Permit - CITY OF TIGAR MECHANICAL PERMIT
DEVELOPMENT H P Tigard, - 639 - 4 171 DATE PERMIT #: ISSUED: 3/16/2005
00112
- 13125 PARCEL: 2S103BD -04700
SITE ADDRESS: 12535 SW 116TH AVE ZONING: R -4.5
SUBDIVISION: HUNTER'S GLEN LOT: 003 JURISDICTION: TIG
Project Description: AC install
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
TRUMMEL, ERIC J + DANETTE J Description Date Amount
12502 SW 116TH AVE [MECH] Permit Fee 3/16/200f $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 3/16/200E $5.80
Phone: 503 -579 -5086 Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045
Phone: 503 - 557 - 2220
Reg #: LIC 72623
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 800 - 332 -2344.
i
Issued By: i` I Permittee Signature: ,
Call 503 - 639 -4175 by 7:00 a.m. for inspections 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.
Mar ,1.5 05 07:51a TriCounty Temp Cntrol 5035570919 p.1
I�Iechanica1 Permit ApplcatioW I /E (� °^ FOR OFFICE USE ONLY
C of Tigard V At . Received 13125 SW Hall $lvd., Tigard, OR 97223 DateBy: 3 / Permit No1/b L . 00 / / a_
Phone: 503.639.4171 Fax: 503.598.1960 , +j 1 Plan Review Inspection Line: 503.639.4175 �i y 4 111 D ate/By: Other Permit:
Internet: www.ci.tigard.or.us CITY OF TIC. __ Date Ready/By: Jurs: I ,
S Se Page 2 for
Notified/Method: ^U!LDING DIVISION SupplemeatalInformation
;#1'1E AFakWOR :11' - .CONIItii tictA.L EEE *'SCHEDULE USE " CHECKLIST
❑ New construction KAdditioNalter 'ation/replacement Mechanical permit tees' are based on the value of the work
❑ Demolition performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other: mechanical materials, equipment, labor, overhead, and profit.
.. i':-7:: OF" CONSTRUCTI Value: $
1 - and 2- family dwellino ❑ C o mm erciaUindusttial RESIDE \ EQUIPMENT / SYSTEMS -FEES*
o ❑ Accessory building
❑ Multi - family ❑ Master builder ED Other:
For special information use cneckGsr.
Description , on Q I Ea Total
T [ I
.JO
` , SIs7NFORMATION .AN,. D LOCATION.: �` ' .TE. ' • Heating/cooling
' •
Job site address: 1 12 5w 11�}'� ,�1 �" life - �+v Air conditioning or heat pump
.*.. r, (requires site plan showing placement) I I 14.00 I
City/State/ZIP 1?
: 'Q x7223 Furnace 100,000 BTU (ducs/vents) I 14.00 111:
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (duets/vents) 17.90
Gas heat pump 14.00 It
Cross street/directions to job site: Duct work 14.00 I •
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. 10.00
Subdivision; I Lot no.: Flueivent for any of above 10.00
Other: i 10.00 .
Tax map /parcel no.: Other fuel appliances
' DESCRIPTION OF WORK. ; d, Water heater 1 10.00 1
I a fi r 'A/ r? d i1 j o - Gas fireplace 10.00
r rv�+.t�. 1.(.� l:U � ( ono- �..� Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10
' Wood fireplace/insert 10.00
4 . • PRUPERTY O�ViNER. Chimney/liner/flue/vent
❑ TF
' (may U I o-
•
10.00
G II l.r i! � Othzr: I ; 10.00
Name: i� .�1,, Environmental exhaust and ventilation
Address: 12535 SW 1 I (e t . ttP. Range hoodiother kitchen
`i" �r �^ Vt�V equipment 10.00
City/State/ZIP: Tigard rd q' 2+c� (3 . Clothes dryer exhaust - 10.00 1
Phone: (p3 5 6 Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) I 6.80
❑ APPLICAN )0, i GQ(`tTACT PERSON Attic /e awlspace fans 1 10.00 )
Business name: Tn n l J r r> COP-P-01 Ca Other: 10.00
1, tl l Fuel piping
Contact name: Vane, Vane, 55.40 for first four; S1.00 for each additional
Address: i,3) .30 cia /'k/1, )Qs Ql /Cr j�V71 Furnace, etc.
/� l t�l i f ((l l tv ji1 1 U rC Gas heat u I
City/State/ZIP: I:I 'JC.il Ct "l J c ( Q C(7 5 Wall/suspended/unit heater
Phone: ( ;5) x57_,7-70 I I Fax:: (5 J ) 2/57- CCi Water heater
E -mail: - Fireplace
4 r Range
e . ,.. _. : '' d '` t . r.:CO \"T12A(TOR,: �, >.. . l.. t. ' r .,; 't Barbecue
Business name: i n CD Temp C/1 / Clothes dryer (gas) I •
Address: • t 1 l t C l t L Other
r.p Y1 CE
MEIANIG
City/State/ZIP: Ol L L � � Subtotal
Phone: (6‘_,) 55 ' _ 2 ?9 ('r `/ I Fax: (6(5 6 5 • I g Minimum permit fee (S72.50)
Plan review (25% of permit fee)
CCB lie.: -7210. State surcharge (8% of permit fee)
TOTAL PERMIT FE ��
Authorized signature: 'n - e " fi n C K-- - This permit appltca tine expires if a permit is not obtains
Print name: bt ]�yy days after it has been accepted as complete.
OJ2.Q Ituoo 1 ! Date: 3! I ( (()t . ' Fee methodology set by Tri- County Building Industry Service Board
0 .Building Termits hrmitApp.doc 122/03 44 (I l/ /02
Mar ,15 05 07:51a
TriCount Temp Cntrol 5035570919 p.
WJ 002/002
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