Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2011 -00489
Date Issued: 11/02/2011
T [WARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 parcel: 1 S133DA04300
Jurisdiction: Tigard
Site address: 12560 SW GLACIER LILY CIR
Project: COOPER Subdivision: AMART SUMMER LAKE Lot: 65
Project Description: Furnace replacement
Contractor: TRI COUNTY TEMP CONTROL INC Owner: COOPER, WILLIAM R /LESLIE
13150 S CLACKAMAS RIVER DR 12560 SW GLACIER LILY CIRCLE
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -2220 PHONE
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/02/2011 $46 75
Type of Use: SF 12% State Surcharge - Mechanical 11/02/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/02/2011 $43 25
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 1 800 332 2344.
Issued By: Permittee Signature 4
IOW
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.
Mechanical l Permit Application c E I V . E 1 l OR 0 1 1 1 ( 1 1 ()NI.,
t3 ' of Tigard
1 /0V 0 1 Received ��� , PermitNo.: /' 10 a ■ 13125 SW hall Blvd., Tigard, OR 9722 ���1 Plan Review - - �,_`��
' Phone: 503.639.4171 Fax: 503.598.t96Q�ITy an Ocher Permit
I t c ^, .n 1c n Inspection Line: 503.639.4175 BUILD D p Notified/Method: �u�' � ® p Information
www.tigltrd- or.gov
, Ii .. ' - TYPE OF_ . - , COMMERCIAL F ' 1 .S 1)UL1H'y. -.'USE c rS ' -
:I New construction ® Addition/alteration/replacement Mechanical permit fees" are based on the value of the work
perfotmed.Indicate the value (rounded to The nearest dollar). of all
❑ Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
, - CATEGORY' OF CONSTRUCTION , - Value: $
RESIDENTIAL EQUTPMLNT,/ SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special wfOrraatioxitue checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description + Qty. Ea. E Total
301, -SITE INFORMATION 'AND LOCATION - , Beating/cooling
Job site address: I 2b(06vt 6 ISOLi l \� 6 r Air conditioning
i (requires site plan showing placement) 46:75
City/State/ZIP: Trod/T.1 11/L23 Furnace I00,000 BTU (ducts/vents) I 46.75
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg. /apt. no.: 1 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, - duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: I Lot no. Other: 23.32
Tax map /parcel no.: Other fuel appliances
' D1 SCRIPTION, Off' WORK - - Water heater - 23.32
�
, ^ Gas fireplace 33.39
�) 1XX f u rn Flue vent for water heater or gas
TT fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney /liner /flue/vent 23.32
PROPERTY .OWNER ❑ T NON 1'. Other: 23.32
Name: nth) - i � Environmental exhaust and ventilation
Address: -Range hood/other kitchen
equipment 33.39
City / State/ZIP: - Clothes dryer exhaust - 33.39
/� Single -duct exhaust (bathrooms,
Phone: ('2o1,) 44l (Q'T Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ' . - - ' r 0 CONTACT ' PERSON Attic /crawlspace fans 23 '
Other: 23.32
Business name: Same as contractor Fuel Loping
Contact name: Diane Mason $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/ State/ZIP: WalUsuspended/unit heater
Phone: ( ) Fax: : ( )
Wester heater
Fireplace
E -mail: Range - I
CONTRACTOR _ Barbecue - - -
Business name: Tri County Temp Control Clothes dryer (gas)
Other:
Address: 13150 S Clackamas River Drive MECHANIC'/tt: PERMIT FEES' ,
City/ State/ZIP: Oregon City, OR 97045 Subtotal
Phone: (503) 557.2220 Fax: (503) 557.0919 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lie.: 72623 State surcharge (12% of permit fee) 1,i'}(} Aj (\
��'� n TOTAL PERMIT FEE 6�IJ+Ov
Authorized signature: !
ature: L0- This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
Print name: I ( C Nt(on I Date: I II { 1 j • Fee methodology set by Tri Building Industry Service Board
I V3ui1ding\Pcrmna\MRC- PermitApp doe 10/01 /09 440 -4617T (11ro2./CONVwea)