Permit q CITY OF TIGARD MECHANICAL PERMIT
1111 I ' ''.. COMMUNITY DEVELOPMENT Permit #: MEC2010 -00642
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/09/2010
Parcel: 2S102CB05700
Jurisdiction: Tigard
Site address: 13045 SW GRANT AVE
Project: Halstead Subdivision: WINSOME TERRACE Lot: 1
Project Description: Heat pump installation.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: HALSTEAD, ERIK
13150 S CLACKAMAS RIVER DR 13045 SW GRANT AVENUE
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -2220 PHONE:
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Heat Pump 12/09/2010 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 12/09/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/09/2010 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.8 .32'2344. c
Issued By:
7 . '' ''-"
�� /� l� Permittee Signature: /-vveZ -,
Call 503. 9.4175 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.
DEC -9 -2010 11:56A FROM: TO: 5035981960 P.1
Mechanical Permit Anplication .
10I4 I >I 1:11 1 1 •I 11 \1 1
City
$ r
of Tigard Received
"' �'
�0 1 Perm No.:
'" . (7 di • 062/
I
• .II 13125 SW Hall Blvd., Tigard, Q 9 0 way:
II ' Phone: 503. Fax: 503 j$ 1460 r �o Plan Review
. Date/By:
Penult:
1 . ,. 1 :,; Inspection Line: 303.639.4175 Date Ready/By: iur e: B Set Pace 2 for
,,. Internet: w O ON /* 1 �� 1 Nolified/Method: '�C9
V ` ` Supplemental Intarnadon
TYPE OF. W O ,,, - COMMERCIAL FEE* SCHEDULE -. USE CHECKLIST
❑ New construction ® Addition /altemtfon/replacement Mechanical permit fees* are based on the value of the work
❑ Demolition ❑Other: performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
• For special srarioa tochectlist.
Multi 0 builder ❑ Other: Description , Qty. ( Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: I 5 AW �" p ( 1 Air conditioning
(requites site plan showing placement) 46.75
fl V � Y� v � 1 1 -1
City/State/ZIP: ?Z Furnace 100,000 BTU (ducts/vents) 4675
Suite/bldg./apt. no.: Project name: ..j ' e� Furnace 100,000+ BTU (ducts/veots) 54.91
/ I� 4J Heat pump 1 61.06 49 1, Q(,
Cross stmet/directions to job site: Duct work 23.32 T
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 Mel appliances
DESCRIPTION OF WORK Water heater 23.32
n ( /l I I heat ,pump yyl FIu fireplace
33.39_ .
kart I l ea u t l ! Flue vent for water heater or gas
23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
n PROPERTY
ttti
OWNER 1 (21 TENANT Chimney /liner /flue/vent
Other: 23.32
�' rl T`-17t � 23.32
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City/Sate/Z1P: Clothes dryer exhaust 33.39
• Phone: ( ) — `'� ,Fart Single-duct exhaust (bathrooms,
V 9j ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: Same as contractor Fuel piping
Contact name: Diane Mason 514.15 for first four; 54.03 for eaeb additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater •
Phone: ( ) I Fax:: ( ) Water heater
. Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business cause: Tri County Temp Control
Clothes dryer (gas)
Other:
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES*
City/Sate/ZIP; Oregon City, OR 97045 Subtotal
Minimum permit fee ($90,00) Cie/ r /d
Phone: (503) 557.2220 Fax: (503) 557.0919
Plan review (25% of permit fee) i J ` s J
CCB Iic.: 72623 State surcharge (12% of permit fee)��ii 'SO
��./� / ply \ /\ TOTAL PERMITFEriln0' , �L
application espires If a permit ia not obtained Authorized signature: 4 4 ; 7fJ � "'ti '� ,., Tb6 permit d ys .fter it her been accepted as complete. within 1110 Print name: Ii W 11.E goon ff _ Date: i 2 ( (11 10 I • Foe methodology set by Tri- County Building Industry Service Board
M10.1617r 1) I1n2/COMIW ®)
1 uildiceartnitaMEC-ParmUApp.dec 1(1/01i09 :la
DEC -9 -2010 11:56A FROM: T0: 5035981960 P.2
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INSTALLATION ADDRESS, IY34.5 8W Gram Av 1
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PROPI lL7Y LINE
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PROPERTY LINE
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