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Permit AUG /31/2009/MON 04:23 PM FAX No. P. 003 MECHANICAL PERMIT CITY OF TIGARD 111 . COMMUNITY DEVELOPMENT Permit it: MEC2009 -00446 TIGARD 13125 SW Hall 8ivd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2009 Parcel: 2S1030000431 Jurisdiction: Tigard Site address: 10770 SW FAIRHAVEN WAY Subdivision: Lot: 0 Project: Hergert Project Description: Install heat pump. Unit must meet 3' minimum rear and side yard setbacks. Owner. FEES HERGERT. AARON Description Date Amount 10770 SW FAIRHAVEN WAY Air Conditioning or Heat Pump 08/25/2009 $14.00 TIGARD, OR 97223 12% State Surcharge - Mechanical 08/25/2009 $8.70 PHONE: 503 -670 -9589 • Minimum Fee Adjustment - Mechanical 08/25/2009 $58.50 • Contractor: • SPECIALTY HEATING & COOLING INC 7500 SW TECH CENTER DR STE 120 TIGARD, OR 97223 PHONE: 503-620 -5643 FAX: 503 -681 -0793 X Type of Use: SF \\LI. Class of Work: ALT Type of Const; Occupancy Grp: Stories: ‘4.P • Fuel Fuel Types: • 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 ey:, .;'5/ Permittee Signature: C i,.:" r r `,/ (',5"� 7C,,v Call 603.639.4175 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 MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2009 -00446 1312 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2009 TIGARD Parcel: 25103DD00431 Jurisdiction: Tigard Site address: 10770 SW FAIRHAVEN WAY Subdivision: Lot: 0 Project: Hergert Project Description: Install heat pump. Unit must meet 3' minimum rear and side yard setbacks. Owner: FEES HERGERT, AARON Description Date Amount 10770 SW FAIRHAVEN WAY Air Conditioning or Heat Pump 08/25/2009 $14.00 TIGARD, OR 97223 12% State Surcharge - Mechanical 08/25/2009 $8.70 PHONE: 503 - 670 - 9589 Minimum Fee Adjustment - Mechanical 08/25/2009 $58.50 Contractor: SPECIALTY HEATING & COOLING INC 7500 SW TECH CENTER DR STE 120 TIGARD, OR 97223 PHONE: 503 - 620 -5643 FAX: 503 - 681 -0793 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: 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: j�Z� ' Permittee Signature: / ,4Zi L' -77Q / 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. t, City of Tigard, Oregon e 13125 SW Hall Blvd. 0 Tigard, OR 97223 = � � y X � �Te �'K�'Yi tsaZ t 1 FEI iii :s; r 'M, t September 24, 2009 �� Specialty Heating & Cooling Inc. 7500 SW Tech Center Dr., Ste. 130 Tigard, OR 97223 Attn: Andrea Dripps Re: Permit No. MEC2009 -00446 Dear Ms. Dripps: The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the following: Site Address: 10770 SW Fairhaven St. Project Name: Hergert 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 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- CancelPern-nt.doc 01/16/07 Phone: 503.639.4171 0 Fax: 503.684.7297 .0 www.tigard- or.gov © TTY Relay: 503.684.2772 