Permit (93) RECEIVE
• City of Tigard . COMMUNITY DEVELOPMENT DEPARTMENT NOV9 201
N Re nest CITY � 'TIGARD
q for Permit Action U LDEVG D1YISIO
TIGARD 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov
V1 0 .
TO: CITY OF TIGARD 0
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223 /Z/Lyll 7
Phone: 503-718-2439 Fax: 503-598-1960 'l'igardBuildingPermits@tigard-or.gov
FROM: n Owner ❑ Applicant E] Contractor ❑ City Staff
Check(✓)one
REFUND OR Name: .
INVOICE TO: (Business or Individual) rtr} A C �vO L.J.
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Mailing Address: `j(-/(�`,; SE;,'. l.V i ?
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City/State/Zip: (v f k 11Tt)v t..��t V15 Q.,, DR u 3-/-Y r-
Phone No.: 5 7 Li V4--- 1.,i4S"-Y^a-
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
x CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
n INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
U REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: 11/1 t C-)--v — as) L,i
Site Address or Parcel#: r)S'1 c SUS .S LO ckt: .4\;, .„ +I- \\)t�
Project Name: C3'1.alv\f
Subdivision Name: {{�,{�,.(tif; , t Lot#: ND r i?
EXPLANATION: ND CZ C. `�L,'1: 4..v 0.0,"- '9 W v'lP,'
Signature: Date: `) ")
Print Name: k o k v I- , 1
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
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FOR OFFICE USE ONLY
Route to Sys Admit: Date By Route to Records: Date 6 �� By
Refund Processed: Date rte/ / 7
1 - Invoice Processed: Date
Permit Canceled: Date /2/2"1/4/2 By -y Parcel Tag Added: Date B
I:\Building\Forms\RegPermitAction_09.,314. c y
illill
N
TIGARD
January 18,2018 City of Tigard
HVAC,Inc.
Attn: Jody Depew
5188 SE International Way
Milwaukie, OR 97222
Re: Permit No. MEC2017-00884
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 10575 SW Cascae Ave, #100
Project Name: Biamp
Job No.: N/A
Refund Method: ® Check#227183 in the amount of$114.14.
❑ Credit card "return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
0 Trust account"deposit"receipt in the amount of$
Comment(s): 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,
.ri
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
III W
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request forPermit 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: HVAC, Inca
DATE: 12/28/2017
5188 SE International Way
Milwaukie, OR 97222 REQUESTED BY:
Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 413807
Date: 11/9/2017 Case#: MEC2017-00884
Pay Method: Check Address/Parcel: 10575 SW Cascade Ave#100
Project Name: Biamp
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80%of permit fees.
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Mechanical Permit r � , cs a c
12%State Surcharge 230-0000-43102 $101.91
100-0000-24001 12.23
TOTAL REFUND: $114.14
APPROVALS: SIG TURES/DATE:
If under$5,000 Professional Staff
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
Case Refund Processed: Date: I
By: ir �
I.\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD
III
2 13125 SW Hall Blvd.,Tigard OR 97223 RECEIPT
503.639.4171
TI GA R.D
Project Name: Biamp
Site Address: 10575 SW CASCADE AVE 100
Receipt Number: 416593 - 04/06/2018
CASE NO. FEE DESCRIPTION
REVENUE ACCOUNT NUMBER PAID
MEC2017-00884
$-114.14
Total: $-114.14
PAYMENT METHOD CHECK# CC AUTH.CODE ID
Check CASHIER ID RECEIPT DATE RECEIPT AMT
227183
Payor: HVAC, Inc. DHOWSE 04/06/2018 $-114.14
Total Payments: $-114.14
Balance Due: $114.14
Page 1 of 1
IN
CITY OF TIGARD RECEIPT
! 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Project Name: Biamp
Site Address: 10575 SW CASCADE AVE 100
(92761 A/41-1----
I Receipt Number: 413807 - 11/09/2017 92017 I
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER
PAID
MEC2017-00884 Permit Fee
MEC2017-00884 230-0000-43102 $127.39 �-
Plan Review 230-0000-43111
MEC2017-00884 12%State Surcharge-Mechanical $35.25
MEC2017-00884 Info Process/Archiving-Lg$2.00(over 100-0000-24001 $ .00 t-
230-0000-43113535 $5
11x17) $2.00
Total: $176.53
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 8477 BTAGGART 11/09/2017
Payor: HVAC Incorporated $176.53
Total Payments: $176.53
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
ll111
Permit#: MEC2017-00884
Date issued: 11/09/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 135 B B00501
Jurisdiction: Tigard
Site address: 10575 SW CASCADE AVE 100
Project: Biamp Subdivision: None Lot: None
Project Description: Duct vent extension from punch press to dust collector.
