Permit C ITY ` O OF TIGARD LI I MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00189
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/15/2008
PARCEL: 2S 104DA -21100
SITE ADDRESS: 12998 SW PRINCETON LN ZONING: R-4.5
SUBDIVISION: QUAIL HOLLOW - SOUTH LOT: 037 JURISDICTION: TIG
PROJECT: FUNDERHIDE
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
DAN FUNDERHIDE Description Date Amount
12998 PRINCETON LN
TIGARD, OR 97223 [MECH] Permit Fee 4/15/200E $72.50
[TAX] 12% State Surch 4/15/200E $8.70
Phone: 971- 246 -0434
Total $81.20
Contractor:
G THOMAS ENTERPRISES
PO BOX 880
NEWBERG, OR 97132 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -804 -6333
FAX 503 -537 -3021
Reg #: LIC 88093
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: Q� */7/6,.. L /� 2(/
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.
Rpr 15 08 09:384 G. THOMRS E �, 503 -537 -3021 p.l
I.
l chancel Permit Applicatio C�jj.` 1 OFF1(F (sE ONLY
d °
City of Tigard / j'0 '�� . ,1 E/
2E3
13125 SW Hall Blvd., Tigard, OR 97 - 1 s'60 `r `
Phone: 503.639.4171 Fax: 503.598.1960 nspecion Line: Pe 1 ,1` other Permit:
t i C. n r. i It Li 503.639.4175 N� �f � ` r tuns See 2
rm ee Page for
Intern www.tigard-or.gov � � Oe \ \�`. . 0 Supplemental ee 2 Information
01 4
TYPE. OF WOltp.� COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, cq prnent, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
Tat- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
Multi- family ❑ Master builder ❑ Other. Description I Qty. I Ea. Total
ARAMbi te_ JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address /21792 7 Air conditioning or heat pump / S� �/Y�LG'�'o'��I cur (tequires site plan showine placement) >I 14.00
City/ State/ZIP: G ,t3'2 q7)--Y) Furnace 100,000 BTU (ductsivents) 14.00
Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldgJapL no.: Project name: 'C � ' j� � r`a( Gas heat pump 14.00
Cross street/directions to job site: S f t) a 1 . • / �L+ LQ DQ Duct work 10.00
/ Iiydronic hot water system 14.00
4 ex) v / Q e c, 7" . Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric).
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
Other: 10.00 _
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
2.‘4.. "ti, A) C. CoAi t, 17 m ()sJ &Tyr.- /gap Flue vent for water heater or gas
fireplace 10.00
to ex/ s rims S Y' S t "1 Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00 •
tg PROPERTY OWNER I 0 TENANT Chimnev/liner /Ilue/vent 10.00
Other 10.00
Name: b4J F UNp' ti I D E Environmental exhaust and ventilation
-! 98 1Q 1I
pre L-P1i'
Range ennt hood/other kitchen
Address: 1 2 10.00
City /State/ZIP: - j(omzp .G It Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms.
Phone: (Cf 7,) 2 'jr'- oq 3 Y Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT 1 ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: S5.40 for first four; SI.00 for each additiona
Address: Furnace, etc.
-- Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Fax: Phone: ( ) ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue 1
Business name: G T/_)'r 4 S tN rte Pie fsB Clothes dryer (gas)
Other.
Address: P O Q coc e2 p MECHANICAL PERMIT FEES*
City/State/ZIP: A)&1441910.6 tJ er e ( 7/ 3_ Subtotal
Minimum permit fee ($72.50) '7) • „51.;
Phone: (503) 20 t',/_ 6 33 _ Fax: (5d3) S37 302. h1 Plan review (25% of permit fee)
CCB lie.: no 93 n -/./j State surcharge (12% of permit fee) • ? p
TOTAL PERMIT FEE % /,a7) .
Authorized signature: /Y11M ature: ' 1 `� •` -- Thu penult application expires it a permit is Rot obtained within to
days after it has been accepted as complete.
