Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00049
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2012
Parcel: 2S 102A B00400
Jurisdiction: Tigard
Site address: 12127 SW LINCOLN AVE
Project: Coleman Subdivision:RTH TIGARDVILLE ADDITION, AMENE Lot: 63
Project Description: Replace furnace.
Contractor: SPECIALTY HEATING & COOLING INC Owner: COLEMAN, TEDRIC V & KARYN S
7500 SW TECH CENTER DR #130 12127 SW LINCOLN ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 620 -5643 PHONE: 503 - 708 -5730
FAX: 503 - 681 -0793
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/26/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/26/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/26/2012 $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 dire estions UNC by callin. 503.232.1987 or 1.800.332.2344.
Issue By: Oi� - - -/ (24 Permittee Signature: �� / r,,t• p
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.
JAN /24/2012/TUE 11:43 AM FAX No, P. 002
Mechanical Permit Application R FOR OFFICE USE ONLY
City of Tigard e a�. , ` . Ri te/By: '� I PennirNo.: ti o41 -om dot
'a 13125 SW Hall Blvd., Tigard, OR ' .-02 ' Plan Review
lig - phone: 503,718.2439 Fax: 50't . ° .0 Date /8y: Other Permit:
I'1CAK17 Ins Line: 503.639.4175 "' 1� ��
Date Ready/By: luri :: 0 See Page 2for
Internet: www,tigard- or.gov \��\ � o Notified/Method: Supplemental Information
�`
v J Gr, COM ER Al ATE* ;SCYIEDCITE USE CHECKLIST
x S(I OF 1 J (\���
V J Mechanical permit fees* are based on the value of the work
❑ New construction tldition /alter t�'ti r��� cement performed. Indicate the value (rounded to the nearest dollar) of all
• ❑ Demolition ❑ Other: C3 mechanical materials, equipment, labor, overhead, and profit.
Value: $
... ., . : . CATEGORY OP CONSTRIJC'I'I • . •1 . :
1 I SYSTEMS FEES... •
D-r nd 2- family dwelling [J Commercial /industrial ❑ Accessory building For special information use checklist.
0 Multi- family ❑ Master builder ❑ Other; Description I Qty. I Pa. I Total • D T.00AT'ION ^.: eating/coo ing:
Jo>B '�rrE uvFORMnxION' AND. conditioning
Job site address: (requires site plan showing placement) 46.75
City/State/VP: Coleman, Ted 812023 W Furnace 100,000 BTU (duets/vents) / 46.75
Furnace 100,000+ BTU (ducts /vents) 54,91
12127 SW Lincoln St Heat pump
Suite/bldg. /apt, no
Tigard, Or. 97223 (requires site plan showing placement) 61.06
Cross street /direct: (503)708 -5730 Duct work 23.32
Hydronic hot water system 23.32
..,_l Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
ie 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:
. . . , . DESCRIPTION :OF WORK .. _ Water heater 23.32
Gas fireplace 33.39
Flue vent for water heater or gas
.A.�`% ` 'I ._( fireplace 23.32
./ A-P-Aa- 4, -A't ...e. bt,, Log lighter (gas) 23.32
Wood /pellet stove 33.39 _
Wood fireplace/insert 23.32
❑ PROPERTY 0'�F',l IR. . .17 TENANT , Chimney/liner/flue/vent 23.32
Other: _ 23.32
Name: 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: ( ) Fax: ( ) toilet compartments. utility rooms) 23.32
• . ❑ APPLICANT ❑ CONTACT PERSON ' Attic /crawlspace fans _ 23.32
Business name: Other: 23.32
Fuel piping: _
Contact name; $14,15 for Elrst four; $4.03 for each additional
Address: Furnace, etc. -
Gas heat pump
City /State/ZfP: Wall /suspended/unit heater
Phone; ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue _
�� / Business name: Specialty Heating & Cooling Inc Clothes dryer (gas)
P Other:
Address: 7500 SW Tech Center Dr Suite #130 1v1ECIIANTCAY PERMIT FEES*
City /State /ZIP: Tigard, OR 97223 Subtotal
Minimum permit fee ($90.00) Cle, CO.'
Phone: (503) 620 -5643 Fax: (503) 598 Plan review (25 %ofpennit fee) -----
CC$ lie.: 66578 State surcharge (12% of permit fee) /e • gp
TOTAL PERMIT FEE , r
Authorized signature: This permit application expires if a permit Is not obtained S{ in 180
days after It has been accepted as complete.
Pr name: f44 ,, - / ‘" D ate: I2.;.r M Fee methodology set by Tri- County Building Industry Service Board
L. Building Permits MI:C- PermiiApp.do° 09 09.10 440.4617T (I1.02.IOM• WaB)