Permit (40) CITY OF TIGARD MECHANICAL PERMIT
'II 2'' COMMUNITY DEVELOPMENT Permit#: MEC2016 00594
TIGARD A' R 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/16/2016
Parcel: 2S 102DB00100
Jurisdiction: Tigard
Site address: 8840 SW BURNHAM ST
Project: Frontier Subdivision: None Lot: None
Project Description: Duct work modifications.
Contractor: HVAC INC Owner: FRONTIER COMMUNICATIONS NORTHWES
5188 SE INTERNATIONAL WAY PO BOX 152206
MILWAUKIE, OR 97222 IRVING, TX 75015
PHONE: 503-462-4822 PHONE:
FAX: 503-462-6555
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 08/16/2016 $115.11
Class of Work: ALT Type of Const: Plan Review 08/16/2016 $28.78
12%State Surcharge-Mechanical 08/16/2016 $13.81
Occupancy Grp: Occupancy Load:
Stories: Info Process/Archiving-Sm$0.50(up to 08/16/2016 $0.50
Project Valuation: $2,000.00 11x17)
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 $158.20
Hoods: Comm Incinerators:
Required Items and Reports(Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work: 1
Fire/Smoke Dampers:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the -ules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You a obtain a copy of the rules
or direct questions to OUNC by calling 503.2 . .::: 32.2344.
q
Issued By: i , /
all
-rmittee Signature: Il
JP--
ll 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until co', pletio of the project.
Approved plans are required on the job site at the time of each in-.ec on.
Mechanical Permit Application FOR OFFICE FSI:ON 1,1
City of Tigard Received
Date/By. Permit No.:
lig q 13125 SW Hall Blvd.,Tigard,OR 9722 i�r �� V 1�/
, E! �a6 E Plan Review /
Phone: 503.718.2439 Fax: 503.598.19 Date./By: Other Permit:� 1 tr s
TIGARD Inspection Line: 503.639.4175 r (; Date Ready/By: ® See Page 2 for
w
Internet: ww.tigard-or.gov AUG 1 `r 2016 Notified/Method: / /(/ lb
„ Supplemental Information
CITY OF TIGARD
TYPE OF
vWffLDING DIVISION COMMERCIAL FEE* SCHEDULE —USE CHECKLIST
❑New construction Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
P performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$ 090
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
0 1-and 2-family dwelling A Commercial/industrial ❑Accessory building For special information use checklist.
o Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
Air conditioning
Job site address: Vit it, a v V ,.V✓'1 got (requires site plan showing placement) 46.75
City/State/ZIP: s { 1111����1�44 Furnace 100,000 BTU(ducts/vents) 46.75
1���1F1' t Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: .i`90_ 9J,' Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler(radiator or
hydronic) 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
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
� �y �v Gas fireplace/insert 33.39
c ,"k' �,D `�l -D'iri' 11 • Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
0 PROPERTY OWNER 0 TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust(bathrooms,
Phone:( ) Fax:( ) toilet compartments,utility rooms) 23.32
0 APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 23.32
Business name:HVAC,Inc. Other: 23.32
Fuel piping:
Contact name:Jody DePew $14.15 for first four;$4.03 for each additional
Address:5188 SE Internaitonal Way Furnace,etc.
` Gas heat pump
City/State/ZIP:Milwaukie,OR 97222 Wall/suspended/unit heater
Phone:(503)462-4822 Fax::(503)462-6555 Water heater
Fireplace
E-mail:jodyd @hvacincorp.com Range
CONTRACTOR Barbecue
Business name:HVAC,Inc. Clothes dryer(gas)
Other:
Address: MECHANICAL PERMIT FEES*
City/State/ZIP: im. )1\ V- Subtotal
Minimum permit fee($90.00)
Phone:( ) Fax:( ) Plan review(25%of permit fee)
CCB lie.:50897 State surcharge(12%of permit fee)
IV
TOTAL PERMIT FEE ! ✓}t,,,G This permit application expires if a permit is not obtained within 180
Authorized signature: vvv days after it has been accepted as complete.
Print name:Jody DePew Date: g 1 \41 I ? * Fee methodology set by Tri-County Building Industry Service Board
I:\Building\Permits\MEC-PermitApp.doc 03/07/12 440-4617T(11/02/COM/WEB)
INI
IN
TIGARD
City of Tigard
November 14, 2016
HVAC, Inc.
Attn: Jody Depew
5188 SE International Way
Milwaukie, OR 97222
Re: Permit No. MEC2016-00594
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 8838 SW Burnham St.
Project Name: Frontier
Job No.: N/A
Refund Method: ® Check#222914 in the amount of$103.14.
❑ Credit card"return"receipt in the amount of$ .