Print name: (. i A4 1 04-g Date: •/S • Fee mahodology set by Tri- County Building Industry Service Board
t: vrntdinawemiteMEC- rlmtitApp.dot 01119107 440.46171' ( 11/O2/COM/WEa)
Apr 15 08 09:38a G. THOMAS E 503 - 537 -3021 p.2
v
1
-- -- '
z r " f i p4mm o 3 au1
cdN , r
cE 33 I
V
•
Dreg
wPrY
ZS 98
5 14i riNe. E to-4
•
G. Thomas Enterprises S / pL
P.O. Box 880
Newberg, Oregon 97132 M *'J 44 e7 7
6`03- Roy -6333
•
• City of Tigard, Oregon o 13125 SW Hall Blvd. 0 Tigard, OR 97223 .
e •
_ .
May 9, 2008
G. Thomas Enterprises
P.O. Box 880
Newberg, OR 97132
Attn: Gary Thomas
Re: Permit No. MEC2008 -00189
Dear Mr. Thomas:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
• Site Address: 12998 SW Princeton Ln.
Project Name: Funderhide
Job No.:
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $64.96.
• ❑ 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.
\ Building\ Refunds\ Admini stration \Ltrltefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard- or.gov • TTY Relay: 503.684.2772
Apr 28 08 01:09p G. THOMAS E 503 - 537 -3021 p.
•
• Community Development RECE.vED
TIGARD
CITY
Request for Permit Action � PR'. ;1
art 1 g
TO: CITY OF TIGARD -
Building Division Services Coordinator
13125 S \V Hall Blvd., Tigard, OR 97
Phone: 503.718.243(1 I'sus: 5113.598.1961) waw.tigard -rlr.t ov
FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff
(check one)
REFUND OR Name: (; . 'I hotnas I :.nrcrpriscs
INVOICE TO: (Business o r I nti t mina I)
Mailing Address: l> () Rox
City/Stare / Newberg CV:' '( 7/ - "
Phone No.: 503 - 8(14 - 61333
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
FA! CANCEL PERMIT APPLICATION.
►.4
REFUND PERMTI FEL;.S (attach receipt, if available).
❑ INVOICE FOR FEES DUI: (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PI (do not cancel permit).
Permit #: MI.:( 2112008-00189
Site Address or Parcel #: 12998 Princeton I .n
Project Name: Funderhide
Subdivision Name: Quail I follow - South Lot #: 037
EXPLANATION: Job Canceled by owner
Signature: , ( - Date: 4/25/08
;a ry 'Thomas
Print Name:
Refund Policy
I. The Director or Building Official may audit nze the refund o I
a) any fee which was erroneously paid in ei iketrd.
b) not more than HIM of the land use application lee mhrn : applical6 a i is w .1hd ra%n or i merit d I c•f.>rr any review rll;m has been expi ndc&
c) not more than IC% of the land use application fee tin issued pernuie.
d) nor more than WY% of the building plan review lee when an apphe:uinii is raucrl,•d brlLn :1,11 Ilan review et in Ices I rcn capeiitkd
e) not more than 80% of the building permit lit fig issued pcmule I +rior n. any inspect. in requests.
2. Refunds will be returned to the original Payer in the s:unc mciii. i ni WIucli p:y111e 1 ivus Turned. Please ant n I 2 weeks li Ixnnssi ng refunds
FOR OFFICE USE ONLY ��
Rte to Sys .Admin: Date lit Ric Iri lildt`. \tlniin: I )aie s r/ Q8' SIIti/I •
Refund Processed: _ Date AtIV mriice I'rixc <sctl I):nc li
Permit Canceled: Date 5 / (/� li . ccl'l';ii :\ 'kW: I )aie lip
Receipt P Date t let h• Id \nutunt $
1: \1 \1 rmAitn Pr m,it. \e h int. d.ir Itri 17/2(11 7
City of Tigard
T I GA RD 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: G. Thomas Enterprises DATE: 5/7/08
P.O. Box 880
Newberg, OR 97132 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 2008 -1242 Case #: MEC2008 -00189
Date: 4/15/08 Address /Parcel: 12998 SW Princeton Ln.
Pay Method: CreditCard Project Name: Funderhide
EXPLANATION: Per applicant's request as job was canceled. Refund 80% of permit fees.
REFUND INFORMATION: . ' . .
