Permit •
CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00426
DATE ISSUED: 8/13/2008
T►G_nitD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102C6 - 06200
SITE ADDRE:.'3_', 10475 SW GRANT CT ZONING: R -4.5
SUBDIVISION: ' „!!(INSOME TERRRACE LOT: 006 JURISDICTION: TIG
PROJECT: HOt;?'NITZ
Project Description: Replacing race and A/C.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
ALAN HOROWITZ Description Date Amount
JUDITH BERMAN
10475 SW GRANT COURT [MECH] Permit Fee 8113/200€ $72.50
TIGARD, OR 97223 [TAX] 12% State Surch 8/13/200E $8.70
Total $81.20
Phone: 503- 475 -1572
Contractor:
CLIMATE CONTROL INC
16500 SW 72ND AVE
PORTLAND, OR 97224 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 453 -4822
FAX 503- 968 -7224
Reg #: LIC 62196
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ~ 'ermittee Signature: cg7 elV
Call o . = '•.4175 by 7:00 a.m. for inspections that busineseday.
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.
Rug 13 2008 2:37PM CLIMATE CONTROL INC 5039687224 p. 2
- - .n ehanical Permit Application yy ` y k` tffi r M"5`' ' !d m . *1 " +' E, kg7r-1. T -
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'i� City of Tigard � , tl Receiv ed y ` . ,, 13125 S W Hall Blvd., Tigard, OR 972 o l�l�, /� �/ y DatelBy: 7 /1 . .tea , " tv
F.1 Phone: 503.639.4171 Fax: 503.598. Plan Review
: Inspection Line: 503.639.4175 ^ DatetBy: artier Permit: 4.-):•''',.'i4' 1 v h n 81J� Date ReadyBy:
' " 4!sk a Internet t: www.tigard- or.gov a )aria' l 121 Set Page 2 for
"
A �r NotiaedMethod: -S'& I Supplementallnformation
l7 i r
I �
TYPE OF WORK e. s . m..5!.;y COMMERCIAL FEE* SCHEDULE - USE C1ftC1iCLIST
❑ New construction 'Addition(alterat ` rig f *. i Mechanical pennit fees* are based cnthe value of the work
❑ Demolition 0 Other: B I mechanical lndicae estte value (rounded to the nearest dollar) of all
equipment labor, overhead, aid profit.
CATEGORY OF CONSTRUCTION Value: $
..,23Commercial/industrial 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
Q Multi family ❑Master builder ❑Other: For special information use checklist.
Description 1 Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION
Healing/cooling
Job site address: / f-75 S ` , . ) 6 ra , I Air conditioning or heat pump
City/State/ZIP: r r , J !JL/ �' (requires site plan showing placement) 1 14.00 L I
GP a Furnace 100,000 BTU (duets/vents) ( 14.00 1 L I
Suite/bldg./apt. no.: ,Project name: t Furnace 100,000+ B7.1 (ducts /vents) 17.90
Cross street/directions to job site: Gas heal pump 1400
Duct work _ 1000
HYdronic hot water system 14.00
Residential boiler (radiator or )
hydronic) 1400
Unit heaters (fiiel -type, not electric), 4 I
in -wall, in -duct, suspended, etc. 1 14.00
Subdivision: I Lot no.: Flue/vent for any of above I 6.80
Tax map /parcel no.: l 10.00
Other fuel appliances
DESCRIPTION OF WORK Water heater 1 10.00
tIA 4 C& Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
•
_ Wood fireplace/insert 10.00
F(PROPERTY OWNER 1 ❑ TENANT Chimney/liner/flue/vent 10.00
Name: �yLA ' 3u d / Oahu: 10.00
1 r� + Environmental exhaust and ventilation
Address: ' D 1.i7 P S 6 ry , r1� Q Range hood/other kitchen
j J f C.l
equipment
City/State/ZIP : - �) D r/ o , 10.00
! � r o 9 -72.2- Clothes dryer exhaust 10.00
Phone: ( ) q 7 6-7 Z I Fax: ( ) • Single -duct exhaust {bathrooms,
At toilet compartments, utility rooms) j 6.80
• APPLICANT 70.00
❑CONTACT PERSON Attidcrawlspace fans
Business name: f ) tr» `7 Z n 41,-04_ i n e....„,
Other: ! 1 10.00 1
Contact name: ,- ij r / r' 'T Fuel piping
Ro ( $5.40 for first four; 51.00 for each additional
Address: t G 5 OO t■i.) 72 4 Furnace, etc.
