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Permit CITY OF TIGARD MECHANICAL PERMIT Ili g COMMUNITY DEVELOPMENT Permit #: MEC2009 -00517 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/02/2009 T:iGARD 9 Parcel: 1 S 134A601600 Jurisdiction: Tigard Site address: 11333 SW IRONWOOD LP Subdivision: Lot: 0 Project: Hall Project Description: Install gas line to range. Owner: FEES HALL, CRAIG Description Date Amount 11333 SW IRONWOOD LP Fuel Piping 10/02/2009 $5.40 TIGARD, OR 97223 12% State Surcharge - Mechanical 10/02/2009 $8.70 PHONE: Minimum Fee Adjustment - Mechanical 10/02/2009 $67.10 Contractor: HEAT RELIEF CO 13122 NE DAVID CIR # 800 PORTLAND, OR 97230 PHONE: 503 - 261 -9915 FAX: 503- 261 -9814 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressue: Total $81.20 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: 1 ` i ,-: f Permittee Si ,^ Call 503.639.4175 by 7:00 a.m. for an inspection that business day. � 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 V FO OFFICE USE ONLY City of Tigard �( �, ' re ce i ved ' J g Date/By: I Permit No.: G S II = " 13125 SW Hall Blvd., Tigard, OR 97223 a 4 — I ��� )� Phone: 503.639.4171 Fax: 503.598.1960 S E P 3 0 2004 Plan Review Other Permit: Inspection Line: 503.639.4175 Date/By: TIGARD rt .te Ready/Sy: See Supplemental S Internet: www.tigard- or.gov CITY OF TIG ' a r•otified/Method: Supplemental Information BUILDING DIVI i - ❑ New construction CO Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. s , # �, t y _ _ Value: $ ❑ I and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ® Multi family ❑ Master builder For special information use checklist. Description I Qty. I Ea. I Total RgAtEN Z , .7, l # t It i o < T _ 1 � H eat i ng/coo l ing Job site address: .�„`•" o Air conditioning or heat pump g - ` — - ,°I '. L� d ( requires site plan showing placement) 14.00 City/State/ZIP: / - / (J) Q 7 � Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 Hydmnic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 10.00 Subdivision: I Lot no.: Flue/vent for any of above 10.00 Other. 10.00 Tax map /parcel no.: Other fuel appliances 2*- 3r"' y a fs T !@t , hdi# 4 a d' : Qi, A ' -n, >'r Water heater 10.00 Gas fireplace 10.00 , / r Flue vent for water heater or gas / / �i i A / j / fireplace 10.00 1 de Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 t tl' 4' , 3 a i Chimn /liner /flue/vent 10.00 = . =� , Other. 10.00 Name: `�i y ;pip / Environmental exhaust and ventilation Address: Range hood/other kitchen equipment 10.00 City/ State/ZIP: Clothes dryer exhaust 10.00 Phone: ( ) Fax: Single -duct exhaust (bathrooms, ( ) toilet compartments, utility moms) 6.80 `. - 3 a . e r. u, s 'F r 1), ~` i Attic /cmwispace fans 10.00 Business name: HEAT RELIEF Other: 10.00 Fuel piping Contact name: MARK - DEFRANCISCO $5.40 for first four; $1.00 for each additional Address: 13122 NE DAVID CIR DR # 800 Furnace, etc. Gas heat pump City/State/ZIP: PORTLAND, OR 97230 Wall/suspended/unit heater Water heater Phone: (503) 261 -9915 I Fax: : (503) 261 -9814 Fireplace E-mail: Range Ba { 5 w5 # a i # ' � zx 6 . -,, : ;d: w�'`zzi tfiecue -T - ,,. 1�' s,:m6� . , ..... ` Clothes dryer (gam) Business name: HEAT RELIEF Other: Address: 13122 NE DAVID CIR DR # 800 :?� s` e City/State/ZIP: PORTLAND, OR 97230 Subtotal /0 Minimum permit fee ($72.50) a Phone: (503) 261 - 9915 Fax: (503) 261 -9814 Plan i 4s---D an review (25% of permit fee) CCB lic.: 122424 State surcharge (12% of permit fee) ,'70 TOTAL PERMIT FEE s �.