A G/31/2009/M0N 04:23 PM FAX Ni, P. 001 Building Division RECEIVED Applicant Requ to Cancel Permit SE' 01 2009 City oard CITY OF TIGRD BUILDING DIVISION TO: CITY OF TIGARD, BUILDING OFFICIAL 13125 SW Hall Blvd_, Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 FROM: Applicant Name: 0 S.W. Tech C,e<<cLr Dr. Mailing Address: Suite i gerx car: City/State/Zip: Y p : www.specialtyheating.com 503 -620 -5643 Phone No.: Fax No.: ,S 8"f 4p (n 5 PLEASE CANCEL PERMIT APPLICATION AND REFUND PERMIT FEES, IF ANY, FOR THE FOLLOWING: Peiliiit No.: I V `t (°,,,, Q - QO L b Type of Permit: `Q Site Address: S 1 !ti r W `� t Subdivision: • Lot No.: EXPLANATION: Signature: � �'�`�' � Date: o / 31 / () , Print Name: O/ l' prS FO R OFFICE USE ONLY Route to Admin.: Date: 4.2 Permit Canceled: Date: } luny By: / ., /�� _'. �,w w Refund Processed: Date: By: � : i:\ Building \Forms\kegCancelPennft.doc 04/03 , AUG /31/2009/MON 04:23 PM FAX No, P. 002 Mechanical Permit Application FOR OFFICE USE ONLY . City of Tigard e iv Permit No.; q 1312$ SW Hall Blvd., Tigard, OR 97223 PlmReview ' _0 Phone: 503.639.4171 Fax 503.598.1960 Date/BY Other Permit T I G AR D Inspection Line; 503.639.4175 Date Reedy/By: kris: • ig See Page 2 for Internet: www.tigard- or.gov Nonfied/Method: Supplemental Information .� ;, : r jigii , ,,. �. .._. . _. , ,_0in ,. ,.. •2ix- . �, .., , r:.y .,. yfip - - "Li ''.rGr.,i'1'.' l:at" :ti %;! c - ,:':: k!'" :ii:`:"' 'I'l "'! e . a1., �I ,u ,1 u ,F ,11 „! ; F. 1 �, 1 pU u F, ��; ; I a. � is f " • ; : h ; � � °.::. - . �Fl r':(l °�. . r I . , . .. ! ra . . • 1, : . -' -, - . r >y l • . " A_ : r (.. • .. h t`. s. 41 N a� : r � , I li� 1 JL - h . I ,r51 ,. x ,a x' 11, , 11 r L ., Y r;, - l�iL_ a ;h; :I ' r.., a e; • y, x u .I+e: I ,:4 : 11.:•:.,::I,•t . ,ic I lls .l. i L i LL t _�.x, ae.u Em. 1,11 ,: ,U, I:y f!!3,: ill irii,l(I au ,.,: I 7., a :s� : - I; l .i ld i �r.,, ' II {. I :,.. 1, : NI a ,,., „ . c ... . .t{ : :!Iti:',..: ,t r , . ii„ ., uL1�tYf-. �E4:, u. 1! Lla�i,! h. 11J.,,. �,.. �Q.. 1_. Ir7Jt I, IIL a.`�fu.a.,:el�'.:��En.�.�,...�. tit` � I{ I ��1 7i, �. 9.. u l.., l... ld� {. �: �iLV.:_ a__ I_ u ul: r .. . a.. 1, 1 . 1 u,. w. 1. �_ c. I: zl. Is a. el. l; �riva� ' : an1.,.1,1. , .a.,1u_ n�: cii: ❑ 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. r ;�7 ^_ h 7 =.. ,ryr.yI uL__1 -E � 1„ r : air ",�; r -rho n 7 • j ,:} r r � a 5-1 ! Value: ��, "'�: ,y I a�;� �lt'`q''�i. . 4. iisK e1 . 1'1�r 1!Sb,1- ;,t;�` -+ - 1'4 , F ::.:`�n :1 -.•':' { hi -,, ., L'C'A.,. .., r i 1 -, l r •" 44L :, .. : :. .!.!:I:.:i Iri: :Ga,n-, - -b. •,a. r rr. n: 1 si ea Ie CI�.�Lht�_�nh. III, I: : . . �: IYSe, �u•_. I.. �� r : h:. i,> a�.. x� w_ x ,�.ta;:r:L '�zr:! I` . u �can� . -a?F� � '�:.Tt... .— L . _._ ��i ... ?'r;!;i� �.;i:�� 1 „ - t1�' .,� � ,, ,-t= +�: �u,lr. .