Fee Descripnon•From Receipt Revenue Account No. .. Refund
Example: [BUILD] Permit Fee Example: 245 - 000.0 - 432000 $ Amount
[MECH] Permit Fee 245 - 0000 - 431010 $58.00
[TAX] 12% State Surcharge 100- 0000 - 207020 6.96
TOTAL REFUND: $64.96
APPROVALS:
If under $500 Professional Staff f-
If under $7,500 Division Manager s 7 '
If under $22,500 Department Manager "7
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY - . •
v . , ' Case Refund Processed: 1 Date: I _; , By: � —
1: Building \Refunds \RefundRequest.doc 05/23/07
III ,-, CITY OF TIGARD 5/9/2008 •
13125 S\\ Hall Blvd. 9:44: I 9AM
Tigard, OR 97223 503.639.4171
TIGARD
Refund Receipt #: 27200800000000001572 4,..(---..1/4572. ;'"-'- --
Date: 05/09/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MEC2008 -00189 Reversal - [MECI -I] Permit Fee 245 -0000 - 431010 (58.00)
MEC2008 -00189 Reversal - [TAX] 12% Statc Sur 100- 0000 - 207020 (6.96)
Line Item Total: ($64.96)
Refund:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal G THOMAS ENTERPRISES 05576C In Person (64.96)
Refund Total: ($64.96)
, i-> a
.t.
,� - - o
0 .� W N v a
'---, a
w a1 ca � r -,
a+ ; `� O y
.w co 0 rn � � E
C O 0 y 0 v O
.. 44 cn p! a 'I7 ` `•
H s Q v= r. cd v x L y .39 2
(4 .5 ( � 'J � o 14.74 x V V -
.�� H 0 „ n a � y M N d
ta. Oa
co q
El o • a) • m
q H w Ix a
0 l I
CITY OF TIGARD 5/6/2008
13121 SW Hall Blvd. 11:30: 18AM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200800000000001242 1 x (--
Date: 04/15/2008
Line Items:
Case No Trail Code Description Revenue Account No Amount Paid
MEC2008-00 I 89 [MECH] Permit Fee 245- 0000 - 431010 72.50
MEC2008 -00189 [TAX] I2`%, State Surcharge 100- 0000 - 207020 8.70
Line Item Total: $81.20
Payments:
Method Payer User ID Acct. /Check No. Approval No. Flow Received Amount Paid
CreditCard G. THOMAS ENTERPRISES BTT 05576C Fax 81.20
Payment Total: $81.20
rRrccipispl Page I of I
CITY OF TIGARD 4 1; 2(III
171_'„\\ 1i:dl llnd. I I:5S:I I: \ \1
• .,
I i,ard. Olt " 23 :I0.63./.41 - 1
N TIGARD
a_ •
Receipt #: 27200800000000001242
I):Itu: 114' 15.'20005
I.IIIe IICIII,:
rase \., '1 ran (. 41r Ilescrilllimi Rcs1•nue \ii,nlul \n \nunnu Paid
-
Cu \11' 11 I'.;'r!! Fc --
(� \.. 12... � Ial: \ u I iII, ' 2ul - .12,1
m Line Ilan I alai: 581.20
N
I I':n mcn1�:
\Iclhud I':ner 1 .cr II) \cil ( hci6 \ \Phrmal \n. Ilu�� I(ecci%cd \nlunui Paid
: \1 \' I \'1 IiI I 'I .' i.(.• -.i._.I
1' :1% nu nl . fn:al: ?8I.211
CIIVIOF TIGARD PERMITS
125 SA HA BLVD
w TGARO, OR. LL 97123
O TERMINAL I.D.: 0817348080980313065E01
O MERCHANT A: 6883138S5B
E
= VISA
tUttt3143U6S19
SALE
RECORD N: 3 THU: B88B83
DATE: APR 15, 88 TIME: 11:55
BATCH: 19
ADS RESP0H5E: 2 ACTH: 855760
•
Q � 5 DIGIT 21P MATCHES, ADDRESS DOES NOT
W
TOTAL $81.28
0
CO
0
O TO ISSUER EHT
Cu (MERCHANT ASREEIENT If CREDIT VOUCHER)
Q
CUSTOMER COPV
CC
1 01'1
•