City /State/ZIP: Po (T n d 0-r � �� Gas heat pump
Phone: (Saz ) C' j � Walllsuspended/unitheata
t- j 5� D Z � i Fax ( i ` ) 9 � - z z y Water heater
C'Ot Q L' i tm a 4 C n� 1 I n C -)
Fireplace
E -mail:
I C� y1'1 l R
CONTRACTOR Barbecue
Business name: ter d T_" ( 2 o I 1 n C Clothes dryer (gas)
-
Address: )16 5 0 0 SA) -7,21 O L -- Other:
MECHANICAL PERMIT FEES*
City/State/ZIP: Po r rice 6 d or q` 2
S� ) ) f i Subtotal - Z�a
Phone: (
3 `7, s3 � LZZr Fax: ( S ) q $ ._.- 7_2_,./ Minimum permit fee ($72.50)
- 7Z .S
CCB tic.: �1 q V
Plan review (25 °/. of permit fee)
1Y State surcharge (12% of permit fee) e, 7 Q
�)
i TOTAL PERMIT FEE 8/ • 2-Z Authorized signature: I \ Th is permit appticrtioo ex Tres if P permit is not obtained within 180
Pent name: r • days after it bas been accepted as complete.
( rrf S Date: D ; • Fee methodology set by Tri-County Building Industry Service Board
I:' ■rBuilaineermitsN¢C- PcmiUDp.doc 07:19/0' 44 - (17 J02/COM/WFb
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JI CITY OF rl'1CAR® 8/
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4:1 3:12PM
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4: Tigard, OR 97223 5113.639.4171 •
It GAR1
Refund Receipt #: 27200800000000003017 /'.f.:= f.:7/i 5
Date: 08/26/2008
Line Items:
Case No "Tau Code Description Revenue .Account No . Amount Paid
MEC2008-00426 Reversal - [MECH] Permit Fee 245-0000-431010 (58.00)
MEC200S -00 426 Reversal - [TAX] 12% State Sur 100- 0000- 207020 (6.96)
•
Line Item Total: ($64.96)
Refund:
Method Payer User ID Acct. /Check No. Approval No. flow Received Amount Paid
Credit Reversal CLIMATE CONTROL INC 04599D Fax (64.96)
Refund Total: ($64.96)
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?► + Tigard, OR 97223 5113,639.4171
Receipt #: 27200800000000002889 2)4,16_- = te -L
Date: 08/13/2008 •
Line I tems:
Case No 'Tau Code Description Revenue Account No Amount Paid
M EC2008 -00426 [MECH] Permit Fee 2 45- 0000- 43I010 72.50
MEC2008 -00426 [TAX] 12% State Surcharge 100- 0000 - 207020 8.70
Line Item Total: $81.20
Payments:
Method Payer User ID Acct. /Check No. Approval No. Ho w Received Amount Paid
CreditCard CLIMATE CONTROL BTT 04599D Fax 81 20
Payment Total: $81.20
•
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"Aug •
18 2008 8:51AM CLIMRTE CONTROL INC 5039687224 p.1
Pe:aived Fax : Au. 16 20FF: 8:4)1 Fax Station : CLIMATE COITROL IMG . 1
Building Division RECEIVED
TI CI RD Request for Permit Action AUG 18 2008
TO: CITY OF TIGARD CITY OF TIGARD
Permit System Administrator BUILDING DIVISION
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigazd- or.gov
FROM: ❑ Owner `I Applicant ❑ Contractor
(check a ❑City Staff
REFUND OR Naiae:
LNVOICE TO: (Hnslnea.n Indirid)aq a fr 4 T �1» = (0 C.
