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Permit r� CITY OF TIGARD MECHANICAL PERMIT 111 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00344 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07(14(2009 Parcel: 2S103BD05200 Jurisdiction: Tigard Site address: 12615 SW 116TH AVE Subdivision: HUNTER'S GLEN Lot: 8 Project: Olsen Project Description: Replace a /c. Owner: FEES OLSEN, TOM E Description Date Amount 12615 SW 116TH AVE TIGARD, OR 97223 Air Conditioning or Heat Pump 07/14/2009 $14.00 12% State Surcharge - Mechanical 07/14/2009 $8.70 PHONE: Minimum Fee Adjustment - Mechanical 07/14/2009 $58.50 Contractor: TRI- COUNTY TEMP CONTROL 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 $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 o OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: (� (� A a I /� n l �∎U Q Permittee Signature: Alp)(Qck* �l` � V� t0 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. - ';UL- 13 12:42P FROM: TO: 5035981960 P.1 Mechanical Permit A EC E I V E D City of Tigard Received PennitNo.: fl n,41 . CjQ• 1. • 13125 SW Hall Blvd., Tigard, OR 97223 JUL 13 2009 p te53 s tew i Y \� 9 l `) • Phone: 503.639.4171 Fax: 503.59&l96 Da te/ey: Other Permit: I 1 t . t: t t Inspection Line 503.639.4175 ITY OF TIGARD Date Ready/By: hri.: la See Page 2 for Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: 1 (c Supplemental information TYPE OF `WORK COMMERCIAL FEE ". SCHEDULE - USE CHECKLIST ❑ 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: $ 1 -and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* ® y g ❑ Commercial/industrial ❑ Accessory building For special information use checklist. Multi -family ❑ y ❑ Master builder ❑ Other: Description I Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling • Job site address: 12.615 6 W I i6-1-#1 Aliffutt, Air conditioning or heat pump (requires site plan showing placement) I 14.00 City/State/ZIP: Tigard, OR v17 Furnace 100,000 BTU ( ducts/vents) 14.00 Furnace 100,0004- 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 Gas fireplace 10.00 Flue vent for water heater or gas • Rt.p (am au r a n d iti o v cy- fireplace , 10.00 Log lighter (gas) , 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 X PROPERTY OWNER ID TENANT Chimney/liner/flue/vent 10.00 Other: 10.00 Name: • $ e - Environmental exhaust and ventilation Address: - ( Range hood/other kitchen equipment 10.00 City/State/ZIP: Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: (60) Sig - 31Qq2. Fax: ( ) toilet compartments, utility rooms) 6.80 ® APPLICANT 121 CONTACT PERSON Atddcrawlspace fans 10.00 Other: 10.00 Business name: Same as contractor Fuel piping Contact name: Diane Mason $5.40 for first four; $1.00 for each additional Furnace, etc. Address: Gas heat pump City/State/ZIP: Wallsu pended/unit heater Phone: ( ) Fax: : ( ) Water heater . 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, 97045 Subtotal Phone: (503) 557.2220 Fax: (503) 557.0919 Minimum permit fee ($72.50) Plan review (25% of permit fee) CCD lie.: 72623 State surcharge (12% of permit fee) ik tl 2,0 TOTAL PERMIT FEE /�� „ �,, "� 7 This permit application expires if a permit is not obtained within 180 Authorized signature: "'" days after it has been accepted as complete. Print name: Diane Mason Date: ' Fee methodology set by Tri-County Building Industry Service Board ,.,n..:u:- _.o- r:....or s....,.. "- .,a,,. mnmm 440.4617T(11/02ICOM/WEB) r ti r- r N • CON I RACI "OR A/C - BEAT PUMP --. UNI T SITE PLAN in CD N 10 B/ICIC f'ROPI:RT1' LINE Pit n cti cek 0 3 -fcc tC7 (-C3 TO SIDE PROPERTY LINE • .1c,-S rfro„ 1 - o per Lim e TO STREET 0 m LA _�� �_� cn �---°- N CUSTOMER INFORMATION NAME -t9�+. ©l..$ Fill) m ADDRESS , . (5 S w L I (o Tti4Y. - e-e.,A4Lb , Y PLEASE REFAX APPLICATION WITH SITE PLAN. ro 1