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Permit - CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2011 -00555 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/2011 Parcel: 2S 102AD01800 Jurisdiction: Tigard Site address: 8975 SW BURNHAM ST Project: Gray's Automotive Subdivision: TIGARD HIGHWAY TRACTS Lot: 21 Project Description: Ductless heat pump installation. Contractor: SKY HEATING & AIR CONDITIONING, INC Owner: CARL H JOHNSON FAMILY L P II 1637 SE NEHALEM ST BY JOHNSON, CARL H PORTLAND, OR 97202 8965 SW BURNHAM • TIGARD, OR 97223 PHONE: 503 - 235 -9083 PHONE: FAX: 503 - 235 -0454 FEES Specifics: Description Date Amount Type of Use: COM Permit Fee 12/06/2011 $151.95 Class of Work: OTR Type of Const: 12% State Surcharge - Mechanical 12/06/2011 $18.23 Occupancy Grp: Occupancy Load: Plan Review 12/06/2011 $37.99 Stories: Project Valuation: $3,122.00 Fuel Air Handlers Fuel Types: Units < 10000 cfm: Gas Pressure: Units > 10000 cfm: Furnaces Boilers & Compressors Furnaces < 100K BTU: 0 -3 HP: Furnaces >= 100K BTU: 3 -15 HP: Floor Furnaces: 15 -30 HP: Unit Heaters: 30 -50 HP: Vents w/o Appliances: 50 or Greater HP: Air Conditioning: Heat Pump: Appliances Vent Fans: Vent Systems: Total $208.17 Hoods: Comm Incinerators: Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions) Clothes Dryers: Other Mech Units: Gas Outlets: Other Desc: Duct Work: Fire /Smoke Dampers: 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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. 44. Issued By // _ Permittee Signature: ` °V.A C: Vii. 175 by 7:00 a.m. for the next available inspection date. 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. 12/02/2011 08:51 5032350454 SKY HEATING AND AC PAGE 01/01 Mechanical Permit Applicati CtEJVED l t)k r)l l it: I: I s,.. �,�1,, • City of Tigard Dill Yd , ffilM /� Permit a t ! • � i ' III Dae d9 4 13125 SW Hall 13lvd., Tigard, OR 97223n L C 2 2011 Plan Review Phone; 503,778.243.4 Pax' 503.598.1960 Other Permit: Dat t' r �;,t R [? Inspection Line: 503.639 Daft Ready/By, Iffi See Page 2 for Internet: www.figard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information . BUILDING DIVISION rot {1p WO ! G M IER AAT; "" !, 9( DtE " .USE MIDI �1411ST Mechanical permit fcc • arc based on the value of the work ❑ New construction tgl Addition /altcration/rcplaccmcnt performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition Q Other. mechanical mniertals, egmpmcnt, labor, overhead, and profit. Value: 22,00 $3 CfCffitu�yfli[�r.KlF c1l7Nst.il�rCIIUN" luc . ': ' "•RE 41.40111; 71+llrt! T / ts'itrt14481tES " . ❑ 1- and 2- family dwelling El Commercial /industrial ❑ Accessory building For speclollnfrmmrelon use checklist. ❑ Multi - family © Master builder ❑ Other; Description ... I Qty. Ea I Total . ' :JOR'SKIT 'FIAT . ;4ND I oCA1T o/4 Hcafinp/ceolinmt ' -- Air conditioning Job site address: 8975 SW BU.RNIIAM. ST (requires site plan showing placement) 46,75 - ' - • Furnace 100,000 BTU (ducic/vetus) 46.75 City /State /ZIP; TIGARD, OR 97223 Furnace 100,000+ BTU (docts/vects) 54 -91 5uite/bldgJapt- no.: Project name: 5ttugacirr ( fi e..,' S MJ �tTt TI�t pump J (requires site plan shaming placement) 1 61.06 Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or h ,ydronic) - 23.32 Unit heaters (fuel -type, not electric). in - wall. in - duct, suspended, etc. 46,75 Subdivision: Lot no ; Flue/vent ' for any of above 23.32 Other. 23.32 fax map /parcel nn.: Other fuel apQliane es: T18$GRrrrrc?f op WORK: Water heater 23.32 INSTALL DATION DUCTLESS HEAT PUMP. Cos fireplace 33,39 Flue vent for waiter heater or gas `Jc � J �CS .aN /�) 16. Log l tgh 23.32 Log lighter (gas) 23.32 p ( -- f ..C.( M t Wood /pellet stove 3339 1 4i 17 , - Wood fireplace/insert 23.32 a. PROPERTY C7 7ENANT' • Chimney/liner /flue/vent 23.32 Other: 23.32 Name; CARL H. JOHNSON FAMILY I.P TT Environmental exhanat and ventilation: Address: 8965 SW $U.RNIIAM ST. Range hood /other kitchen equipment 33,39 City /State /ZIP: TIGARD, OR 97223 Clothes dryer exhaust 3339 _ - - - Single-duct exhaust (bathrooms, Phone: (503)620 -9444 Fax: ( ) toilet compartments utili rooms) 2332 Et .AIPLICANIT 0 CON'1", PER3OIi1 Atticterawtspace fans 2332 Business name: SKY HEATING & A /C, INC. Other. 