•.�. �. �,55...1..::,EI;, .J..._ 'r fig +pr r ; �r.�y d- : 4 I � 1 ' •� , :'•,` - ` L:,��erti ! r I t:ifi a l p2-il1�; NI; iltd;, ?1 C1:! !L':+1 II: :.I e,:i _ ' E i �li�ilgr Nvl i �p!I��::; 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For speeral t►;formattorr use checklist ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. ( Ea. 1 Total ��a GSi;�I)'F iii; x-;; 1 1�,1,.: . 1 �_j;�j4n a r �tr iSIW: U :`'( P:` ;. /, °kiiP ::.:, iI :9 � i` F !'. :51SP 19 ... ,1 .q!LI { ... 'L t � c I� I 5 �,a<t r5? ,_t '..L' '1- 'i 1 •i�I l' l:h,: t, , r i � 41,. Heating /cooling ? Idf GIi��6 ti , „ vflc Lv:.z....it r y:,�w, s &d !G' c� , dr._._._!�`. 1�1 Job site address: i t )1 la S � ` r ' Air conditioning or heat l pump j (requires site plan showiart placement) ! _ 14.00 City/State/ZIP: Furnace 100,000 BI'IJ (ducts/vents) 14.00 Furnace 100,000+ BTU (ducta/venta) 17.90 Suite/bldgJapt. no.: I Project name: Gas heat pump I 14.00 Cross street/directions to job site: Duct work 10.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 14.00 Subdivision: Lot no.: Flue/vent for any of above 6.80 Other. 1 10.00 Tax map/parcel no.: Other fuel appliances ar:+u' liyw! H;.h r;; l . : IIII its " `i, ux ;l u,�: ,_- ! I 4:3- i: `.:.ui`Ir ; i Y'}h.,' .:?n �1!. �?g;;et:r!1 i i diiP.Il . !`: i I I : 10.00 %li Water heater p I. i I Ill • LII �i<ii+.11l•I Y I I j !�cuen'i L tyv. J ��� g.G.r:A. y.L',1:1 n,ll i i:1! I .,.. ! 1 . , . ... :4L Gas fireplace 10.00 . , Flue vent for water heater or gas - f , � "�� 1 - ti � fireplace 10.00 Log lighter (gas) 10.00 • ( r Wood/pellet stove . 10.00 L Vitt.. , kr Wood fireplace/insert 10.00 - i; r i r ,,. .._, , ;i! " ;•"" . ..._..., - .,.- ti,.._..:._ --:'' . .... -' -= .....,ate_-: =''''' _!, -,1 E�f 1 ',t -r rr Chimney/liner/ ue/vent 10.00 a .;,Ai, i i'Y�.L., 1 i ' % T a I i eEz: I ;',1111, "Igt. i'; Hergert, Aaron R09254 other: 10.00 Name: F4rvlron 1, t xhaust and ventilation 10770 SW Fairhaven Way ' ge ,., 0 kitchen Address: Tigard, Or. 97223 — e ' pl ., 10.00 City/State/7 P: (503)670 -9589 ac es dryer exhaust 10.00 e -duct exhaust (bathrooms, Phone: ( ) r We toilet compartments, utility rooms) 6.80 1,:: tt< !tifill `; = La :a;r: ?;7�; ._r'r' p,,i_F- u iL: -- gl :f: iLig91'g 4 ,1 '4:: -p,l AttiGerawls ace fans ., ` 10.00 Ii�'R' ��F1+i iII I::ctt�l`:i.!7� ,,it.C, 1i hp` - _ ;}, .�' .a :k', � "pp�5���� P Pa Vie i } ,,. S wi: rlb„u �M ij 1;i' 1 . I ,t, te : I L �4�N 5114 d ,1 :. n: rlll :::l;lf'.4'_GI:4:z1C:�di:7 '.:i.�' e,li J11.:�.6.:,1.'tl�:C�H '�1::..L'L',IJ.I,:.'.'9 :L' lEirji.� �r•I:L'�i..t�.:.C: �11 Other. ,.