTRIAL Furnace. etc.
NEWBERG, OR 97132 — Gas heat PlunP
City/State/ZIP: Wall/suspended/unit heater
----- I F ( ) 5 5 S - 0 ( t c— Water heater
Phone: ( SON 6 r 9 s O a'L —L. ,--- Fireplace
E-mail: Range
. . •
Business name: Orh!tr. .
AND AIR CONDITIONING i 1 . ;; :,.,::. ... mEizapac.A.00017
AddreS
Subtotal '
City/State/ZIP: N ENBFRG OH r in Minimum pcmlit the ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
State surcharge (12% of permit the) 8, -7 0
CCB Ito.: 9115;________
_ TOTAL PERMIT FEE 3 i., 9,0
_
1th peewit militating expires if a permit is tat obtained wittiin tan
Authorized signature: C:64..A....s. days after It his keg attapted as compbeen.
• Fee melhadetioay see by Tri-County Building lethargy Wrist Board
Print - 1:1 X b (kj_---- [Date: - —3 - 0 ...- -----kegosse: I
01/119107 440.4617T (11MCOMIV1513)
VaundizePeasitallIC-PcrozitApp.doc
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�p�p ee, NE NEATlN
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r ,-r GONDIT10NINd INC.
1 AG INDU$T IIAL,PK!r AND AIR IVE HEATING
tiEWBEr IT«?�IING INC,
1005 INN i.) SIAL PKWY
NEWS €ei0; UA VIM
SIN Plan: W: (1 i RYYIS
Property Iles
I tO'
- . - erttt 40`
Front
•
SW 80th
OUR ClA"7 iw" !,PE
D All C ".:;; ' : c I NG �NQi
1 0051R' :,: ":' ,:;1 mine
INC.
NEWBERG, Uhl 97132
X�dj 6l :bl 8002/ZL/C0
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500 /ZOOI�J