Permit RECF►VFD
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT MAY 2 8 2020
TIGARD
Request for Permit Action BUILDING+�3 "a DIVISION
T I G A R I) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor City Staff
Check(1)one
REFUND OR Name: f�
INVOICE TO: (Business or Individual) C/Ice I;�i: 7 *-rG- 7/� ca p I- fN6r
Mailing Address: 7.oi) f 4-.9 7` e.rA/7E-72. _2!2 / 0
City/State/Zip: 77 ,q / 9i(. 9'7 2- 3
Phone No.: 50 (D 26 - Co q 3
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
❑ CANC - PERMIT APPLICATION.
REFUND-13E IT FEES (attach copy of original receipt and provide explanation below).
IN R FEES DUE (attach case fee schedule and provide explanation below).
Permit#: ,,i/ �`�dZU;S v -002 S 7 /
Site Address or Parcel#: /3 j 7 3 S �CG�'�/ L . —
Project Name: '/Z- / , ' 06(/
Subdivision Name: /� Lot#: ---
EXPLANATION: Ader-Z . •
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Signature: &", , - Date: .1./ G
Print Name: Tuii' /Qti)4/<4 y-,---
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
Route to Sys Admin: Date S- By Route to Records: Date/az g/2J By 0
Refund Processed: Date qy 1,0 Li By 47 Invoice Processed: Date ! i By
Permit Canceled: Date 4// By, e) Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_120 18. oc
TIGARD
Tigard
g
October 3,2021 City of Ti
Specialty Heating&Cooling
7500 SW Tech Center Dr, 130
Tigard, OR 97223
Re: Permit No. MEC2020-00257
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: 13035 SW Pacific Hwy
Project Name: Alexin Analytical Labs
Job No.: N/A
Refund: ® Check#2'1'D(ein the amount of$90.00.
❑ Credit card"return" receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Refund additional plan review fee collected in error.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Ornelas
Building Division Services Coordinator
Enc.
\Building\RefundaLai orKaeBdar-dvetp4igarciategon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
' City of Tigard
1(, �`�� 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: Specialty Heating&Cooling DATE: September 20,2021
7500 SW Tech Center Dr,Ste 130 '
Tigard,OR 97223 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 429381 Case#: MEC2020-00257
Date: 5/15/2020 Address/Parcel: 13035 SW Pacific Hwy
Pay Method: CreditCard Project Name: Alexin Analytical Labs
EXPLANATION: Customer charged additional$90.00 plan review fee in error;refund 100%.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Plan Review 230-0000-43111 $90.00
TOTAL REFUND: $90.00
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff ,,,,��,�,,""
If under$12,500 Division Manager 'D. L. (9Yrte.Za4
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: /lo/ z3/ -/ By: 1,47 0
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
71 q
CITY OF TIGARD RECEIPT
# 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Alexin Analytical Labs
Site Address: 13035 SW PACIFIC HWY /6--. 11)ti46,
Receipt Number: 437131 - 10/23/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2020-00257 $-90.00
Total: $-90.00
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 240698 DHOWSE 10/23/2021 $-90.00
Payor: Specialty Heating&Cooling
Total Payments: $-90.00
Balance Due: $90.00
Page 1 of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
-- 503.639.4171
If(IA D
Project Name: Alexin Analytical Labs
Site Address: 13035 SW PACIFIC HWY
Receipt Number: 429381 - 05/15/2020
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2020-00257 Permit Fee 230-0000-43102 $188.79
MEC2020-00257 Plan Review 230-0000-43111 $47.20
MEC2020-00257 12%State Surcharge-Mechanical 100-0000-24001 $22.65
MEC2020-00257 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $3.00
11x17)
MEC2020-00257 Additional Plan Review 230-0000-43111 $90.00 &—
Total: $351.64
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 6370957 PUBLICUSERO 05/15/2020 $351.64
Payor:
Total Payments: $351.64
Balance Due: $0.00
Page 1 of 1
.
