Permit , ; ;..... I' ' CITY OF TIGARD MECHANICAL PERMIT
` , COMMUNITY DEVELOPMENT Permit #: MEC2009-00591
i-IGAkb: 13125 SW Hall Blvd., Tigard OR 97223 503,639.4171
Date Issued: 11/04/2009
Parcel: 2S102CA00935
Jurisdiction: Tigard
Site address: 13410 SW VILLAGE GLENN CT
Subdivision: Lot: 0
Project: Carlisle
Project Description: Add gas line for new stove.
Owner: FEES
CARLISLE, ANDY & KATHIE Description Date Amount
13410 SW VILLAGE GLENN CT
TIGARD, OR 97223 Fuel Piping 11/04/2009 $14.15
12% State Surcharge - Mechanical 11/04/2009 $10.80
PHONE: 503 - 684 -5954 Minimum Fee Adjustment - Mechanical 11/04/2009 $75.85
Contractor:
BLUE LINE PLUMBING INC
1820 SW WYNWOOD AVE
PORTLAND, OR 97225
PHONE: 503 - 706 -0091
FAX: 503 - 644 -7373
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
i.15
Issued By: 4 _ Permittee Signature: DN fr c/ 6./ �',.� SO
��'`"`----CCCC��� 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.
• City of Tigard, Oregon 0 13125 SW Hall Blvd. O Tigard, OR 97223 " • `'
s
MN ' Yd 4
5
December 11, 2009 A
Blue Line Plumbing
1820 SW Wynwood Ave.
Portland, OR 97225
Re: Permit No. MEC2009 -00591
Dear Mr. Skoro:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 13410 SW Village Glenn Ct.
Project Name: Carlisle
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $80.64.
❑ 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,
Dianna Howse
Building Division Services Supervisor
Enc.
1: \ Building \ Refunds \ Administration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 o Fax: 503.684.7297 o www.tigard - or.gov o TTY Relay: 503.684.2772
. ��,� C Z0 01- 6(Z (
I,
14 q City of Tigard
TIGARD Accela 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 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: Blue Line Plumbing DATE: 12/10/09
1820 SW Wynwood Ave.
Portland, OR 97225 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 175919 Case #: MEC2009 -00591
Date: 11/04/09 Address /Parcel: 13410 SW Village Glenn Ct.
Pay Method: CreditCard Project Name: Carlisle
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Exainple: [BUILD] Permit Fee Example:. 245 - 0000 - 432000. $ Amount •
Mechanical Permit Fees 2300000 -43102 $72.00
12% State Surcharge 1003100 -24001 8.64
TOTAL REFUND: $80.64
APPROVALS:
If under $500 Professional Staff Gj--r- 1(2- LLA/A -A.1-6-:A.
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 ACCELA SYSTEM ADMINISTRATION USE ONLY
Refund Request Reviewed: Date: I .. ' : , I By: I
Case Refund Processed: Date: By:
1: \ Building \ Refunds \RefundRequest.doc 04/13/09
City of Tigard
T I G A R D Accela 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 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: Blue Line Plumbing DATE: 12/10/09
1820 SW Wynwood Ave.
Portland, OR 97225 REQUESTED BY: Dianna Howse
TRANSACTION INFORMATION:
Receipt #: 175919 Case #: MEC2009 -00591
Date: 11/04/09 Address /Parcel: 13410 SW Village Glenn Ct.
Pay Method: CreditCard Project Name: Carlisle
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80% of permit fees.
REFUND.INFORMATION:
,Fee, 'Description From Receipt Revenue Account No . Refund
Example: 245 - 0000 - 432000 . $Amount
Exairiple:' Permit Fee • • • • • . P
Mechanical Permit Fees 2300000 -43102 $72.00
12% State Surcharge 1003100 -24001 8.64
TOTAL REFUND: $80.64
APPROVALS:
If under $500L 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 ACCELA SYSTEM ADMINISTRATION USE ONLY. . .
Refund Request Reviewed: Date: , ,. ; 4 t By:
Case Refund Processed: Date: f . : By:
I: \Building \Refunds \RefundRequest.doc 04/13/09
•
CITY OF TIGARD RECEIPT
11 2 1 3125 SW Hall Blvd., Tigard OR 97223
• 503.639.4171
TIGARD
IC r f.C.ly:
Receipt Number: 176274 - 12/11/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2009 - 00591 $ - 80.64
Total: $40.64
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 02152C DHOWSE 12/11/2009 $ -80.64
Payor: No Skoro, Blue Line Plumbing
Total Payments: $ - 80.64
Balance Due: $80.64
Page 1of1
CITY OF TIGARD RECEIPT
. S : • • 13125 SW Hall Blvd., Tigard OR 97223
503.639.4171
•
TR3 AR, f)
61 / !E i 4 6--
Receipt Number: 175919 - 11/04/2009
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MEC2009 -00591 Fuel Piping 2300000 -43102 $14.15
MEC2009 -00591 12% State Surcharge - Mechanical 1003100 -24001 $10.80
MEC2009 -00591 Minimum Fee Adjustment - Mechanical 2300000 -43102 $75.85
Total: $100.80 .
PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 02152C DHOWSE 11/04/2009 $100.80
Payor: No Skora, Blue Line Plumbing
Total Payments: $100.80
Balance Due: $0.00
•
•
•
• Page 1 of 1
• FROM FAX NO Nov. 11 2009 08:04AM P1
•
VED
• NOV 1 2O09
CI T OF TIG
:1 Cimamuinity Deveio p meet N GOivisi
� Ortr
• Request for Permit;.dlction
•
To: • CITY OF TIGARI) •
Building Division Services Coordinator
. 13125 SW Ha11 Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503,598.1960 www.tigard- or.gov
• FRO.M:. • Owner Applicant Contractor City Staff
(oheok onc)
REFUND OR Name:
INVOICE TO: animate or individual) . ,4 Or. 1-.. f E • PZ-Lg /06- /Ale •
Mailing Address: /440 5.1x/ , W i IV (t4f1 0
• Cit /state /zip: • _
Phone No.: .S D .3 .7Q6 D. & 9/
PLEASE TAKE ACTION FOR THE ITEM(8) CHECKED(/):
CANCEL PEIiNITT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available). V
INVOICE FOR FEES DUE (attach case fee schedule and'explain below),
REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: , e - (), s
Site Address or Parcel #: / /L /0 S tti. 02.1-.6/6 6 A 6I • `
Project Name:
Subdivision Name: Lot #:
EXPLANATION: • .70e 1
Signature; _
Date: //-7/-
Print Name: Po S L7e
/Ifo zdh
.. . 4-TROM : FAX NO. : Nov. 03 2009 01 38PM P1
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