Permit Support Document (10) CITY OF TIGARD MECHANICAL PERMIT
IS `� Permit#: MEC2018-00406
s COMMUNITY DEVELOPMENT
Date Issued: 06/04/2018
TI C_;A 1<.C) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 v '
xf Parcel: 1S125DA00600
i Jurisdiction: Tigard
Site address: 9166 SW 66TH AVE
Project: Garland Subdivision: None Lot: None
Project Description: Gas Pipe from meter to furnace and water heater,install gas furnace. 6/19/18:REPRINT to add(1)water heater.
Contractor: COLUMBIA HEATING&COOLING INC Owner: GARLAND, MARCIA C
PO BOX 230397 7464 SW 48TH AVE
TIGARD, OR 97281 PORTLAND, OR 97219
PHONE: 503-624-2704 PHONE: I
FAX: 503-598-0270
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 06/04/2018 $46.75
Type of Use: SF Water Heater 06/04/2018 $23.32
Class of Work: ADU Type of Const: Fuel Piping 06/04/2018 $14.15
Occupancy Grp: Minimum Fee Adjustment-Mechanical 06/04/2018 $5.78
Stories: 12%State Surcharge-Mechanical 06/04/2018 $10.80
Fuel
Fuel Types: Natural Gas
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 calling5/ /.232.1987 or 1.800.332.2344.
Issued By: 0 "4/ ,, ‘,,,o_ 0.7.:....„. „.".00,„_ Permittee Signature: ,,,";/4Go /l
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.
Jun 14 2018 13:01 Columbia Heating Cooling 503-598-0270 page 1
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please, acid W-171- Veii-f-Ins apP 1
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Mechanical Permit Applies i - • ?t-- VL., .,-,r FOR()Flit l-,1 SF oNi.
City of TigardR....i..d
'ow eltemy: Permit No.V:t ja ii?rt)0100
• 1312B
5 SW eT
l Blvd., igard,OR 97223 JUN 1 4 2013 iNan Rey]
1141' - Phone: 503.718.2439 Pax: 503,598.1r,, r,t. t_tr.x 171_,, Date/By: Other Pane&
TR;,,,rz.0 inspection Line: 503.639.4175 T kir i iv;it-Irl t) Date ReadpliY: Anis, el ee Page 2 for
Internet: www,tigard-or,gov 31,111.D1 NG 1)1V1S101\ N'r""dethpd: SopPloncnrol Information 1
_________ _ , ,.., • : . :,.,-, .. . • . •, • •Tt
: • : • :,- • ' pr:16iF.:„.%iit6.#4 .:i:::tg,!!!..r.,#,.,. ;;.,;, ::1;3:!,.k:i. _;i,: :: :'1;:,010fERCIAlf:TFP4EM34
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Mechanical permit fees'arc based on the value of the work 1
1:1 NCW construction k Add iti cmlal terationireplacement performed.Indicate the value(rounded:to the nearest dollar)of A I
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and prof+I.
, Value:S
: ;I:, •••:'' ' tli:1*04AY,tiF dONtrittitifidPf:',.'il.. rr,,. .!. ,,4'.,.,-':.',,.' ; .,,, --.:, ,, , ,:.,,.., .,... 7,-, ,: ...
FLI
'1)Er41.-and 2-family dwelling C-.1 Commercial/industrial 0 Accessory building For special information ilse Ntecklist
Ej Multi-family 0 Master builder 0 Other; Dcsenvion -1 Qty. I Ea Total
•' • ': 4Ott;'SITE:101e0.81YriA,TION ANWIR.!eititOV..t?. .,! ''''''::!i''•‘77':''..' •
14.1iernconditc:Itihtrigr.
Job site address: C i k)ip . t , 647111 1)11E . tccquites sue plan showing placement) , 46.75
furnace 100,000 BTU(ducts/vans) . 46.75_
C ityiStiaciZIP: ' *0 ili '6
Furnace 100.000+PITU(duetsivents) ] 54.91
Suite/bldg./apt.no.: C Project name', 4. CIO if a d Heat pump
(requires eite plan shenvimplarement) ! ,. 61.06
Cross street/directions to job si(e: Duct work 23.32 , •& ,
llydrenic hot water system 1 23.32 ,
Residential boiler(mdiator or
hydronic) . 23.32
- Unit heaters(fuel-type,not electric). '.
in-wall.irt-duct,suspended,etc. 46.75
Subdivision: LOt no.: event for;my of above 23.32
Other - 23.32
Tax murparcel no.: --, -
Other feel appliances;
.
.: • ':."‘ ''.. ""-•:• ''•'nr4cVrI,WorAypAtii: ::-.3-.N,. - : •,-•.....:.,:::,-:..-.,,i-q,!!-y.;.: ,Water healer 23.32
.‘-ter hon - verii-. 4-r)
-, -it a tat 11_1 1,1
------T4 Gas ftreplace
Flue vent for water beater or gas ,
fireplace 33.39 '
23.32
- Log lighter gas) 23.32
,MI
Wood/pellet stove : 33.39
,
Wood fireplace/insert 23.32
' •
.531.PRPERP -gg :--;. . . . a.
Chi atey/liner/fuelvent ' 23.32
.01* ii ,„,‘ , :q : Oher:
23.32
F.1:2zt/:_aytraCt..._ _Al
Environmental exhaust and ventilatibm _ _______ ___
Address: 7/1.4..a.D ;-.'.•+h (..de...,„ Range Mod/other kitchen
equipment 33.39
City/StateiZIP: i it i OA critat el Clothes dryer exhaust
Single-duct,exhaust(bathrooms.
