Permit Support Document (10) CITY OF TIGARD M- MECHANICAL PERMIT
FAIM
COMMUNITY DEVELOPMENT Permit#: MEC2018-00938
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/04/2018
T f t' !t�O g Parcel: 2S 1028801000
Jurisdiction: Tigard
Site address: 10085 SW JOHNSON ST
Project: BLP-10085 Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 10
Project Description: modification of ductwork to home,venting for 2 bath fans, 1 dryer fan and 1 range. 12/17/2018: REPRINT permit
to correct number of duct work.
Contractor: ULTIMATE COMFORT Owner: BUZZARD LAKE PROPERTIES LLC
5946 SE LLOYD ST 6708 SE OVERLAND ST
MILWAUKIE, OR 97222 MILWAUKIE, OR 97222
PHONE: 503-786-0494 PHONE:
FAX: 503-821-7423
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 12/04/2018 $33.39
Type of Use: SFA Clothes Dryer Exhaust 12/04/2018 $33.39
Class of Work: ALT Type of Const: Single Duct Exhaust(Bathrooms,Toilet, 12/04/2018 $46.64
Occupancy Grp: Utility Rooms)
Stories: Duct Work 12/04/2018 $23.32
12%State Surcharge-Mechanical 12/04/2018 $16.41
Investigation Fee 12/04/2018 $90.00
Investigation 12%State Surcharge 12/04/2018 $10.80
Cash Over 12/04/2018 $186.50
Fuel
Fuel Types:
Gas Pressure:
Total $440.45
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. �r
Issued By: Permittee 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 completion of the project.
Approved plans are required on the job site at the time of each inspection.
1111
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TIGARD
City of Tigard
January 24,2019
Ultimate Comfort
5946 SE Lloyd St.
Milwaukie, OR 97222
Re:Permit No. MEC2018-00938
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 10085 SW Johnson St.
Project Name: BLP-10085
Job No.: N/A
Refund: ® Check#231063 in the amount of$186.50.
❑ Credit card"return"receipt in the amount of$
❑ Trust account"deposit"receipt in the amount of$
Notes: Refund overpayment for duct work permit taken out online.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Howse
Building Division Services Coordinator
Enc.
I:\Building\Refund"s\3AcminiS4Hatretu�n,,d-Uv• y.d c 01 1gor�egon 97223 • 503.639.4171
TTY Relay: 50.684.277 • www.tigard-or.gov
1111 CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TEG A R:D
Project Name: BLP-10085
Site Address: 10085 SW JOHNSON ST 052,1 IV.4.
Receipt Number: 421251 - 01/25/2019
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2018-00938 $-186.50
Total: $-186.50
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 231063 DHOWSE 01/25/2019 $-186.50
Payor: Ultimate Comfort
Total Payments: $-186.50
Balance Due: $186.50
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CITY OF TIGARD RECEIPT
i 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
_rr r t;. f t
Project Name: BLP-10085
Site Address: 10085 SW JOHNSON ST er2/ (1��t--
Receipt Number: 420600 - 12/04/2018
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2018-00938 Range Hood/Other Kitchen 230-0000-43102 $33.39
MEC2018-00938 Clothes Dryer Exhaust 230-0000-43102 $33.39
MEC2018-00938 Single Duct Exhaust(Bathrooms, Toilet, 230-0000-43102 $46.64
Utility Rooms)
MEC2018-00938 Duct Work 230-0000-43102 $23.32
MEC2018-00938 12%State Surcharge-Mechanical 100-0000-24001 $16.41
MEC2018-00938 Investigation Fee 230-0000-43102 $90.00
MEC2018-00938 Investigation 12%State Surcharge 100-0000-24001 $10.80
MEC2018-00938 Cash Over 100-0000-48001 $186.50 G
Total: $440.45
PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 004133 PUBLICUSER116 12/04/2018 $440.45
Payor: Ralph Shafer
Total Payments: $440.45
Balance Due: $0.00
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