Contractor: HVAC INC Owner: ICON OWNER POOL 3 WEST LLC
5188 SE INTERNATIONAL WAY BY INDCOR PROPERTIES
MILWAUKIE, OR 97222 2 NORTH RIVERSIDE PLAZA, STE 235
CHICAGO, IL 60606
PHONE: 503-462-4822 PHONE:
FAX: 503-462-6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/09/2017 $127.39
Class of Work: ALT Type of Const: Plan Review 11/09/2017 $31.85
Occupancy Grp: Occupancy Load: 12%State Surcharge-Mechanical 11/09/2017 $15.29
Stories: 1 Info Process/Archiving-Lg$2.00(over 11/09/2017 $2.00
11x17)
Project Valuation: $2,350.00
Fuel Air Handlers
Fuel Types: Units<10000 cfm:
Gas Pressure: Units> 10000 cfm:
Furnaces Boilers&Compressors
Furnaces< 100K BTU: 0-3 HP:
Furnaces>=100K BTU: 3-15 HP:
Floor Furnaces: 15-30 HP:
Unit Heaters: 30-50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $176.53
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 1
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started withii 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to {pllow the rules adopted b the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ay ob,. • a c•py of the rules
or direct questions to OUNC by calling 503.232.1987 • :00.332.2344. DC
, 0 I ) ,
Issued By: r, ittee Signature: .v '
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completi•n of e projec.
Approved plans are required on the job site at the time of each inspecti• .
Mechanical Permit Application FOR OFFICE CSE Oyl.l
City of Tigard Received
g Re eBy: ! 7 Permit No.: . - r` "/
111
4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 w a • 1 ' Other Permit:
t d... I— gc Date/By:
T 1 G A R D Inspection Line: 503.639.4175 ,$X t Date Ready/By: 1 MI Juris: ® See Page 2 for
Internet: www.tigard-or.gov rrtt V t1 / Notified/Method:// SupplementalInformation
NCiz--,
TYPE OF WCOMMERCIAL FEE* SCHEDULE - USE CHECKLIST
r,�, Mechanical permit fees*are based on the value of the work
,L^J
❑New construction Addition/al t } 1( i performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ d 0 "^
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling gCommercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
>t\ Air conditioning
Job site address: to-)'i 5� C S( N-Old, (requires site plan showing placement) 46.75
ty / I ` c.)-V._/j Furnace 100,000 BTU(ducts/vents) 46.75
Ci /State/ZIP: C 5}�,
J Furnace 100,000+BTU(ducts/vents) 54.91
it .� p
Suite/bldg./apt.no.: Project name: R.vl pv,0 LJ r�y 10 ves,s Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,notelectric),
in-wall,in-duct,suspended,etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
t',% Gas fireplace/insert 33.39
0 G ✓ '" V-e/lA • - ; / l W-\\ 4-14:,f71 p Got c,/ 1 Flue vent for water heater or gas
S k 1, 10- c.A\ fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
0'PROPERTY OWNER 0 TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
Phone:( ) Fax:( ) toilet compartments,utility rooms) 23.32
0 APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name:HVAC,Inc.
Fuel piping:
Contact name:Jody DePew $14.15 for first four;$4.03 for each additional
Address:5188 SE Internaitonal Way Furnace,etc.
Gas heat pump
City/State/ZIP:Milwaukie,OR 97222 Wall/suspended/unit heater
Phone:(503)462-4822 Fax::(503)462-6555 Water heater
Fireplace
E-mail:jodyd @hvacincorp.com Range
g
CONTRACTOR Barbecue
Business name:HVAC,Inc. Clothes dryer(gas)
Other:
Address: Jf. MECHANICAL PERMIT FEES*
City/State/ZIP: j Subtotal
Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
CCB lic.:50897 State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Vir\
Date: This permit application expires if a permit is not obtained within 180
Authorized signature:
name:Jody DePew days after it has been accepted as complete.
