Permit a
� MECHANICAL PERMIT
4 § , " � CITY OF TIGARD
l 'i 4 t , : ' COMMUNITY DEVELOPMENT Permit #: MEC2009 00379
44G� 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/24/2009
;1a.4.4.3 Parcel: 1S134BD06800
Jurisdiction: Tigard
Site address: 11725 SW SPRINGWOOD DR
Subdivision: Lot: 0
Project: McCormick
Project Description: Install Air Conditioner Must maintain 3' rear and side yard setback
Owner: FEES
MCCORMICK, ANTHONY D & Description Date Amount
SHERILYN M, 11725 SW SPRINGWOOD DR Air Conditioning or Heat Pump 07/24/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 07/24/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 07/24/2009 $58.50
Contractor:
FIRST CALL INSTALLATION COMPANY
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 231 -3311
FAX: 503 - 557 -0919
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: Permittee Signature:_ 1r2
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.
'' TUL -2 -2009 08:28A. TO:5035981960 P.1
M echanical Permit Applica +CEWED s'�" - ,d.�2�' aye f.`r;+'»'� .etu., �?i.� .AFB �'.<.4 wG: Yw _, ..' � : « ��e7 /�.h .:,!,�.
"C "' ` `' Received ��*
City of Tigard 4 2009 Date/By: Permit Received O. O�Jt9 - ov3 .7 ?
131 25 SW Hall Blvd., Tigard, OR 97223 �UL Plan Review
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# o Phone: 503.639.4171 Fax: 503.598.1960 • p Other Permit.
r1 14w �yy 1 D
,l i,l,, 1tls Line: 503.639.4175 l li Date Ready/By: ® y: June. See Page 2 for
[4 ,rch.R;% Internet: www.tigard -ocgov '.`� ; u.d D e, t0' Notified/Method: Supplemental Information
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TYPE OF WORK COMMERCIAL FEE* SCHEDULE USECHECKLIST
❑ 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 EQUIPMENT /SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building -
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. F Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
1 t TZ 6W ep r r16w o b r Air conditioning or heat pump
Job site address: (requires site plan showing placement) ' 14.00
City/State/ZIP: Tigard, OR Fumace 100,000 BTU (ducts/vents) 14.00
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 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: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
to 1 fl U ^" r C0 1 fy -- Gas fireplace 10.00
It I I 1 ll 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
Chimney/liner /flue/vent 10.00
PROPERTY' OWNER , . TENANT
)14 PROPERTY
( El 10.00
Name: , CO II/1I/lf/1U Environmental exhaust and vendladon
Address: �'C Range hood /other kitchen
equipment • 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
603) C , 4 ` t comp
Single-duct s t (bathrooms,
Phone: 0 (�.� Fax: ( ) toilet compartments, utility rooms ) 6.80
El APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
T ¶ 1O�, Other. 10.00
Business name: Fuel piping
C7 Contact name: Diane Mason $5.40 for first four; 51.00 for each additional
`x ` 0 0. p n r ,, Furnace. etc.
Address: 1 V 0 {�L IJ V v
�} Gas heat pump
Q City /State /ZIP: O On � 4 Gt-70 Wall/suspended/unit heater
Phone: (S OS 7 ? 2 . 6 I Fax: : ( 55r/ 09 19 Water heater
Fireplace
E -mail: Range
CONTRACTOR . 'n Barbecue
Business name: Fi r t lS t l ,, I I V ► , iQti on Clothes dryer (gas)
Other:
Address: 13150 S. Clackamas River Drive MECHANICAL PERMIT FEES*
City /State/ZIP: Oregon City, 97045 Subtotal
Minimum permit fee ($72.50)
Phone: (503) 557.b 2,O f Fax: (503) 557.0919 Plan review (25% of permit fee)
CCB tic.: 107I4- State surcharge (12% of permit fee) 410 /1
TOTAL PERMIT FEE b (�J
This permit application capirea if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: Diane Mason Date: 1124[0q • Fee methodology set by Tri- County Building Industry Service Board
.......,. -- .....mn..�...--.-- n,nmm 440-4617T (I1 /02/COM/WE11)
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