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,
/ .7)).147-4)-1-e--
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
14
° 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: HVAC, Inc. DATE: 11/7/2016
Attn: Jody Depew
5188 SE International Way REQUESTED BY: Dianna Howse
Milwaukie, OR 97222
TRANSACTION INFORMATION:
Receipt#: 405656 Case#: MEC2016-00594
Date: 8/16/2016 Address/Parcel: 8838 SW Burnham St
Pay Method: Check Project Name: Frontier
EXPLANATION: Per applicant's request as job was cancelled. Refund 80%of permit fee.
.',:t1--'e'177,47 i niNu 1 t .a,+"" 5wai `x re.: 7s..s... Fck
} ix
R
°°1g1 ai't 0$174.:--; a •: asg3i1a6 &' 7- G` ' kEg! $_`
Mechanical Permit 230-0000-43102 $92.09
12%State Surchar.e 100-0000-24001 11.05
TOTAL REFUND: $103.14
APPROVALS: SIGNAdt ' S DATE:
If under$5,000 Professional Staff r r i
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
..,.. � w „,rQR TIDE��ARKSYSTEM ADMINISTRATION O� � l .
Case Refund Processed: Date: / "/ By: I 4004--
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
11/03/2016 15:16 5034626555 HVAC INC PAGE 01/03
•
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IVRY
OR Calif 50897 WA L&I#HVACI**125J6 CA 863290
HVAC FAX# (503)462-6555
DATE:1113/2016 FROM: JODY DEPEW-503-462-6566
To: COMMUNITY DEVELOPMENT DEPT
COMPANY: CITY OF TIGARD
SUBJECT: REQUEST FOR REFUND OF PERMIT MEC2016-00594
FAx#: (503) 598-1960 No. OF PAGES: 3
(INCLUDING THIS SHEET)
PLEASE SEE ENCLOSED PAGES REQUESTING REFUND FOR MECH PERMIT !
THANK YOU
JODY DEPEW
HVAC, INC.
IF ALL PAGES ARE NOT RECEIVED, PLEASE CALL US AT (503)462-4822
5188 SE INTERNATIONAL WAY, MILWAUKIE, OR 97222-4602
11/03/2016 15:16 5034626555 HVAC INC PAGE 03/03
P)
CITY OF TIGARD MECHANICAL.PERMIT
Permit#: MEC2016.00594
COMMUNITY DEVELOPMENT
Date issues: 08/16/2016
T I,;n 1 r, 13125 SW Hall Blvd.,Tigard OR 97223 503,718.2439
Parcel; 251020800100
Jurisdiction; Tigard
Site address; 8940 SW BURNHAM ST
Project: Frontier Subdivision: None Lot: None
Project Description: Duct work modifications.
Contractor: HVAC INC Owner FRONTIER COMMUNICATIONS NORTHWES
5188 SE INTERNATIONAL WAY PO BOX 152206
MILWAUKIE,OR 97222 IRVING,TX 75015
PHONE: 503.462-4822 PHONE:
FAX: 503362-6555
FEES
Specifics: Deacription Date Amount
Type of Use: COM permit Fee 08/16/2016 $115.11
Class of Work: ALT Type of Const: Plan Review 08/16/2016 $28.78
Occupancy Grp: Occupancy Load: 12%State Surcharge•Mechanical 08/18/2016 $13.81
Stories: Info Process/Archiving•Sin$0.50(up to 08/16/2016 $0.50
11x17)
Project Valuation: $2,000.00
FAA Alrilancllera
Fuel Types: Units c 10000 cfm:
Gas Pressure: Units}10000 crm;
Furnaces potters&C9inoressors
Furnaces<100K BTU: 0-3 HP;
Furnaces>=100K BTU: 3.15 HP;
Floor Furnaces: 15-30 HP:
Unit Heaters: 30-50 HP: 4. C rs 7 47
Vents w/o Appliances, 50 or Greater HP: ~fµ1,`;i. •
Air Conditioning:
Heat Pump:
Appliances
vent Fans: Vent Systems: Total $158.20
Hoods: Comm incinerators: — Required Items and Reports(Conditions)
Woodstovee: • Gas Fireplaces:
Clothes Dryers: Other Mach Units:
Gas Outlets: Other Oast
Duct Work: 1
Fire/Smoke Dampers:
This permit is Issued subject to the regulations contained In the Tigard Municipal Code, State of OR. Specialty Codes end 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 clays. ATTENTION: Oregon law requires you to follow the les adopted by the Oregon
Utility Notification Center. Those rules are set forth In OAR 952-001.0010 through OAR 952-001-0090, ou obtain a copy of the rules
or direct questions to OUNC by calling 503.2 : 32.2344. /
issued By: _ rmittee Signature;
� � J
all 503.639.4175 by 7:00 a.m.for the next available Inspect)•n date.
This permit card shall be kept in a conspicuous place on the Job site until co• pletl. of the project
Approved plans are required on the job site at the time of each I - s on.