Permit Support Document - A
TIGARD
City of Tigard
February 6, 2014
Specialty Heating&Cooling, Inc.
Attn: Andrea
7500 SW Tech Center Dr.,Ste. 130
Tigard, OR 97223
Re: Permit No. MEC2013-00768
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 11970 SW Walnut St.
Project Name: Boyce
Job No.: N/A
Refund Method: ❑ Check# in the amount of$
® Credit card"return"receipt in the amount of$96.60.
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit"receipt in the amount of$
Comment(s): Per applicant's request as 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.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard
TIGARD Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Specialty Heating&Cooling, Inc. DATE: 1/30/2014
Attn: Andrea
7500 SW Tech Center Dr., Ste. 130 REQUESTED BY: Dianna Howse
Tigard, OR 97223
TRANSACTION INFORMATION:
Receipt#: 194356 Case#: MEC2013-00768
Date: 12/20/2013 Address/Parcel: 11970 SW Walnut St.
Pay Method: CreditCard Project Name: Boyce
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80%.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104 $Amount
Mechanical Permit 230-0000-43102 $86.25
12%State Surcharge 100-0000-24001 10.35
TOTAL REFUND: $96.60
APPROVALS: SIGNAT _ RES DATE:
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
FOR TIDEMARK SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: _ /G B :
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
From: 01/02/2014 10:54 #262 P.002/003
C �
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT RECEIVFI)
:t
Request Permit Action JAN 0 2 27
T I G A R 1.) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-ors' OOF TIGAHU
!UICDING DIV C
TO: CITY OF TIGARD
Building Division Services Supervisor
13125 SW Mall VOID Blvd.,Tigard,OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov
iitYPY '
FROM: ❑ Owner ❑ Applicant flii• Contractor ❑ City Staff
(check one)
REFUND OR Name: ,S1eolafEy `n9 &eoo(ing,ilne.
INVOICE TO: (Business or Individual) 7500 S.W.Tech Center Dr.
Suite 130
Mailing Address: Tigard,OR 97223
www.Speclahyheatiny.cotrr
City/State/Zip: 503-620-5643
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: 1'4 e C v j 3_ 60 7 (o
Site Address or Parcel#:
Project Name:
Subdivision Name: Lot#:
EXPLANATION: k , IT)y t,,,cr, 1 e
Signature: (j--_- Date: 41--.31-1 3
Print Name: v21tl.r� /07,6F/, .`'`:; /?.9$1
�0 t . GPO
Refund Policy
1. The Director or Building Official may authorize the refund of: p/ 35 a) any fee which was erroneously paid or collected. t7 �o •oZ-S �` �� Y /9
(�
b) not more than 80%of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. /e-- -11'J.A
c) not more than 80%of the land use application fee for issued permits. / , has , _ / /5
/ /
d) not more than 80%of the building plan review fee a-hen an application is canceled before any plan review effort been expended.
e) not more than 80%of the building permit fee for issued permits prior to any inspection requests. /2. jNeb
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 2-4 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to S s Admin: Date B Rte to Bid• Admin: Date 0 , B .‘1711M1
Refund Processed: Date, B' 411V,,. voice Processed: Date B
Permit Canceled: Date /ky,�, 13' •!� Parcel Ta. Added: Date B
Receipt# Date Method Amount$
I:\Building\Forms\RegPermitAction.doc Rev 05/25/2012
From: 01/02/2014 10:54 #262 P.003/003
V
CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: MEC2013-00768
13125 SW Halt Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/20/2013
TI{'A)t I? g Parcel: 2S 1036000600
Jurisdiction: Tigard
Site address: 11970 SW WALNUT ST
Project: Boyce Subdivision: 2007-085 PARTITION PLAT Lot: B
Project Description: install furnace and mini split
Contractor: SPECIALTY HEATING&COOLING INC Owner: BOYCE,RONALD J/ANA L
7500 SW TECH CENTER DR STE 130 11970 SW WALNUT ST
TIGARD,OR 97223 TIGARD,OR 97223
PHONE: 503-620-5643 PHONE: 503-730-1986
FAX: 503-681-0793
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 12/20/2013 $46.75
Type of Use: SF Heat Pump 12/20/2013 $61.06
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 12/20/2013 $12.94
Occupancy Grp:
Stories:
1)r
�LI
Pt lt1
Fuel
Fuel Types: Natural Gas Rai (01
eop) •
Gas Pressure:
kitS))
11)11# r 6V) 4i
C0IIP Total $120.75
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 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 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.