Mailing Address: 1( c) 7 1 2 N fl f7/E
V 0 1 ® Cit /State /zip: f3 ('tCt_ n c1 oNC' ch Zzy •
S z .e Phone No.: 553 4 E.-3-c12zz
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (d):
t= CANCEL PERMIT APPLICAtTION.
• REFUND PERMIT FEES (attach receipt, if available).
INVOICE FOR FEES DUE (attach cue fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: kA, F.z 2t7o3 — by TZLO
She Address or Parcel #: 1b975 SW C)lra nT — CA
Project Name: T ?'A•rb /5 r 9 - 2.i3
Subdivision Name. 1 1 Lo #:
EXPLANATION: CIJ�j ((A1'1CeUed , Ja}� •
•
•
•
Signature: Date: p d
/4 Print Name: Rey /fin $
Bolideihince
1. The Director or Building Official may ourbonce the refland of
a) am fee vhith was or mammal? peal or collected
b) ea mom Chao 80% of the land use application Few when an application is withdrawn or crteeled before any review often hat been eapendod.
e) em mom than erne of the Mud we application tea for issued permit*.
e) not mom dtve NM of dtc building plan review lee when on appkcation is canceled before any plan review cffon has born expended
4) not more dean Mr ref the builm permit fee foe issued pane print to any in peeaiam vegeccet.
2. ReRtndawip ha..etorned to the nri�nel in the are method In whit) yin? war received car .e allow 1.2 wank he prooesaing relnnds.
FOR (.)1j lc_ t:. I.ISE tlN l.1
Ittc to S • Amur Date
Refund Processed: Date . o zd �d I Invoice Dm 26 'MI II _ Z=
QE. � al Invoice Processed: Darr g.
Pernik Canceled: Date `• 'and To Added: One fQM.=
Rem .t # �, , ',y Daft • jj};a Method .9hnount>s
1 :\ Pdtilddog1t 'oems1Rcype.ndititdon,doe R v115 /24/tw
p a es 9
•
g 13 2008 2:37PM CLIMATE CONTROL INC 5039687224 p.3
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City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
F- .11
TIGARD
August 26, 2008
Climate Control Inc.
16500 SW 72n Ave.
Portland, OR 97224
Attn: Roy Harris
Re: Permit No. MEC2008 -00426
Dear Mr. Harris:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 10475 SW Grant Ct.
Project Name: Horowitz
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $64.96.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
4 0947707-e.-
Dianna Howse
Building Division Services Coordinator
Enc. •
I: \Building\ Refunds \Administra tion \LtrRefund- CancelPermitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Climate Control Inc. DATE: 8/26/08
16500 SW 72n Ave.
Portland, OR 97224 REQUESTED BY: Dianna Howse
Attn: Roy Harris
TRANSACTION INFORMATION:
Receipt #: 2008 -2889 Case #: MEC2008 -00426
Date: 8/13/08 Address /Parcel: 10475 SW Grant Ct.
Pay Method: CreditCard Project Name: Horowitz
EXPLANATION: Per applicant's request as job was cancelled. Refund 8O% of permit fees.
REFUND INFORMATION: • • •
Fee Description From Receipt - . • Revenue Account No. Refund
Example: [BUILD] Permit Fee • Example: 245- 0000 - 432000 $ Amount
[MECI -1] Permit Fee 245- 0000 - 431010 $58.00
[TAX] 12% State Surcharge 100 - 0000 - 207020 6.96
•
TOTAL REFUND: $64.96
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager •
If under $22,500 Department Manager
If under $50,000 City Manager
If over $50,000 Local Contract Review Board
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY •
L_" Case Refund Processed: Date: I t 1 / d I By:
I: \Building \Refunds \RefundRequest.doc 05/23/07