Loading...
Permit (44) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENIIRD E EI C Request for e SEP 2 q o Permit Action 1 zoos TIGARD 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.ti• • .•..v € '1 DIVISION TO: CITY OF TIGARD Building DivisionVC) I 13125 SW Hall Blvd.,Tigard, OR 97223 D Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov FROM: IA Owner ki Applicant ❑ Contractor ❑ City Staff Check(✓)one REFUND OR Name: INVOICE TO: (Business or Individual) 1` O n_I C (1l a &(e a v Mailing Address: 14 S W 1. 02 rzt C.l v-e. City/State/Zip: -119'/1 r-ok- 0 R.- 912-2e\ Phone No.: (o [ G(. SOS —00 c PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): CANCEL/VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit#: m .eG 24/& - 00333 Site Address or Parcel#: 14 G5 0 SW 1 0 3 rG{ • Project Name: (o CAA". Subdivision Name: Lot#: EXPLANATION: ( I (rt i cLL Col,Y .L 1 v G1 n d o.�- U Vt O 1'W cu. I pPxcr)11- M e zoic - o oh z so ✓l o w tnr2. h U vie of v p Signature: /�.� Date: g/31 Print Name: o n j C GI /S I j o r(.Q G V Refund Policy 1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of: • Any fee which was erroneously paid or collected. • Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort has been expended. • Not more than 80%of the application or permit fee for issued permits prior to any inspection requests. 2. All refunds will be returned to the original payer in the form of a check via US postal service. 3. Please allow 3-4 weeks for processing refund requests. F-' , lv V ' /4' Route to Sys Admin: Date By Route to Records: Date/0 7///, By Refund Processed: Date/n,7//k> By Invoice Processed: Date By Permit Canceled: Date /.5f/A By Parcel Tag Added: Date By I:\Building\Forms\RegPermitAction_ 92314.doc 1,1 q TIGARD City of Tigard September 23, 2016 Monica Bilodeau 14650 SW 103`d Ave. Tigard, OR 97224 Re: Permit No. MEC2016-00333 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 14650 SW 103`d Ave. Project Name: Bilodeau Job No.: N/A Refund Method: ® Check#222398 in the amount of$80.64. ❑ Credit card"return"receipt in the amount of$ 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 this was a duplicate permit (see MEC2016- 00633). Refund 80%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 IN . City of Tigard T t GARD Accela Refund Request c, This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit 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: Monica Bilodeau DATE: 9/16/2016 14650 SW 103`d Ave Tigard, OR 97224 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 403790 Case#: MEC2016-00333 Date: 5/10/2016 Address/Parcel: 14650 SW 103rd Ave Pay Method: CreditCard Project Name: Bilodeau EXPLANATION: Duplicate permit;contractor was issued permit MEC2016-00633. Refund 80%of permit fees. ;REFUND INF ATION ` :,,A t � ,4inpt 4 � V hk ,i,� '., y, br`Y"?Y �� # 'ssi I s#' N5 �� 7'� �.� y ..xF�u <F;� d� � e:4yy fi s j 2 Tf £�3a�, r'.xT f- „%'. S t .0 n F s.�+ sr^� c f w r �x 0` tm 1B U slag a::1112410g' ie !:' all; a: s . �, �i'm` y � �' � 'fir r. g�, �' *fa ;;L' y Pe t F p �' ;�. �1:. r '�'•._ft YI2 WI .04 0 n e e i s Mechanical permit 230-0000-43102 $72.00 12%State surcharge 100-0000-24001 8.64 TOTAL REFUND: $80.64 APPROVALS: SI • R S/DATE: If under$5,000 Professional Staff r e/ - ' 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 . ..= OR. I JEl1 l;R Y:S.' 'EM.A I INIS'TI ATION 5 ON).71 Case Refund Processed: Date: 4017//4 By: I:\Building\Refunds\RefundRequest.doc x 09/01/2010 CITY OF TIGARD MECHANICAL PERMIT s COMMUNITY DEVELOPMENT Permit#: MEC2016 00333 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/10/2016 Parcel: 2S111BCO2302 Jurisdiction: Tigard Site address: 14650 SW 103RD AVE Project: Bilodeau Subdivision: None Lot: None Project Description: Gas line extension for new fireplace insert. Contractor: NATURAL GAS CUSTOM PIPING INC Owner: BILODEAU, MONICA 1014 NE 177TH AVE 14650 SW 103RD AVE PORTLAND, OR 97230 TIGARD, OR 97224 PHONE: 503-319-6557 PHONE: FAX: 503-335-9950 FEES Specifics: Description Date Amount Gas Fireplace 05/10/2016 $33.39 Type of Use: SF Fuel Piping 05/10/2016 $14.15 Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 05/10/2016 $42.46 Occupancy Grp: 12%State Surcharge-Mechanical 05/10/2016 $10.80 Stories: Fuel Fuel Types: Gas Pressure: Total $100.80 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: 'tee Signature: (V1 (9/1",,N, t/1.0, -----....... Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. J Mechanical Permit Application FOR OFFICE USE ONLY Received _ / City of Tigard ,Q.,.�- Permit No.: Date/By: S �"/ft() 4.37- / '1 J�W�3 - 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.19960 Other Permit: Date/By: TI GA R D Inspection Line: 503.639.4175 Date Ready/By: orris: I ® See Page 2 for Internet: www.tigard-or.gov �Q�C Notified/Method: Supplemental Information n U TYPE OF WORIO1""� `� � N0) COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit tees*are based on the value of the work ❑New construction Addition/alteratioept�� 760. 1� performed.Indicate the value(rounded to the nearest dollar)of all ❑ Demolition ❑Other: ��� (+� mechanical materials,equipment,labor,overhead,and profit. Value:$ CATEGORY OF CONS CTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES* AI_and 2-family dwelling ❑ Commercial/industrial ❑Accessory building For special information use checklist. ❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning 46.75 Job site address: i 4(psO sw I 03 r A. GtV-e . Furnace 100,000 BTU(ducts/vents) 46.75 City/State/ZIP: 1-1 9 Gtrbt. 0 2 flZ 224 Furnace 100,000+BTU(ducts/vents) 54.91 Heat pump 61.06 Suite/bldg./apt.no.: Project name: QiIOt.CM,1. el uJ Itvu. Duct work 23.32 Cross street/directions to job site: Hydronic hot water system 23.32 \/-eJ� S(� OC. 103 Ck V`€ . Residential boiler(radiator or _ hydronic) 23.32 S Unitheaters(fuel-type,not electric),U tie) .7 I-- C a✓1 1b v M L h. cAnot no r t� in- all,in-duct,suspended, etc. 46.75 O c- inn U rel O c.14._ S 4- . Flue/vent for any of above 23.32 Other: 23.32 Subdivision: Lot no.: Other fuel appliances: Tax map/parcel no.: 2s ill tG oz'3 0 2- Water heater 23.32 DESCRIPTION OF WORK *Gas fireplace/insert 1 33.39 4"33,34/ Flue vent for water heater or gas E.x f&/in S 1 O r\ 0 it C—I Ca d I IYU F'90 r F►ve.q)l G u_ fireplace 23.32 i In S-tr-i— Log lighter(gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 Chimney/liner/flue/vent 23.32 Other: 23.32 121,PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation: Name: M 0 n j Col 6;(O a-Gt U Range hood/other kitchen Address: 1 9 bS0 .vW ( 03 r-a \j-e, equipment 33.39 Clothes dryer exhaust 33.39 City/State/ZIP: -r v G1(-a_ Q 2 cl Z Z Zq Single-duct exhaust(bathrooms, toilet compartments,utility rooms) 23.32 Phone:(4 f9 ) .cos — 0001 l0 Fax:( ) Attic/crawlspace fans 23.32 APPLICANT 0 CONTACT PERSON Other: 23.32 Business name: 6,//A Fuel piping: //�� $14.15 for first four;$4.03 for each additional Contact name: M Q r)7 co e 1?o d- G( U Furnace,etc. Address: 14 6 S o S vU (03 cAL.re_ Gas heat pump Wall/suspended/unit heater City/State/ZIP: 1-i,al reit. OR- C11'2_2_4 Water heater _ Phone:(6 ICI ) S Q $ —00°I (, Fax: :( ) Fireplace 1 II,IS Range E-mail: Barbecue CONTRACTOR Clothes dryer(gas) Nei C P Inc . Other: Business name: 'MECHANICALPE T!HES• Address: I O III N. G . 17'7 G1 v'e- Subtotal City/State/ZIP: 'Q O C-}-l CAM G( Q 01"7 2 3 Q Minimum permit fee($90.00) 50,0© Phone:(S 03) 3 1 c1 — 6 s S 1 Fax:( ) Plan review(25%of permit fee) "- State surcharge(12%of permit fee) O.,raj CCB lie.: 12- 5 03 I TOTAL PERMIT FEE l , This permit application expires if a permit is not obtained within ISO nn _ 1 days after it has been accepted as complete. Authorized signature: /v _ rl * Fee methodology set by Tri-County Building Industry Service Board Print name: m0 alUr. ( %.1 0 4 o_014.'L Date: s/g/ 1 Co l:\Building\Permits\MEC_PermitApp_0401I3.doc 440-46171(11/02/COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial& Multi-Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to$500.00 Minimum fee$69.06 $500.01 to$5,000.00 $69.06 for the first$500.00 and $3.07 for each additional$100.00 or fraction thereof,to and including $5,000.00. $5,000.01 to$10,000.00 $207.21 for the first$5,000.00 and $2.81 for each additional$100.00 or fraction thereof,to and including $10,000.00. $10,000.01 to$50,000.00 $347.71 for the first$10,000.00 and $2.54 for each additional$100.00 or fraction thereof,to and including $50,000.00. _ $50,000.01 to$100,000.00 $1,363.71 for the first$50,000.00 and $2.49 for each additional$100.00 or fraction thereof,to and including $100,000.00. $100,000.01 and up $2,608.71 for the first$100,000.00 and $2.92 for each additional$100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\Building\Permits\MEC_PermitApp_0401 I 3.doc 2