<'``� 10,00 Business name: J Fuel�Biull Contact name: ,.r.: ` . $5.40 for first four; $1.00 for each additional Address: ' ` Furnace, etc. Oas heat pump City/State /ZIP: : " WalUsuspended/unit heater - Phone: ( ) Fax: : ( ) Water heater Fireplace E -mail: Range .y F ; , J1' _ ¢Fx::`+ �'.? -�: -- . : •f i 1 .l epL sr.: • , >? , , i,ir• �'• :ti-op`''�i ., 'jW.1 : is _ ' r _a. rk;l ; ' � 'k T i jl': si do :1 ; -..f> !�'�r.s.1; a!l . >r ; � . 11 v : ci_ _,; m : ; ; , t N y IL: Tr•! 4 : ! 1 .A . • Barbecue vi,rh' a dl i.- _ ,n`.� .:� r1: ��,IiKn;: _� = �� ?�: iJ, 1 �J_- �r��� ;c1,h1.:.L$::.'.::r1��L Business name: Specialty Beating & Cooling, Inc. Clothes dryer (gas) , Other: rti . i'L ,:It ' 7 , 411' , C'r: c, :pn;:, I n.7 i L if li1 I Fll; :l i• i l,: {, " „ •„ 1 ,t :, • ; I 1 Address: 7500 SW Tech Center Drive #130 1,11 etii5i1 f ii`� .,',' T. !�;, c�:a i, �ll; ?,1441 ��I F L i'1 1 • 110,, a L!„ s!•y:'i� k 4c,.,,,Ur. ,„..._._:...,.,, l:e_: I}•: I :, : ! .: !,d„ fl l a :c..cL City /State/ZIP: Tigard, Or. 97223 Subtotal — Phone; (503) 620 -5643 Fax: (503) 681 -0793 Minimum permit fee ($72.50) Plan review (25% of permit fee) CCB lic.: 66578 State surcharge (12% of permit fee) TOTAL PERMIT FEE Authorized Signature: ig'w"'�� This permit application expires If a permit is not obtained within 180 gnu - days after it has been accepted as complete. Print name: Andrea bripps Date: '4M17 . 6 4 Fee methodology set by Tri- County Bu Industry Service Board I ;1Buasn3Wemuts\MEC- PennitA99.doe 01/19/07 440-4617T(11/07Je0M/WOE) nUG /21/2009/FRI 04 :35 PM FAX No, P.002 Mechanical PermitApnlicatihr0 IC I L ' 6 FOR OE.1.1SE ONLY City of Ti and n. , Received IwIC j . 1)ate/By: er� 09 4i. Pemn;t NVV '0200 / p la / /� to II ' '' 13125 SW Hall Blvd„ Tigard, OR 97223 e� Plan Review Phone: 503.639.4171 Fax: 503.598.196St 2 2009 Date/By: Other Permit/ eat' "1' f C AR T) Inspection Line: 503.639.4175 Ds[e Ready/By: E] See Page 2 for Internet: www,tigard CITY OF TIGARD Notified/Method: Supplemental lnformatton r I ill IMt' I I CI I LL IONE 1..� 9a' • Jti' ..t11 • N tr n'�'!'F i!7' i tu �;•=r ,r. ..,,� t' H 5, ! 1. -' a` �4111y , ':, a ; ' t • =uu ,.a t +1'� ? r • c pt t f i ,. . { }pf ,�.1j�1�� 1 � li�i}i,.i 1, il.k9 'l4." �itf3,. �i17... �1I „�r. f { �� ,l(. +�.r;; ' z��:.�rt p'i °'�1�.u'� rltu�l'khlx.w` 6 - i ningc,� I t l killi iiiltl�l ills �1>lig ! 1 �,tl : tti �.: trr 1r:l, t,...l�::Vr- ur lh.l: ['New construction Fr2 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. :,••� ) f 7't �T'�"4: � 17��( ?fiM f .• -•• ',•pun '3f 1 . c..} 1l�'" i tGfb t f7; :1411 J „ i t 1 ! 1ill - f + Value: i "t z,,1 1, ^ ?.d.;�'. _gi il, s. tt��I {; II „.' l, I'. 4 } i1 . 41 .�., . ,. a +l 4i :.. t . ,. l .... ,,. - . •r ,.:• d . , ..� -1.0 if{d) �.0 . ., ......, II lil i.', ; r= C f n , .R; : +.: 79 i iil tuna id,t1111L; rf r :;t p �T , fi ll to . �� 11G t�� r.. tai.. l- l��- I,.,IItrl.�, {uut r�� r 1 t, I I f r j I i i iiii t5 1 1 titAltiatlr � ar.l i i{ h lalia flllt A 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building }l au tow: -t1r.