Permit CITY OF TIGARD MECHANICAL PERMIT
` '! : COMMUNITY DEVELOPMENT Permit #: MEC2011 -00582
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TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2011
Parcel: 2S114BA09300
Jurisdiction: Tigard
Site address: 16575 SW WOODCREST AVE
Project: ACKLEY Subdivision: COPPER CREEK STAGE 2 Lot: 46
Project Description: Gas furnace replacement.
Contractor: ABLE HEATING & COOLING Owner: ACKLEY, ROY E &
16285 SW 85TH AVE #105 RODACKER, NANCY J
TIGARD, OR 97224 16575 WOODCREST AVE
TIGARD, OR 97224
PHONE: 503 - 579 -2250 PHONE:
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/16/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/16/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/16/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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:
4111
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 Permit Application
V FOR,OFFI('L• USr O LY
City of Tigard Received 2
't 13125 SW Hall Blvd., Tigard, OR .j Date/By: i C., PermsNo.: V _ •�
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Phone: 503.7182439 Fax: 503. 4 • Plan Rev ew
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7' I G A P.O Inspection Line: 503.639.417 '1'°\ Date Ready/By: Other Permit:
www.tigard - ongov y
�C 15 1G g o Norified/hlettw Supplemental Information
d: ® See Page t for
TYPE OF e . - '9'1. 1 5` COMMERCIAL FEE* SCHEDULE -LSE CHECKLIST
�a � acement Mechanical permit fees* are based on the value of the work
ID New construction ® Addition /alte ,
• performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: - mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES`
® 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder
❑ Other: Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 16575 SW Wooderest Ave. Air conditioning
(requires site plan showing placement) 46.75
City, /State/Z1P: Tigard, OR 97224 Furnace 100,000 HTU (ducts ,ronu) I 46.75 46.75
Furnace 100,000+. BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Ackley Heat pump
_ (requires site plan showing placement) 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, in -duct, suspended, etc. 46.75
Subdivision: 1 Lot no.: Flue /vent for any of above 23.32
Tax map/parcel no.: Other: 23.32
Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
Replace existing gas furnace Gas fireplace 33.39
Flue vent for water heater or gas
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 ! ❑TENANT
Name: Roy Ackley Other: 23.32
Environmental exhaust and ventilation:
Address: 16575 SW Wooderest Ave. Range hood /other kitchen
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equipment 33.39 '
City/State/ZIP: Tigard, OR. 97224 Clothes dryer exhaust 33.39
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Phone: (503 )620 - 7389 Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
0 APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Other: 23.32
Contact name: Fuel piping:
$14.15 for first four: $4.03 for each additional
Address: Furnace, etc.
City/State/ZIP: Gas heat pump
_ Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue -
Business name: Able Heating & Cooling LLC Clothes dryer (gas)
Other:
Address: 16285 SW 85 Ave. Suite 105
MECHANICAL PERMIT FEES*
City /State/ZIP: Tigard, OR- 97224
Subtotal 46.75
Phone: (503) 579 -2250 Fax: (503) 620 -3980 Minimum permit fee ($90.00) 9P,00
CCB lie.: 184392 Plan review (25% of permit fee)
State surcharge /t 9uG ,f :• fe e.)
1 10.80 1
. `' � TOTAL PERMIT FEE I 100.80
Authorized signature: I l -
1 "` This permit application expires if a permit is not obtained within 180
.i "' days after it has been accepted as complete,
Print name: Kelly Wilhi /� Date: I2 - - 2011 I ' Fee methodology set by Tri-County Building Industry Service Board
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