23.32 Fuel piping: Contact name: TAMT HACEMAN $14.15 for first four; 84,03 for each additional Address: 1635 SE NEHALENI ST. Fumac. etc. Gas heat pump City/State/ZIP: PORTLAND, OR 97202 Wall/suspended/unit heater Phone: (503) 235 -9083 Fax; : (503) 235 -0454 Water heater - Fireplace E -mail: TAME a(SKYHEATfNG.COM Range CONTRACTOR Barbecue T. Business name: SKY HEATING & A /C, INC. Clothes dryer (gam Other, • Address: 1635 SE NEHALEM ST . 1. igtst gitA pER1GIYrtitt W " ' . City /State /ZIP: PORTLAND, OR 97202 Subtotal . I IT1. • Phone: (503) 235 -9083 Fax: (503) 235-0454 Minimum permit fee (590.00) .,3 - Plan review (25% of permit fee) 7'39 CC.B lie.: 50244 3 $ 1 T State surcharge (12% of permit fee) 195 1 PERMIT 2 R FEE � g98—' Authorized signature, ti , r This per mit application ex 'res if a ¢411 / Pt TOTAL permit is a MIT M obtalne tthia IRO , da after it has been accepted as complete, 20$i L/ Print name: TAM.I HACEMAN a I Date: 12,1/2011 . J • Pee methodology set by Tri Counry Building Industry Service Board t :laklldIngrermiI ?MPC•PormltApp dnc n9/09/10 44n-4617T (11 /02/COM/WRa) 11 . Building Division Development Code Provision Review TIGARD Commercial Projects - No Associated Land Use Case Building Permit No: Mg — if — ons ❑ Expedited Review Plan Submittal Date: ai,?1 // 0• To the Applicant: ➢ If the proposed use is not permitted within the zone, please contact the Building Division to cancel the permit application. Building Permit Technicians (503) 718 -2439. ➢ If a land use is required and for all other questions, please contact the staff person listed above the Planning Review section. Staff: please check items along left only if approved. Planning Review (contact Cr't t Cap "eS at 503- 718 -a'f37 or ek terctl C. @ tigard- or.gov) l ( Zoning !ALL CSD Permitted Use Yes ❑ No ❑ Lii!( Land Use Required: Yes 0 No ❑ (explain below) Notes: CWook' 1°0. n- -- h-. 1 i901 Dc lie( O -.te CVd r etc;tcs a. 't I -si- :e v';ew o. T" , 21. . J; Rev ;c c.. }7' 17 Ia..eticcy.'n.S /of f to : /1 bC `eelcc.a. • , - 5.9 or t 1,..s -- J ;5 a4 S (cc, 4-61.-ki ,i, . - 11..c L4 ‘4: a ( pl ct.�.d oh -114_ (.,,,a(( i but . + 11 loe t�Ir. d -a • ct A scluu.k; 45 . La n d.sca f ,, 45 L...);// nod- be aikc -11 d. W Approved Not Approved Date: 12._ 6' li � i' ca veisaf ; Trsvii n � 1 Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov) Notes: Routed back to Building Division Date: I: \CURPLN v � a it City of Tigard January 6, 2012 Sky Heating & A/C Inc. Attn: Tami Hageman 1635 SE Nehalem St. Portland, OR 97202 Re: Permit No. MEC2011 -00555 Dear Applicant: The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the following: Site Address: 8975 SW Burnham St. Project Name: Gray's Automotive Job No.: Refund Method: ❑ Check # in the amount of $ ® Credit card "return" receipt in the amount of $136.14. Note: Please allow 2 -5 days for this refund transaction to be credited to your account by the company that issued your card. ❑ Trust account "deposit" receipt in the amount of $ Comment(s): 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. \ Building \Refunal; ` olialk ,4finaei r Ckei in 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard- or.gov CITY OF TIGARD RECEIPT 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TIGARDi Receipt Number: 185101 - 01/06/2012 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2011 -00555 /1CC /� /L!'