� /l This permit application expires if a permit is not obtain within 80 / Authorized signature: L_ �_ /e zAi days after it has been accepted as complete. Print name: MARK DEFRANCISCO Date: * Fee methodology set by Tri -County Building Industry Service Board City of Tigard, Oregon ° 13125 SW Hall Blvd. ° Tigard, OR 97223 U1 1, . . . . , November 20, 2009 Heat Relief & Cooling 13122 NE David Circle, #800 Portland, OR 97230 Attn: Mark DeFrancisco Re: Permit No. MEC2009 -00517 Dear Mr. DeFrancisco: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 11333 SW Ironwood Pl. Project Name: Hall Job No.: N/A Refund: ® Check #101655 in the amount of $64.96. ❑ Credit card "return" receipt in the amount of $ . ❑ Trust account "deposit" receipt in the amount of $ . Notes: Per applicant's request as customer cancelled job. Refund 80% of permit fees. If you have any questions please contact me at 503.718.2430. Sincerely, Dianna Howse Building Division Services Supervisor Enc. I: \Building\ Refunds\ Administration \LtrRefund- CancelPermit.doc 01/16/07 Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov a TTY Relay: 503.684.2772 a City of Tigard TIGARD \ Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request Ibr Permit Action or Refund form (if applicable) must be attached to this form. Refund requests are due to Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Hcat Relief & Cooling DATE: 11 /5/09 13122 NE David Circle, #800 Portland, OR 97230 REQUESTED BY: Dianna Howse Attn: Mark DeFrancisco TRANSACTION INFORMATION: Receipt #: 175448 Case #: MEC2009 -00517 Date: 10/2/09 Address /Parcel: 11333 SW Ironwood Pl. Pay Method: Check Project Name: Hall EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% of permit fees. c REFUND' „INFORMATION: Fee 'Descriptiori :Receipt. ': ' Revenue :Account No: ;:Ref E'it ` le ' U;II D. .I?er'rriif Fee «` Exam le: . p. Mechanical permit fees 2300000 -43102 $58.00 12% State Surcharge 1003100 -24001 6.96 TOTAL REFUND: $64.96 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager 111140.4 1 ( \ 1 If under $22,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board ::' ..FOR'ACCELA SYSTEM ADMINISTRATION USE ONLY Refund Request Reviewed: _ Date: By ' Case Refund Processed: Date: r i G / By: 1: \Building \ Refunds \RefundRequest.doc 04/13/09 .4 RECEIPT q CITY OF TIGARD E a 13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD /' U A/i� Receipt Number: 176094 - 11/20/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2009 - 00517 $ - 64.96 Total: $ -64.96 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 101655 DHOWSE 11/20/2009 $ -64.96 Payor: Heat Relief & Cooling Total Payments: $ - 64.96 Balance Due: $64.96 • , J rr � ! \ N O v , Q 0 \y ' ti - A. L L O W y v � . ch. o v -C C • v) iii O ` '+ y 0 P.) :.§: 1 0 ( V N u V u w v a) V C 1, �i � 'V h 0 0.i 4j Q G Q �l w h S lx 1 v c n s C ;.1 -, o �Wx ��U o W h s O. r \ 0 .r,+I p C9 >> y v N . Q 2 a, \ u.. a) A H w e a -.1 • • • Page 1 of 1 • +1 CITY OF TIGARD RECEIPT it . _ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 T [GARD C)/e_,i6 Receipt Number: 175448 - 10/02/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2009 -00517 Fuel Piping 2300000 -43102 $5.40 MEC2009 -00517 12% State Surcharge - Mechanical 1003100 -24001 $8.70 MEC2009 -00517 Minimum Fee Adjustment - Mechanical 2300000 -43102 $67.10 Total: $81.20 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Check 9144 LSELLERS 10/02/2009 $81.20 Payor: Heat Relief & Cooling Total Payments: $81.20 Balance Due: $0.00 Page 1 of 1 • "0/21./2009 WED 16:25 FAX 5032619184 001 /001. • Communi ty Development , rn -� • ; , TIGARD Request forPeutAction ''�' � `� ' r f, f1 TO: CITY OF TIGARD CfT aF Tf GAt�D Building Division Services Coordinator c ;;ll pl?�1Ci DIVISIC31\ 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov FROM: El Owner ❑ Applicant ® Contractor El Cit Staff • (check one) REFUND OR Name: HEAT RELIEF INVOICE TO: (Business or Individual) Mailing Address: 13122 NE DAVID QRCI.R # 800 City /State /Zip: PORTLAND, OR. 97230 Phone No.: (503) 261 -9915 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ® 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 # : MEC2009 -00517 Site Address or Parcel # : 11333 SW IRONWOOD PL PARCEL # 1S134AB01600 Project Name: CRAIG HALL Subdivision Name: Lot # : EXPLANATION: CUSTOMER CANCELLED Signature: // Date: 10/21/2009 MARK D . CIS • Print Name: - Refund Policy 1. The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended e) not more than 80% of the building permit 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. Please allow 1 -2 weeks for processing refunds. {�` ire � j� +- '.