= n u srrutll ilalr l ^ictr u saf (r =i 1t� It -.ss rf. For special trtformation use checklist. ❑ Multi family ❑ Master builder ❑ Other }tss + i 1 ,1tit +ku�y }ta�l.l { I,�t x u} t ii,!rt� u�,�t i l l r ' {f, 1}: all I 1 111 Description I Qty. Ea. Total mina C� l 111U{ ?4h.11{ f�I ��,� 1, Nov ; 1. . UFi. fU tt Yl i ;V {' {f t . ' f )lle L oo1i[7 isri u Y 7 n+G1 t 1 �,11 1 1 r A. a lt..✓ g l fl IC r r. ns;.11f � a,l,tt :.. ta't 21111,u. • r �'� .r I.� , �� Air conditioning or heat pump Job site address: ( yo . t4 ; . G� f , GA--r 1 (requires site plan showing placement) I 14.00 City /State /ZIP: 1 Furnace 100,000 BTU (ducts/vents) 14.00 Furnace 100,000+ BTU (ducts/vents) 17.90 Suitc/bldg. /apt. no.: Project name: _ Gas heat 14.00 Cross street/directions to job site: Duct work 10.00 Hydronic hot water system 14.00 Residential boiler (radiator or hydronie) 14.00 . - Unit heaters (fuel - type, not electric), in -wall, in -duct, suspended. etc. 14.00 Subdivision: Lot no.: Flue/vent for any of above 6.80 - Other 10.00 Tax map /parcel no.: Other fuel appliances 1 t lglpl 1 r ', .r i ;} r rt rst¢ 4 a 1 81 �' ! 1'A `)1 r f { I I t .l +[t t r tl` ,` i Water heater 10, i i l� ' , 1 E� ;� , t : t,h� � ;' #t� C it �r'l�l l I' l l }111 s1! .�� t . .11.41.. 1 l - Gas fireplace 10.00 Pine vent for water heater or gas fireplace 10.00 t Log lighter (gas) 1 0 _ Wood /pellet stove 10,00 Wood fireplace/insert 10.00 _:,..,, w _: , : Chimney /liner /flue/vent 10.00 �, k {{��� i��' t l l f t1 `d I :ti t]}i. lttilft)iE111i1i1ElI' r }' ., �4f3'iI'IIE #lrlt:ll� Oth 10.00 Hergert, Aaron 809254 - Name: Environmental exhaust and ventilation 10770 SW Fairhaven Way -, Range hood /other kitchen Address: Tigard Or. 97223 , equipment 10.00 City /State /ZIP: (503)670 -9559 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone; ( ) toilet corn. artments, utili rooms) 6.80 = v w t : [ r, '1 t t a yv t tr r:p r } sl t r 1 u t , } Attic/crawlspace fans 10.00 i'If I�l a t r ,lnt itil : � V 11. IF I d 4 : t t t , lit . if , - p Other: 10.00 Business name: Fuel li gin! Contact name; 55.40 for first four; $1.00 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) Fax:: ( ) Water heater Fireplace E - mail Rang t _ f .� itr t'1aL 3?, , t1' , t r 711 F�I;fut l4 ruts) t i tt. l' k = 1. rl f =1 {ilr tl..r REMENIK ISSI �tl , � tM� tf 1, B lu t 1 I,fiS �, i f : l lz:� ,, :.�I Barbecue l . Business name: Specialty Heating & Cooling, Inc. Clothes dryer (gas) Other: Address: 7500 SW Tech Center Drive #130 #{ Ij' tr r iii ; "'f r ,r l t 4 4ti 'f '; K t ` ` If } '0 i i tir tt ia• . l g l 4.H.4(. l : ;:l . . w �� l' � �: ?