Permit (163) City of Tigard • COMMUNITY I)EVUI,OPMENT DEPARTMENT i"
74i. Request for Permit Action
1 TAiti Y L+ 4 2J8
T I c;r A R.D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • tvs.'u' _ ,;rd-u rov
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TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223 //7/201" `
Phone: 503-718-2439 Fax: 503-598-1960 7:'iga.rdBuildingPertnits@tigard-or.go
FROM: Owner jk, Applicant fi Contractor r- City Staff
Check(V)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address: . ilk ar - - '
City/State/Zip: ', i co-z,,,,
Phone No.: 7-,S2 -4.497.-77— -1`4'
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
J' INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
0 REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: ,.... l 7 - Ut7L
Site Address or Parcel#: � Ai . 14 0
Project Name: .: ,*
Subdivision Name: Lot#:
EXPLANATION: * c.. ,. I i
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Signature: �" 6' . .� '.'' .'-- Date: // ,r
Print Name: ,«« -, r�.. . (
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
FOR OFFICE USE ONLY
Route to Sys Admits: Date By Route to Records: Date `WA, By i9
Refund Processed: Date ' ,Alalinirig Invoice Processed: Date By
Permit Canceled: Date _ ;• -. Parcel Ta. Added: Date By
isA1 ilding\I'oums`1I x1PermitAcrion')923I oc
Dianna Howse
From: Dianna Howse
Sent: Wednesday,January 24, 2018 8:54 AM
To: 'kjerkovich@bcradesign.com'
Cc: #Building Permit Technicians
Subject: FW: MEC2017-00365 - 7700 SW Dartmouth, Ste 110 - Fido's
Attachments: Req PermitAction_092314.pdf
Importance: High
Hello Kathryn,
This mechanical permit application submitted by BCRA, Inc. on 5/24/2017 appears to be a duplicate of the mechanical
permit application submitted for the same work on 10/23/2017 by the mechanical contractor Comfort Flow Heating. On
7/3/2017,we emailed you to let you know the amount of the permit fees due and that a licensed contractor needed to
be identified before we could issue the permit. On 12/5/2017,we issued permit MEC2017-00830 to Comfort Flow
Heating.
Please complete the attached form to request that the permit submitted by BCRA, Inc. can be voided as a duplicate and
email to TigardBuildingPermits@tigard-or.gov. We need this permit closed out so that the new tenant can obtain
occupancy. No refund is due as not fees have been paid on this permit.
Thank you and please let me know if you have any questions.
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 1503-718-2439 Permits
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
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Mechanical Permit Ap licatio Pi
p FOR Oh1l( i: I St, t).A1.1
City of Tigard �1//�;';� Received
Date/By: , Permit No.: r
13125 SW Hall Blvd.,Tigard OR 97223 G .� 0 !—=Gv4
1111 J= Phone: 503.718.2439 Fax: 503.598.1960 Vt Plan R, '��
Date/By: ) Other Permit: f
1 �, �.,1, Inspection Line: 503.639.4175
111 A.
� �'"a'"��7'�
Internet: www.tigard-or.gov Date Rea. :y: 1 Juris: See Page 2 for
f, Notified/Method: Z/ ^�/, Supplemental Information
Print name: 'athryn Jerkovich
ff1 7,' 'f'` r s.l'1(`41".1/-11'f r`f` ,% f # i'' r f 1 ,Y740",,,,,:'•14-(04,ff� �'1 )
`
El New construction '-
®Addition/alteration/Mi.. ,•nt �= s t• ' ; t ;1 � �,
❑Demolition 0 Other: . 96 Mechanical permit fees*are based on the value of the work
txvx
performed.Indicate the value(rounded to the nearest dollar)of all
12 '. as`,.ff� r`tl t ° t t t w 4,,,,,,,;,,r,,`:•;0 , F,, „,/,/,,,,4 mechanical materials,e•ui•ment,labor,overhead,and rrofit.
,1,.,.: f ,
❑ I-and 2-family dwelling ®Commercial/industrialValue:$18,250
D Accessory building X 4,7)- a1 1, 1.
❑Multi-family 0 Master builder 0 Other:
r f, For special information use checklist.
8 f U j �' rns g , ( all.: t 1 l 4 6+ 1, fir 41A,-0 r,-1 it Description
/V f''�!!;-,,i' -100,.,,,,A p Qty. Ea. Total
Job site address:7700 SW Dartmouth St. Heating/cooling:
Air conditioning 46.75
City/State/ZIP:Tigard,OR Furnace 100,000 BTU(ducts/vents) 46.75
Suite/bldg./apt.no.: 110 Project name:Fidos—Landlord Work�t- Furnace 100,000+BTU(ducts/vents) 54.91
' 4A Heatum
Cross street/directions to job site:SW 72nd Ave p p 61.06
Duct work 23.32
Hydronic hot water system 23.32 '
Residential boiler(radiator or M
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Tax map/parcel no.:2S101BA00101 Other: 23.32
Other fuel a t liances:
C43.5,`,(2/°'4,744,":,... .A144"011,—*/ ; ,. 1 ;; t t �: '1, ,� Water heater
23.32
Demising of interior space,construction interior walls,restrooms and provide electrical Gas fireplace/insert 33.39
and plumbing connections for future tenant. Scope of work excludes actual tenant Flue vent for water heater or gas
improvements,this work to be completed by Fidos. fireplace 23.32
Log lighter(gas) 23.32
- ,,, t[a ) a .- 41 libi _.v cx _ ' :`, ,....-11‘,/, / 4f Wood/pellet stove 33.39
Wood fireplace/insert 23.32
„' :' f ' t r,, Chimne /liner/flue/ventrc 23.32
Other:IP/
23.32
Name:Walmart Stores,Inc.,Attn:Denise West
Environmental exhaust and ventilation:
Address:2001 SE 10"'St. Range hood/other kitchen
equipment 33.39
City/State/ZIP:Bentonville,AR 72716-0550 Clothes dryer exhaust 33.39
Phone:(479)204-3354 Fax ( ) Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
r as 'jf F,,,,,, 4,'r• r ✓� xr . %r;�f '''''/"'t , F 47,14•'';1447'`47'9744'';'''''''4
'' f r//.`, / Attic/crawlspace fans 23.32
Business name:BCRA,Inc. Other: 23.32
Fuel piping:
Contact name:Kathryn Jerkovich $14.15 for first four;$4.03 for each additional
Address:2106 Pacific Ave,Suite 300 Furnace,etc.
City/State/ZIP:Tacoma,WA 98402
Gas heat pump
Wall/suspended/unit heater
Phone:(253)627-4367 Fax::( ) Water heater
E-mail:kjerkovich@bbadesign.com Fireplace
'-
Ran_e r� f i d, yr,xrfBarbecue
f , fi :,,/ll ,` M4,s 4a f.4;,lf4, ,/�1r f'1� r ,, %f;f ,tf ,* e,fit e ,,.J / a, ,, 44,4 J,
Business name AClothes dryer(gas)
Address
- - Other
•
;,
City/State/ZIP: Subtotal
Phone: /T1^ Fax:( ) Minimum permit fee($90.00)
1 1 Plan review(25%of permit fee)
CCB lie.: t _` State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
1\Building\Permits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
' Fee methodology set by Tri-County Building Industry Service Board
Mechanical Permit Application - City of Tigard
Page 2 - Supplemental Information
Commercial& Multi-Famil Fee Schedule:
$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_040113.doc 2