��{'• r 'ilf'��d y , +xx�, o1 \ "vEFICIrA USfr ONLY ��� F - rrz.u-.�a'�S iF 1 t . Y ll:v.L. ..1 iF. \..,. 7:..t -.; \ 7�.: ..cM1:.I. 1.�it�:'h �i,t'.. ., -:..., N. .- ....- ..+�... ... _l:,.. .-- �,. - .J].1 ..3�•. a1 F .,�, i4 f. ! .::,; .ti, I 4t. .. 1. .; � },, Rte to Sys Admin: Date By Rte to Bldg Adrnin: Date .1' ?� /G' 9 By • -" Refund Processed: Date/7/.:2-e-/e." j By !- Invoice Processed: Date By • Permit Canceled: Date • / (;!'- rc /i';= B Parcel Tag Added: Date By Receipt # /7.5" d -Date Method ,- Amount $ I:\ Building \Forts \RegPermitAction.doc Rev 07/26/07 Ph .6 22o 7 - 7 City of Tigard T[GARD, Accela Refund Request This form is used for refund requests of land use, engineering and building application fees. Receipts, documentation and the Request jOr hermit Action or Refund form Of applicable) must be attached to this form. Refund requests are due to Accela System Administrator by Friday at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Accela System . Adtinistrator for distribution. Please allow 1 -2 weeks for processing. PAYABLE TO: Heat Relief & Cooling DATE: 11/5/09 13122 NE David Circle, #800 Portland, OR 97230 REQUESTED BY: Dianna Howse Attn: Mark DeFrancisco TRANSACTION INFORMATION: Receipt #: 175448 Case #: MEC2009 -00517 Date: 10/2/09 Address /Parcel: 11333 SW Ironwood Pl. Pay Method: Check Project Name: Hall EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% of permit fees. REFUND'INFORMATION: Fee D From Receipt • Revenue Account No.. ,..Refund Example: [BUILD] Permit Fee Example: 245- 0000 - 432000 • • $ Amount Mechanical permit fees 2300000 - 43102 $58.00 12% State Surcharge 1003100 -24001 6.96 TOTAL REFUND: $64.96 APPROVALS: If under $500 Professional Staff If under $7,500 Division Manager Jl %ti I under $22,500 Department Manager If under $50,000 City Manager if over $50,000 Local Contract Review Board FOR ACCELA SYSTEM ADMINISTRATION USE ONLY • Refund Request Reviewed: Date_ B Case Refund Processed: Date: By ~- = 1:ABuilding \Refunds \RefundRapesL do: 04/13/09 . ;0/21/2009 WED 16:25 FAX 5032619184 Z 001 /001. ii iVe L Z)0 "OCD- / 7 miiii IN ° C ommunity development 1q 1 Request ��CE� TG A uest for Permit Action OCR 2 t 2c109 TO: CITY OF TIGARD CITE' OF TIGARD Building Division Services Coordinator BUILDING D VISION 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax 503.598.1960 www.tigard- or.gov FROM: ❑ Owner ❑ Applicant ® Contractor ❑ City Staff (check one) REFUND OR Name: HEAT RELIEF INVOICE TO: (Business or Individual) Mailing Address: 13122 NE DAVID CIRCLF, # 800 City/State /Zip: PORTLAND, OR 97230 Phone No.: (503) 261 -9915 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( ✓): ® 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 # : MEC2009 -00517 Site Address or Parcel # : 11333 SW IRONWOOD PL PARCEL # 1S134AB01600 Project Name: CRAIG HALL Subdivision Name: Lot # : EXPLANATION: CUSTOMER CANCET F D • Signature: / Date: 10/21/2009 MARK D ,� . CIS, •,- Print Name: Lisi +r1 .ei_: _ .ddu4., ?fund Policy 1. The Director or Building Official 'nay authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. e) not more than 80% of the building permit 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. Please allow 1 -2 weeks for processing refunds. ` .`` S biai i .. :: l - sx riera FOIZTOFFI IVSKONKVMYt , 4.. ' TM .;: j a ife Rte to S Admin: Date B Rte to Bid: Admix' Date < Ann B Refund Processed: Date / /Oath B 4� Invoice Processed: Date B Permit Canceled: Date / /A� :-;j Parcel T. • Added: Date B Recei.t # / .5 Date /0 .2 0 Method 445911111111.1111 Amount $ I:\ Building \Forms \RegPermitActioad.. ` v 07/26/07