�J /T F�� � p - (]eoo — 1 ,.;"/0 2 - 42 /, ' $- 136.14 /a `) .. �79 - 7 t� C ' /cry -t1 ooO — d2 ye) /7 "'"' Total: $- 136.14 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 81602G DHOWSE 01/06/2012 $- 136.14 Payor: Sky Heating & A/C Total Payments: $- 136.14 Balance Due: $136.14 • Page 1 of 1 CITY OF TIGARD RECEIPT 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 TWA ic ARD Receipt Number: 184800 - 12/06/2011 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID MEC2011 -00555 Permit Fee 230 - 0000 -43102 $151.95 MEC2011 -00555 12% State Surcharge - Mechanical 100 - 0000 -24001 $18.23 MEC2011 -00555 Plan Review 230 -0000 -43111 $37.99 Total: $208.17 PAYMENT METHOD CHECK # CC AUTH. CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 81602G BTAGGART 12/06/2011 $208.17 Payor: Sky Heating & NC Total Payments: $208.17 Balance Due: $0.00 Page 1 of 1 City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building application fees. Receipts, documentation and the Request forPermit Action form (if applicable) must be attached to this request. Refund requests are due to Accela System Administrator by Wednesday at 5:00 PM for processing by the following Wednesday. Accounts Payable will route refund checks to Accela System Administrator for distribution. Please allow up to 2 weeks for processing. PAYABLE TO: Sky Heating & A/C Inc. DATE: 1/4/2012 Attn: Tami Hageman 1635 SE Nehalem St. REQUESTED BY: Dianna Howse Portland, OR 97202 TRANSACTION INFORMATION: Receipt #: 184800 Case #: MEC2011 -00555 Date: 12/06/2011 Address /Parcel: 8975 SW Burnham St. Pay Method: CreditCard Project Name: Gray's Automotive EXPLANATION: Per applicant's request as job was cancelled. Refund 80% of permit fees. REFUND INFORMATION ,, -Raii* a 0M - M - i€ � i 0 �� �.�� ��: �.,� � � � � g � ��r ��� .� Revenue Ae`count No �- �-�,. �Refurid.P Example x li g. Perniit Fee . 110 01 E a nple ' 23QOPA):104 1:= a $Amount Mechanical permit fee 230 - 0000 -43102 $121.56 12% State Surcharge 100 - 0000 -24001 14.58 - TOTAL REFUND: $136.14 - - APPROVALS: - If under $5,000 Professional Staff If under $12,500 Division Manager - If under $25,500 Department Manager If under $50,000 City Manager If over $50,000 Local Contract Review Board :;; , R_ u s _ MO:R.'TIDEMARI SYSTEM ADMINIS"I'rRATI - T Case Refund Processed: Date: ' / /c.= By: I: ABuilding \Refunds \RefundRe s 09/01 /2010 12/14/2011 09:41 5032350454 SKY HEATING AND AC PAGE 01/02 V 0 I DI C/i� ; v R ECEIVED 1 Community Development Request for Permit Action D T IL A , R I) CITY NG C14 2011 . ARD D IVISION TO: CITY OF TIGARD • Building Division Services Supervisor " 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.71.8.2430 Fax: 503.598.1960 www.tigard -or gov FROM: n Owner, ❑ Applicant ® Contractor n City Staff (check one) REFUND OR Name: Sky Heating & A /C, Inc. INVOICE TO: (Sustncss 'Jr Jndividtwl) . Mailing Address: 1635 SE Nehalem St. City /State /Zip: Portland, OR 97202 _ __ Phone No.: 503- 235 -9083 _. PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): ❑ CANCEL PERMIT APPLICATION. El REFUND PERMIT FEES (attach receipt, if available). 0 INVOICE FOR FEES DUE (attach case fee schedule and explain below). n REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). Permit #: MEC201.1 -00555 Site Address or Parcel #: 2S102AD01800 Project Name: Gray's Automotive Subdivision Name: Tina ,d 1•-iighway Tracts Lot #: 21 EXPLANATION: Please refund our permit fees; this job cancelled after Mr. Johnson refused to pay the planning fee regarding landscaping that the City of Tigard put a road through his . to c and took .' 15% re, - - lands= .' • dr. NI Signature: Date: 12/14/2011 Tani Hageman Print Name: Cmaaulir 1- The Director or. Building Official may authorize the refund of a) any Fee which War crroncously paid or collected. b) not more than RO% of the land use application fcc when an application is withdrawn or canceled before any review eff»rt has barn capendcd. c) not more than B0' /n o&'thc land use application fee For issued permits. t1) not more than 30% of the building plan review fee when an application is canceled before any plan review effort has been expended. c) not more than BM of the building permit fee tot issued permits prior m any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received Please allow 1 - weeks for processing refunds. A---(C-u- -�. /1/44A FOR ni:i:lcl: I. ;;I; ()NIX Rte to S Adxmn: Date /A MaallEnOrn Rte to Bid! Admin: Date i!M / a7, 3- 4 Refund Processed: IralffelPrAMII ; . 4 Invoice Processed: Da .B / y SR' Permit Canceled: Date ,- ea 4,2- By 1 • i .1-Tag Date By Receipt # Date Method _C_r;'____ Amourit $ is \Pundit,g \Forms \RcriPcrmiticticm.d % � � oc Rey 02/23/2011 . /