Permit 111
CITY OF TIGARD MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00496
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/9/2007
PARCEL: 2S 110AA -CC211
SITE ADDRESS: 10719 SW CANTERBURY LN 101 ZONING: R -12
SUBDIVISION: CANTERBURY CREST CONDOMINIUMS LOT: JURISDICTION: TIG
PROJECT: GUY
Project Description: Install a/c unit.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: MF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R1 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOQDSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
STEVE GUY Description Date Amount
10719 SW CANTERBURY LN #101
TIGARD, OR 97224 [MECH] Permit Fee 8/9/2007 $72.50
[TAX] 8% State Surcha 8/9/2007 $5.80
Total $78.30
Phone: 503- 686 -5772
Contractor:
OREGON HEATING & AC
.P0 BOX 397
DUNDEE, OR 97115 REQUIRED ITEMS AND REPORTS
Contact #: PKI 503 - 538 -2953
FAX 503 -537 -2172
Reg #: LIC 172126
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 • uestions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Is ed By: _
#//1/ / Permittee Signature: lib,. a-
all 503.639.4175 by 7:00 a.m. for inspections that business day.
•ermit 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.
Flug 09 07 10:54a Oregon Heating & A/C 503 - 537 -2172 p.1
Mech;;;Lnical Permit Application
..:::,.. ,...,-- .. -,:-,-, OFFICE USE ONLY
City of Tigard RECEFVE ceivzd Pennit 13125 SW Hall vd., Tigard, OR 97223 ew
Phone: 503.639.4171 Fax: 503.598.1960 AUG 0 Q 2007 Data By: Other Permit
TIGARD Inspection Linz: 503.639.4175 Date Rcady /B• H See Page 2 for
Internet: www.tigard or.gov C1TYOLT Notified /Method: M Supplemental Information
alMI.F'tt; OIf •
TYPE OF,.�i'OKK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ® 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.
.. , . • CATEGORY OF CONSTRUCTION Value: $
.. RESIDENTIAL EQUIPMEI\`T,I SYSTEMS. FEES* ` . .
® 1- and 2- family dwelling ❑ Commercialiindustrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
' .; JOB SITE INFORMATION AND LOCATION •• Heating/cooling
(� � y Air conditioning or heat pump
Job site address:
10'1 ` 1 SW C�zr�te rh urn ( � *k I O1 (re site plan showing placement) 1 14.00 .
.
-ti G 7 1 Furnace 100,000 BTU (ducts/vents) 1 J 14.00
City /State /ZIP: 1` eC`1
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
Hydronic hot water system f 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended- etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other. 10.00 •
Tax map /parcel no.: Other fuel appliances •
. ''_ DESCRIPTION :,OE`�V.ORK..., Water heater at Y
Gas fireplace 10.00
hiVAG
lnstaai !\L 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
. .... - . . , mer. flue, vent 10.00
10
- Chimney;7� � .
PROPERTY :OWNER ❑TENANT. . -. Othe r 10.00
Name: Steve. G , Environmental exhaust and ventilation _
t ` v � . I O Range hood /other kitchen
Address:
��� ICI S W Cflnler b� r lJt in l equipment 10.00
City /State /ZIP: r 4::a rd gaIy Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: 60 3 ) e _ 577 Fax: ( ) toilet compartments, utility moms) 6.80
. craw sp
®
APPLICANT `, . � CONTACT .PERSON - '
Att[c ce fans a
Other. 10.00
Business name: Oregon Heating & A/C Fuel piping
Contact name: F r4 )P I1 P $5.40 for first four; $1.00 for each additional
Address: PO BOX 297 Furnace. etc.
Gas heat pump
City /State /ZIP: Dundee OR 97115 Wall/suspended'unit heater
Phone: (503) 538 -2953 I Fax :: (503) 537 -2172 Water heater
Fireplace
E -mail: Range _
- CONTRACTOR Barbecue
Business name: Oregon Heating & A/C Clothes dryer (gas)
Other. , • Address: PO BOX 397 .. • •.MECHANICAL PERMIT,FEES* ,
City/State/ZIP: Dundee OR 97115 Subtotal /44 4)
Phone: (503) 538-2953 , Fax: (503) 537 -2172 Minimum permit fee (572.50) 7:2,„5
Plan review (25% of permit fee)
CCB lie.: 172126 State surcharge (8% of permit fee) 5, cU
TOTAL PERMIT FEE 7n' 33
Authorized signature: ' ' t This permit application expires if a permit is not obtained within 130
s i • days after it has been accepted as complete.
Print name: Fasirvelle. cube, • I Date: $ - q - 0 ' Fee methodology set by Tri- County Building Industry Service Board
I: Building \Pecmits\MEC- Peruiiwpp.doc 04:06106 440.4617T p 1502 %COb1'WEa) •
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City of Tigard, Oregon • 13125 SW Hall Blvd. v Tigard, OR 97223 '
RICWRIDA
y g g g rr. a
August 20, 2007 5411,946itIMOS
Oregon Heating & A/C
P.O. Box 397
Dundee, OR 97115
Attn: Roshelle Bybee
Re: Permit No. MEC2007 -00496
Dear Ms. Bybee:
The City of Tigard has canceled the above referenced permits) and enclose a refund for the
following:
Site Address: 10719 SW Canterbury Ln, 101
Project Name: Guy
Job No.:
Refund: ❑ Check # in the am ount of $ .