CITY OF TIGARD RECEIPT
11111 a 2 • 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
T(GARI)
Project Name: Alexin Analytical Labs
Site Address: 13035 SW PACIFIC HWY
Receipt Number: 429381 - 05/15/2020
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2020-00257 Permit Fee 230-0000-43102 $188.79
MEC2020-00257 Plan Review 230-0000-43111 $47.20
MEC2020-00257 12%State Surcharge-Mechanical 100-0000-24001 $22.65
MEC2020-00257 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $3.00
11x17)
MEC2020-00257 Additional Plan Review 230-0000-43111 $90.00
Total: $351.64
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 6370957 PUBLICUSERO 05/15/2020 $351.64
Payor:
Total Payments: $351.64
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD MECHANICAL PERMIT
INa. . COMMUNITY DEVELOPMENT Permit#: MEC2020-00257
T I A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/15/2020
U
Parcel: 2S 102BD03000
Jurisdiction: Tigard
Site address: 13035 SW PACIFIC HWY
Project: Alexin Analytical Labs Subdivision: NORTH TIGARDVILLE ADDITION Lot 35
Project Description: Replacing gas furnace like for like.
Contractor: SPECIALTY HEATING&COOLING Owner: TRUCK TERMINALS INC
7500 SW TECH CENTER DR STE 15965 NW TULLAMORRIE WAY
PORTLAND, OR 97223 PORTLAND, OR 97229
PHONE: 503-620-5643 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 05/15/2020 $188.79
Class of Work: ALT Type of Const: VB Plan Review 05/15/2020 $47.20
Occupancy Grp: B Occupancy Load: 12%State Surcharge-Mechanical 05/15/2020 $22.65
Stories: Info Process/Archiving-Sm$0.50(up to 05/15/2020 $3.00
11x17)
Project Valuation: $4,350.00 Additional Plan Review 05/15/2020 $90.00
Fuel Air Handlers
Fuel Types: Natural Gas Units<10000 cfm:
Gas Pressure: Units>10000 cfm:
Furnaces Boilers&Compressors
Furnaces< 100K BTU: 1 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 $351.64
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
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 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. 2.1987 or 1.800.332.2344. /7�/
Issued By: /�^ 2 � .^� Permittee Signature: , ,-,H., //-z
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.
Mechanical Permit Application 1 )R O1 l,t_i-: t ,F:I)SI
City of Tigard Received
Dale/BY .�72�k)/i rk-zo�J - J-2S l
_J Phone: 1 7 503.718.2439 6R0 xj7(_ , ` Plan Review
13125III SW Hall Blvd..Tigard,OR 97223 t �—� /J
inn
ne•
+ —'ffYi
Fax: 503.598 196D Date/By: �
-- __. -----Qatc Rwd gee Page trbr-_ -
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Internet: www.tigard-or.gov Naified/Method. TT,7:o /,i Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE— USE CHECKLIST
Mechanical permit fees'are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$4,350.0
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building For special information use checklist.
❑Multi-family ❑Master builder 0 Other: Description ! Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address:13035 SW Pacific Hwy Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP:Tigard Furnace 100,000+BTU(duets/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: I Project name:Alexin Analytical Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct.suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Other. 23.32
Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
Replace 95%gas furnace with new 96%furnace.Like fo Like. fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insen 23.32
Chimney/iiner/fluelvent 23.32
® TENANT Other: 23.32
0 PROPERTY OWNER Environmental exhaust and ventilation:
Name:Alexin Analytical Range hood/other kitchen
' equipment 33.39
Address:13035 SW Pacific Hwy. Clothes dryer exhaust 33.39
City/State/ZIP:Tigard 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) , 23.32
Phone:(9503)639-9311 Fax:( ) Attic/crawlspacc fans 23.32
® APPLICANT ® CONTACT PERSON Other: 23.32
Business name:Specialty Heating and Cooling LLC Fuel piping:
814.15 for first four;54,03 for each additional
Contact name:Jeff Schwab Furnace,etc.
Address:7500 SW Tech Center Dr.#130 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:Tigard 97223 Water heater
Phone:(503)616-0773 Fax::( ) Fireplace
r Range
E-mail:jeffs@specialtyheating.com Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Specialty Heating and Cooling LLC Other:
MECHANICAL PERMIT FEES
Address:7500 SW Tech Center Dr.#130 Subtotal
City/State/ZIP:Tigard 97223 Minimum permit fee(590.00)
Plan review(25%of permit fee) _
Phone:(503)616-0773 Fax:( ) State surcharge(12%of permit fee)
CCB tic.:224977 TOTAL PERMIT FEE
This permit application expires if a permit k not obtained within ISO
_a/
days after it has been accepted as complete.
Authorized signature: ' Fee methodology set by Tn-County Building Industry Service Board
Print name:Jeff Schwab Date:5/6/2020
I:BuildingUMritstMEC PermIApp_0411113 doe 440.4617TI 11/02./COMMTll1