Phone:( 1 Fax:( ) toilet compartmcits,utility nuns) _ 33.39
23.32
0..Ae11$1.CA.N1' • .•'' , . ', -..':,•i'-,:.,,13,CoNTA04.,•!.otitistoc„.:.,c.::4,,., .. Alticlerawlspace fans 2132
liminess name:Cltillmbis Floating and Coaling,Inc. (10ter iritnikieti.V4 -7, I
Fuel piplatu
Unniact name:Marietta Meedoin $14.15 for that four;84.03 To each additional
Ackiress:PO Box 230397 Furnace,eto . .
Gat heat punt"
City/Sttote7IP:97281
Wallistopendediunit heater
Phone:(503)624.2704 Fax::(503)598-0270 ' 7w1*ter heater
, -
Fireplace
E-mail:colambhetteleport.com
. Range
: . ,..-.i:"'::••••••••:.', • ' CONTRA.eiri*:: :':°1!-7:.:• ; .:7,,,•'.: : :•:; • f-71.',• Barbecue
titisiness name:Columbia Cleating anti(:oaling,Inc. _Clothes dryer(gm) . .
Other;
Address:Pt)Box 230397
. t,. .y7:;.!:::,5,f,E,4:1iAgiLe4c14.,E44,414±,O.BE84".1''','
niyiSiatc/ZIP.,.Tigard,OR 97281 Subtotal
, Minimum permit fee($90.00)
Phone:t51}3)624-2704 I Fax;(50315913-0270
Plan review(25%of permit ree)
-
1 CCB lie.:76359 State surcharge(12%ofpermit fee) _
TOTAL PERMIT FEE ..,
Authorized signature:JIAathita..k,1 This permit a pplicadno expires lea permit is net ebtanted%within 180
&VI Sher It has been Accepted as romplere.
i Print name:Marlena R Meedom Date:40_7 ....18 ' rev pielliodology ad by Tri-County Building industry Service&did
i_ SSSiS .1.114%17T J I I arlairOWWFFIS
Jun 08 2018 13:07 Columbia Heating Cooing 503-598-0270 page 1
4,..5Ar RESER/Er)
/Ill Community Development
JUN 1 i 7018
TIG
ARD Request for Permit Action CITY OF I IAHL)
BUILDING tiros l
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: 0 Owner ❑ Applicant a Contractor ❑ City Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) / k h a/ f'k IN 6_, %T" cook/
106_,6''
Mailing Address: 1 '7
City/State/Zip: 7% Rn o/ ! 7.2 W
Phone No.: a51).9- 4r q IQ 70 C„!
�
PLEASE TAKE ACTION FOR THE ITEM(S)CHECKED (1):•
g. CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt,if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT(do not cancel permit).
Permit#: M E3_20!t,-OC
Site Address or Parcel#: 9i 14,4a 61.1.) (00-th Ave_
Project Name: C9ar rid
Subdivision Name: Lot#:
EXPLANATION: .' A , -(/1 L I9SU~ ,1♦.' II i lugs' /
Sc I i IV/lJ '' 2 �.//.J� 9
Signature:
1....21.1111% Date: C o- 7-16b
Print Name: /7/) j"/ fl(), ,f..Q(I
Refund Policy C .ez} 702, Ertl /rn.- ce
1. The Director or Building Official may authorise the refund of 41,dLJ e', /v y = /4,
a) any fee which was erroneously paid or collected. rt"e .c t) /
6'
b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review of ort has been expended.
c) not more than 80" of the land use application fee for issued permits.
d) not more than 805 t of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80"a of the building petmit 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. Pease allow 1-2 week,for processing refunds.
I'OR 5)1 }JCL I SLONI '
Rte to Sys Admin, Date By Rte to Bldg Amain: _Date 3 2-41 /- B. 4"'
Refund Processed: Date 4,177� By .q/'_, Invoice Processed: Date By
Permit Canceled: Date 4,//3//r B-- Parcel Tag Added: Date By
Receipt 4 Date Method Amount$
L'\Budding\14orzns\RegPemlitAetion.doc Rev 117/26/07
11111
G .
TIGARD
City of Tigard
July 16, 2018
Columbia Heating& Cooling
Attn: Marlena Meedom
PO Box 230397
Tigard, OR 97281
Re: Permit No. MEC2018-00406
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9166 SW 66th Ave.
Project Name: Garland
Job No.:
Refund Method: ® Check#228916 in the amount of$80.64.
0 Credit card"return"receipt in the amount of$
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 this was a duplicate permit (see MEC2018-
00399). Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
i
/.d
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
° City of Tigard
T I GA R D 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 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: Columbia Heating& Cooling DATE: 6/22/2018
PO Box 230397
Tigard, OR 97281 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt#: 417594 Case#: MEC2018-00406
Date: 6/4/2018 Address/Parcel: 9166 SW 66th Ave.
Pay Method: CreditCard Project Name: Garland
EXPLANATION: Per applicant's request as this was a duplicate permit(see MEC2018-00399). Refund
r� 80%� of permit fees.
'
Vl N ` FOA` IOR ta x 4
Fee �►esc p n l'roi Receipt` R even e c� nt No
a :
Mechanical Permit Fee 230-0000-43102 $72.00
12%State Surcharge 100-0000-24001 8.64
TOTAL REFUND: $80.64
APPROVALS: SIGArdb . • ES 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
=FORTIP*MA, S '' �i'EM'O/liONTST TION TSE tinir ,
,
Case Refund Processed: Date: 3p,;/ By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010