® Credit card "return" receipt in the amount of $62.64.
❑ 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
Permit Specialist
Enc.
I:\ Building\ Refunds \Adrrunistration \LtrRefund- CancelPermit.doc 01/16/07
Phone: 503.639.4171 ® Fax: 503.684.7297 ® www.tigard- or.gov e TTY Relay: 503.684.2772
Aug 10 07 10:Ola Oregon Heating & A/C 503 - 537 -2172 p.1
•
Building Division
r�'� I I Request for Permit Action or Refund
in ..{ �� ��'J r �� ^ ® J �
City of Tigard kcv,
TO: CITY OF TIGARD
Permit System Administrator AUG 1 ; 2007
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 CITY
f ¢��
BD DIVISION
FROM: ❑Owner ❑ Applicant Contractor ❑ City Staff
(check one)
Name: •
( Business or Individual) GS dr • se
V 0 1 .,Mailin Address: , j •)( 3C1 7
00 7 City /State /Zip: ( �+(� _ OR 97115
• Phone No.: 0506 r ag 53
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( ✓):
❑ CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES.
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: MEC anal- CC tAa
Site Address or Parcel #: 10119 5% C n r }, Th JO I
Project Name: CDC; t I
Subdivision Name: .00 h4er burc__Cres C ondos Lot #:
EXPLANATION: i('1Mk rner Ca nce/frd Irl$ J // 11nr) OF
A1(, on i+
Signature: j Date: - / 0 -c) 7
Print Name: Fershel e. Noe
Refund Policy
1. The Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80 percent of the permit fee for issued permits prior to any inspection requests.
c) not more than 80 percent of plan review fee when an application is canceled before any plan review effort has been expended.
2. Refunds will be returned to the original Payer in the same method in which payment was received.
" FOR OFFICE USE ONLY '
Rte to Sys Admin: Date / p Byl5 Rte to Bldg Admin: Date 21/07 B
Refund Processed: Date 1;720/0 ? By 470 Invoice Processed: Date By
Permit Canceled: Date d'/20 7 By " ' . eel Tag Added: Date By
Receipt # 07- ay Date lit /07 Method Amount $
L\ Building \Fonns\RegPermitAction- ldg.doc Rev 10/17/05 S 07 )
(WV/ v -a 36,9/ y �6V
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: Oregon Heating & A/C DATE: 8/20/07
P.O. Box 397
Dundee, OR 97115 REQUESTED BY: Dianna Howse
Attn: Roshelle Bybee
TRANSACTION INFORMATION:
Receipt #: 2007 -3681' Case #: MEC2007 -00496
Date: 8/9/07 Address /Parcel: 10719 SW Canterbury Ln., 101
Pay Method: CreditCard Project Name: Guy
EXPLANATION: Per applicant's request as job was cancelled. Refund 80% of permit fees.
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E asn e� 4SO.00d 432; , °� >:� un'
..... «.. «>- .,._n,W,_ . _ .. <. <,,�«_,,...._ , ..>2w... C•a..., ...y- �. ,^ <�, D,0.0: <�:.,M,�, °;,,. ..:Arno t
re p ' -� � ,_ , F ., a ..�"�•;u.. ., < _. ., x „.<n'�, 6f< «>w .. .., l] � ,. «. „.,, .<n <..., �; ».. n -. ..� .. -..,_ w ., ..� e
[MECH] Permit Fee 245 - 0000 - 431010 $58.00
[TAX] 8% State Surcharge 100- 0000 - 207020 4.64
TOTAL REFUND: $62.64
APPROVALS:
If under $500 Professional Staff
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
AIN U-R TIDElYIARWSYS0M ' =TIVISTRATION:000N4V0*Pa
Is Case Refund Processed: Date: f://„.„ge,,y4, 7 By: /
l: \Building \Refunds \RefundRequest.doc 05/23/07
- (ALA 01 '1 8/20/2007
IIII
MI , 13125 SW Hall Blvd. 1 1:33:20AM
Tigard, OR 97223 503.639.4171
TIGARD
Refund Receipt #: 27200700000000003801 /' v' ALS"; -T
Date: 08/20/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MEC2007 -00496 Reversal - [MECH] Permit Fee 245- 0000 - 431010 (58.00)
MEC2007 -00496 Reversal - [TAX] 8% State Surc 100 - 0000 - 207020 (4.64)
Line Item Total: ($62.64)
Refund:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal OREGON HEATING & A/C 819010 Fax (62.64)
Refund Total: ($62.64)
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cReceipt.rpt Page 1 of 1
•
IIII CITY OF TIGARD 8/14/2007
v 1 3125 SW Hall Blvd. 9 :07:44AM
• Tigard, OR 97223 501639.4171
TIGARD
Receipt #: 27200700000000003681 / / =W.l - e—
Date: 08/09/2007
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MEC2007 -00496 [MECH] Permit Fee 245- 0000 - 431010 72.50
MEC2007 -00496 [TAX] 8% State Surcharge 100 -0000- 207020 5.80
Line Item Total: $78.30
Payments:
Method Payer User ED Acct. /Check No. Approval No. How Received Amount Paid
CreditCard OREGON HEATING & AC SLN 819010 Fax 78.30
Payment Total: $78.30 .
cReceipt.rpt Page 1 of I