�rtx{t, �w��i r Ir � ,.f�� 1.1 r �,zne{ur City /State /ZIP; Tigard, Or. 97223 Subtotal Phone: (503) 620 -5643 m Fax: (503) 681 -0793 Minimum permit fee ($72.50) r a, sa Plan review (25% of permit fee) CCB lie.: 66578 State surcharge (12% of permit fee) ?, 70 a r-t TOTAL PERMIT FEE /, ,;L 0 Authorized signature: jt� This permit application expires if a permit s not obtained within 181 lm �✓ days after it has been accepted as tomplete• /n 1 Print name; Andrea Dripps Date: 1 _ ' 6 5 . Fee methodology set by Tri- County Building Industry Service Boar. y /) 1:1Buildinav mitiU C-P rmitApp dot O/19/07 440.4617T (11 /02 /COM /WE 'tUG /21 /2009 /FRI 04:35 PM FAX No. P. 003 SITE PLAN `l PL , PL PL PL CI F ,`r d1� � lam' 7 4( ,'F2-2-3 STREET NOTE — Please show the following on the site plan: • Location of Indoor Unit and Outdoor Unit • Indicate how the flue will be run (thru the roof — out the sidewall — etc) -:- Indicate with dotted line how the lineset will be run and approx. distance • Indicate how the condensate will be run SRC 7500 SW Tech Center Drive SPECIALTY Suite # 130 PECIALT HEATING Tigard, OR. 97223 • COOLING (503) 620 -5643 Fax: (503) 681 -0793 www.sDecialitvheatina.corn 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: Specialty Heating & Cooling, Inc. DATE: 9/22/09 7500 SW Tech Center Dr., Ste. 130 Tigard, OR 97223 REQUESTED BY: Dianna Howse Attn: Andrea Dripps TRANSACTION INFORMATION: Receipt #: 174973 Case #: MEC2009 -00446 Date: 8/25/09 Address /Parcel: 10770 SW Fairhaven St. Pay Method: CreditCard Project Name: Hergert 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:.; (BUILD] Permit Fee • Example: 245 -0000- 432000 $ Amount, Mechanical Permit Fee 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 PA-/A\ IE 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: 7: , 2 A:2 By: Case Refund Processed: Date: -ef! /f By: I: \Building \Refunds \RefundRequest.doc 04/13/09 CITY OF TIGARD RECEIPT 4 D . 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 175330 - 09/24/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2009 - 00446 $ - 64.96 Total: $ -64.96 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 014275 DHOWSE 09/24/2009 $ -64.96 Payor: Sheri L Matheis, Specialty Heating Total Payments: $ - 64.96 Balance Due: $64.96 Page 1 of 1 CITY OF TIGARD RECEIPT E g 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARD Receipt Number: 174973 - 08/25/2009 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2009 - 00446 Air Conditioning or Heat Pump 2300000 -43102 $14.00 MEC2009 -00446 12% State Surcharge - Mechanical 1003100 -24001 $8.70 MEC2009 -00446 Minimum Fee Adjustment - Mechanical 2300000 -43102 $58.50 Total: $81.20 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 014275 DHOWSE 08/25/2009 $81.20 Payor: Sheri L Matheis, Specialty Heating & Cooling Total Payments: $81.20 Balance Due: $0.00 • Page 1 of 1