Permit n CITY OF TIGARD MECHANICAL PERMIT
',14 _ - COMMUNITY DEVELOPMENT Permit #: MEC2011 -00243
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/02/2011
Parcel: 2S103ACO3200
Jurisdiction: Tigard
Site address: 12495 SW 112TH AVE
Project LESAGE Subdivision: MCMICHAEL HEIGHTS Lot: 6
Project Description: Heat pump and gas furnace installation. Heat pump must meet 3 ft. minimum rear and side yard setbacks.
Contractor: SPECIALTY HEATING & COOLING INC Owner: LESAGE, PETER C AND ANN T
7500 SW TECH CENTER DR #130 12495 SW 112TH
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 620 -5643 PHONE:
FAX: 503 -681 -0793
FEES
Specifics: Description Date Amount
Air Conditioning 06/02/2011 $46.75
Type of Use: SF Heat Pump 06/02/2011 $61.06
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 06/02/2011 $12.94
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $120.75
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 1.800.332.2344.
Issued By: . „7" i ��� - // • Permittee Signature:
Call 503.639.4175 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.
MAY /31/2011/TUE 01:29 PM FAX No. P. 001
Mechanical Permit Application FOR OFFE..Cr US ONLY
14 City of Tigard Received -
r g \ D Penult No.: %.1 (( vhf
i
131_5 SW Ball Blvd., Tigard, OR 97 1.,%\ Plan Review
u Phone: 503.718.2439 Fax: 503,598. N6 c,, Other Permit:
D ate /By:
1 1GAKD Inspection Line: 503,639,4175 e �P ( Reedy /By: lurk F1 Set Page 2 for
Internet: www.tigard- or.gov 1 C�, \ C i .lNotit" ied/Method: 'Pi - Supplemental Information
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• Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition/alteration /rep perfonned. Indicate the value (rounded to the nearest dollar) of an
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead andprofit.
,.; a .�.. eft. ; ;'(9 ^, , Qt '"r q_p:p . may - ..,r:. • r.r,� t ^:ij crv't, . r'`' ° "`" �'`:. ; r96'r, 0
Value: $
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® 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.'
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. _ Ea. Total
;, ' , {��' ,>r;a; �?,ft3,�. ��a5�:� �.�; , >� , � , : ,r an ,.'t ;�`k� >E3(eatingJln
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Job site address:
21 � J 1 t h ��i A{� � l 1`ry���N��lr�,y�,�•{�(LJ� } p! (�M1yN MN�rli��} Lx ,�ry� 'W! PN,
Pg a il e F3?,,, i„lt r e� '^„ :?7?,' 77 0' /y tji,lt ;.t" 'er 7 ,41 o�l&Ci'I �, iiJfM� ,t. 41:1,:',,:,ari �7 �" ..
6 "t --- Air conditi
I t � j t� �,� `'�"� 46.75
l � 1 rc•uirea site .ran showrn:.lacc
Furnace 100,000 BTU (ducts /vents) ( 46.75 4 '
City/State/ZIP: Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump p /
..,, (requires site plan showing placement) f 61.06 I / p E • ` b
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or •
hydronie) 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:
l j !E, ti, t7�r� q s „< i>nh'r i ill t),.��. Lfi , }, r`� �a"(” i'��vP{) {9 ^�rlKY �,�� rw i',, .-
i r% . i'N.; X . 1$,d 64 Fo- .Z't' . X ;$�,. .4.1.0, l�l„ ,; tiJ , to i, ka t i 1e'9 1- :k,' r,4, :: :') 9'( '', Water heater 23.32
9,�1�h
www- -- _Gas fireplace 33.39
.. � ] l (1i + 11 h P �r 1 ,I J i t lye. 4- 305 J '- j f (W/0' F luo vent for water heater or gas
1 J fireplace 23,32
Log lighter (gas) 23.32
Wood/pellet stove 33.39 — .,
Wood fireplace/insert 23.32
lwi1 wg.; is .l * Rt;2/ a;,.ii,, , u=�i; ,uki i . 6Digi? , 7:6 71. i6;li'li r(Ya A i'( ' 1d1 D Chimney/liner /fbuc/vent 23.32
'" - " •' Ann Lesage R11146 '`�' r� ' `u )' Other: _ 23.32 •
Name: 12495 SW 112th Ave Environmental exhaust and ventilation:
Address: Tigard, OR 97223 Range hood/other
equipment 33.39
City /State /Zip: 503 -684 -5926 Clothes dryer exhaust 33.39
"" Single -duct exhaust (bathrooms,
Phone: ( ) toilet compartments, utility rooms) r 23.32
• ;itl , ,. c ", rr r ir a7 ' u a; ! Y ,r^,^ --
; � r il`''t
� ;' 1� U7. ��, 1 PP L JC` k�� �!�? �"l� } 'm� , �r0' :.'1��,�,�,5�� Attic /crawlspacefans 23.32
Business name: Other. 23.32
• Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State/ZrP: Wall/suspended/unit heater
Phone: ( ) pax :: ( ) Water heater
E -mail: Fireplace
Range
,
Business name: Specialty Heating & Cooling, Inc
Clothes dryer (pas)
Other:
Address: 7500
Tigard, OR SW Center Dr #130 a r R u ! M) C A,116:t-i PFRMI'I" F* ?. S 97223 Subtotal o ((J .1n
Minimum permit fcc ($90.00)
Phone: (503) 620 -5643 Fax: (503) 598 - 0718 Plan review (25% of permit fee)
CCB lie.: 66578 • State surcharge (12% of permit fee) t 0 (-1 r j).:9 9
� TOOT PERMIT PEE I, (1 jaa175 R
This p4r ird ntie ketiha ermit is not obtained within 180
y�
Authorized signature: 1 r ( t lias .��!! p en sated as complete.
T
Print name: Suzie James Date: * Fee i tho tnla r su h1si -Gotta Building Industry Service Board
I;\ Building \PetmitiatEC- PernitApp.doc 09/09/10 440-46171 (11/02/C OM/WEB) .
MAY /31/2011/TUE 01:29 PM FAX No, P.002
SITE PLAN
PL
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I 13
PL PL
V
12.Actc € to Q{ n`' koe,nc e
STREET / n L sv.oe_ vi
a ,a., mo o, o- 6 1 - 7a-3,-
NOTE — Please show the following on the site plan:
• Location of Indoor Unit and Outdoor Unit
• Indicate how the flue will be run (thru the roof — out the sidewall — etc) 1— • Indicate with dotted Tine how the lineset will be run and approx. distance
• Indicate how the condensate will be run
7500 SW Tech Center Drive
Sp ecialty Suite #130
Tigard, OTC. 97223
HEATING & COOL ING INC. (503) 620 -5643 Fax: (503) 681 -0793
- ww w.specialitvheatine.com
We're not comfortable moil yvu ore!