} % '� * Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Permits\MEC-PennitApp.doc 03/07/12 440-4617T(I1/021COM/WEB)
City of Tigard • BUILDING DIVISION
Over-The-Counter (OTC) Mechanical Permit
Appointment Checklist
Permit Record#: Clec2c)(7--foni(
Contact Name: pI y /'g f Phone #:5p3 -n.2 6566
Business Name: /11/iie, f,G Appointment Date: ///97f7 /p,rre 47iy
Site Address: /, 75' 3'sJ C,C° i- g /& Bldg/Suite #: /27-0
Project Name: ai,9111,)
Project Description: C �'A a" ‘4.7177— 7 .4 siz, €/4/1-4_4— 1�0e._
CXIS TiAlG 1)41 vCff "66,3...C ,
Related Record#:
GENERAL INFORMATION
*Class of Work: L. 4Occupancy Group: ,d Type of Construction: V)
*Tr e of Use: a.1� , Oregon Specialty Code: j
Number of Stories:
FUEL FURNACES
Type: Furnace< 100K BTU Furnaces>= 100K BTU
Gas Pressure: Roof Top Unit(RTU) Tons
Floor Furnaces Unit Heaters
Vents without Appliances Air Conditioning
Heat Pump
AIR HANDLERS HOODS
Units <= 10000 cfm Type 1 Hood Type 2 Hood
Units > 10000 cfm Grease Duct 1 Hour Shaft
Fire Wrap
APPLIANCES
Boiler(BTUs) Vent Fans Gas Line
Solid Fuel Fireplace/ Clothes Dryers Gas Outlets
Woodstove Duct Work i Gas Fireplace
Fire/Smoke Dampers Other Mechanical Units—Describe:
Total Project Valuation: $
$ 12.,-7 r3 J Mechanical Permit Fee
$ 3 j . g g Plan Review
$ ) S. aci 12%State Surcharge
$ 2. ---. Info Proc/Arch,Lg(over 11x17 $2.00)
$ Info Proc/Arch,Sm(up to 11x17$0.50)
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
$ Other:
Building Staff:
Date/Time: $ J 76 • 4-3 TO' AL FEES DUE ,
I:\Building\Forms\OTC_MEC_021116.docx
Dianna Howse
From: Jody Depew <JodyD@hvacincorp.com>
Sent: Wednesday, November 01, 2017 3:21 PM
To: Dianna Howse
Cc: Andy Vail;#Building Permit Technicians
Subject: RE: OTC commercial mech permit
I will take that appointment at 10AM on Nov 9th. See you then.
Thank you,
Jody
From: Dianna Howse [mailto:Dianna@tigard-or.gov] _ n
Sent: Wednesday, November 01, 2017 3:10 PM
To: Jody Depew
Cc: Andy Vail; #Building Permit Technicians
Subject: RE: OTC commercial mech permit
Hi Jody,
Our next OTC appointment is out to Thursday, November 9th at 10:00 am.
Otherwise,you can email the completed/signed mechanical permit application and (2) copies of the plans to us. Plan
review should be completed within one week. When the permit is ready, we will contact you and let you know the
amount due and provide you with the link to pay the permit fees online, however someone will need to pick up the site
copy of the plans and permit, or we can put them in the mail to you for an additional cost of$5.00.
Please note that according to our records, the tenant Biamp is in Suite 100.
Please let us know which option you prefer.
Thank you.
Dianna L. Howse
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct I 503-718-2439 Permits
From: Jody Depew [mailto:JodyD@ hvacincorp.com]
Sent: Wednesday, November 01, 2017 2:33 PM
To: #Building Permit Technicians
Cc: Andy Vail
Subject: OTC commercial mech permit
Good Afternoon,
Trying to remember if you do affidavit's over email/fax and pay with credit card.
We have a very simple job at Biamp—10575 SW Cascade Ave.
1
We are extending 8"vent to a sidewall for existing punch press. No equipment in scope.
Total value$2000.
Can I email you a 11x17 drawing and application and pay with credit card. Or do I need to make an appointment for OTC
time?
Thank you,
Jody DePew
Construction Project Assistant
HVAC, Inc.
5188 SE International Way
Milwaukie, OR 97222
Phone: 503.462.4822
Direct: 503.462.6566
Fax: 503.462.6555
'ocyd@hvacincors.com
.4!
- • , .
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