Permit `��G'i`'' CITY OF TIGARD PERMIT
fI�l: Permit #: MEC2010 -00220
a C OMMUNITY DEVELOPMENT
ll Date Issued: 05/12/2010
:TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2E1120314100
Jurisdiction: Tigard
Site address: 14845 SW KENTON DR
Subdivision: Lot: 0
Project: GORNICK
Project Description: Replace A/C. Unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
GORNICK, LEE Description Date Amount
14845 SW KENTON DR Air Conditioning 05/12/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 05/12/2010 $10.80
PHONE: 541 -519 -6231 Minimum Fee Adjustment - Mechanical 05/12/2010 $43.25
Contractor:
TRI COUNTY TEMP CONTROL INC
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 557 -2220
FAX: 503 - 557 -0919
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
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: , ��� �2►� ��� �
Permittee Signature: 0/ _ PG/ e 7
i CaII 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.
MAY -11 -2010 08:54A FROM: TO : 5035981960 P.1 (,0'
Mechanical Permit A 1>� O ' '
p WI( t >hllt I I .�t t)\1.1 •
City Of Tigard Received r ,. Permit s
., , Date/By: t /rZ / NIC=c t / a -a> 0 p
j 13125 SW Hall Blvd Tigard OR 1 1 2010 Plan Review
Phone: 503.639.4171. Fax: 503.5 60 p ars Other Permit;
tit .\Iti.) Inspection Line: 503.639.4175 � /�
Internet: www.tigard- or.gov CI l i O 1' L- A, ' I r) Note e d /Met o: &1 See Page 1 for
Notified/Method:
IM Supplementallnformadou
OUILDING DIVIS `
.
TY,PL Qb`W
, ORK COMM�`„RCtAL Fklf* SWil>4DV DSEdigOic iLST
❑ 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 E (SUICMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building
❑Multi- family ❑Master builder . For specialinformatlon use checklist.
❑ Other: Description 1 Qty. I 13a. 1 Total
30D-SITE INFORMATION AND LOCATION Heating/coaling
Job site address: 1 4.84 W n In v V Air conditioning
(requires site plan showing{ placement) 1 46.75
fl
City/State/Z1P: i ZT12
Furnace Fuace 100,000 BTU (duets/vents) 46.75
V u
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: ' Project name:
Heat pump 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
DFSCRTPTION: WORK Water heater p23.32
Gas fireplace 33.39
Flue vent for water heater or gas
` fireplace 23.32
�� �`I1� al r `"' - O� Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert - 23.32
[ - Chimney /liner /flue/vent 23.32
X..PROPIR9'Y; OWNER I 0 TENANT Other: 23.32
Name: ire QOM ICi Go owl C k_ Environmental exhaust and ventilation
Address: ' 4 5 y Y �n Range . ther kitchen
equipment ant 33.39
City/State /ZIP: ! 4122_ Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: 5 Fax: ( ) toilet compartments, utility rooms) _ 23.32
'' '' ' Attic/crawls ace fans 23.32
®' APPL1CA. 0 pF RSON P
Other. 23.32
Business name: Same as contractor
Fuel piping
Contact name: Diane Mason $14.15 for brat four; 54.03 for each additional
Furnace, etc.
Address:
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Fax: : Phone: ( ) ( ) Fireplace
E-mail: Range
' CONTRACTOR Barbecue
Business name: Tri County Temp Control Clothes dryer (gas)
Other:
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES*
City/State /ZIP: Oregon City, OR 97045 Subtotal 76 . 07)
Minimum permit ( mit fee
Phone: (503) 557.2220 Fax: (503) 557.0919
Plan review (25%ofpermit fee) )
6p lie.: 72623 State surcharge (12 %ofpermit fee) / t; �L
TOTAL PERMIT FEE II 1Y)
1 his permit application expires if a permit is not obtained within 1$0
Authorized signature: days after it has been accepted as complete.
I Print name: Vanr, MQ90f1 Date: • Fec methodology set by Tri -County Building Industry Service Board
I Itw di •y Punt s\MEC•PermitApp doc 10/01/09 440 -4619f (I I /02/COM,WHH)
MAY -11 -2010 08:55A FROM: TO: 5035981960 P.2
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