Permit CITY OF TIGARD MECHANICAL PERMIT
m COMMUNITY DEVELOPMENT Permit #: MEC2012 -00165
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03/2012
Parcel: 1 S136AD01300
Jurisdiction: Tigard
Site address: 10470 SW 69TH AVE
Project: MONROE Subdivision: VILLA RIDGE Lot: 1
Project Description: Gas furnace replacement.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: MONROE, ROSS &
13150 S CLACKAMAS RIVER DR MONTERRUBIO, ROSA
OREGON CITY, OR 97045 10470 SW 69TH AVE
TIGARD, OR 97223
PHONE: 503 - 557 -2220 PHONE:
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/03/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04 /03/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/03/2012 $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.
4111. C
Issued By: Permittee Signature:
Call 503. 9.4175 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.
APR-2-2012 9:24 FROM TO : 5035981960 P . 1
• Mechanical Pertnit AnnlicatiRECE NED ,‘„,,,,,,, „ , ,!, 1 / NI \
• City of Tigard Received
1 • 13125 SW Hall Blvd., Tigard, OR 97223 APR 0 2 Z012 DatrJBy: HAN ir 11 1/f/I=JAJITIM
Plan Review
. III Phone: 503.639.4171. Fax: .503.598.1960 • Date/By: Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGAP1D Date Ready/By WI SS See Page 2 for
Internet: www.tigard
BUILDING DIVISION Notified/Method: Supplemental Informadon
::..:::.".:::-:. 2 ' 1
0 New construction El Addition/alteration/replacement Mechanical permit fees* are baSed on the value ofthe work
performed.Indicate tbe value (munded to the nearest dollar)..of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
%- '':::; ; :' .: ' , '. : ' •,! •CATEGORY OF; C0141:011i.CrION 1 '' . : ' '::'.:!. : i . ' " Value: $
RE:SRANTIA.i■ $0 0.4TET:4:*tt0' . .- - ••
co 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
. For special Worn:allot use checklist.
0 Multi-family 0 Master builder 0 Other:
Description I Qty. I Ea I Total
z .. : 1„ . : • _ _.: ,....:-. : ' JO SITE .1100444:1101419'ipcx : ,,,-, --- : - , - • Heating/coaling
Job site address: 1047giv (oh hiCnUO Air conditioning
(requires site plan showing placement) 46:75
City/State/ZIP: -n 8 11223 Furnace 100,000 BTU (ducts/vents) 1 46.75 fl A — lc --
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg./apt. no.: I Project name: AlY1 A
r 1 01171 4 2-- 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),
Irpwall;in-itnet, suspended, etc. 46.75
Flue/vent for any of above "1
Subdivision: I Lot no.:
Other: ' 23.32
Tax map/parcel no.: Other fuel appliances
. = • . ... .: ,',. , : DOPWITON:QE •WO.RN- . ' '' ' ' ' : ' ' , . -2332
I) [ace) 8a6 lin-no,co Gas fireplace
Flue vem for water harder or gas 33.39
fireplace 23.32
bog lighter (gas) - 2332
Wood/pellet stove 33.39 ,
Wood fireplace/insert - 2332
•. ' ' Chinmay/liner/flueivent 23.32
', ......",, -. Other. 23.32
Name: met Morro Environmental exhaust and ventilation
-Range hood/other kitchen
Address: age) equipment 33.39
• City/State/ZIP: - Olothes-dlya.exhaust - 3339
Phone: 510)46z-bbo Fax: ( ) Single-duct exhaust (bathrooms,
, toilet compartments, utility rooms) 23.32
Arruc.o O
7 . s, . - . ,.:, . --. ,...coNT,iye.r SIri
. ttso. • _ Atdc/cravilspace fiats - 2332
. -
, Other: 2332
• Business name: Same as contractor
" Fuel piping
. . .
Contact name: Diane Mason $14.15 for first four $4.03 for each additional
,
Furnace, etc.
Address:
Gas heat pump
City/State/ZIP: Wall/suspendedhmit heater _.
Phone: ( ) I Fax: : ( ) Water heater
- Fireplace
E-mail: Rants . . -
. - , ' ..- : - . '•:-...: • - CONTIACTO11 . : -' : .- ' . • - ..' '. Barbecue
, .
. " Clothes dryer (gas) • ' , ,,' •
Business name: Tri County Temp Control
Other: .
. Address: 13150 S Clackamas River Drive .• MECHANIOA 001%0T-SE.V
•
City/State/ZIP: Oregon City, OR 97045 Subtotal 1 14 , 7S
Minimum permit fee ($90:00) 441.-00 ,
Phone: (503) 557.2220 I Fax: (503) 557.0919 Plan review (25% of permit fee) —
CCB lic.: 72623 VI./ i I State stucharge 02% of perniit tee)
Authorized signature: . 66744:07 TOTAL PERMIT FEE
ThPi (toot I s
permit application expires if a permit obtained within 180
days after It has been accepted as complete.
Print name: Vane, kittebn I Date: 4/4/2 I • Fee methodology se by Tri-County Building industry Service Board
1:111011dlegTennitAMEC-ParmitApp.doc 10/01/09 4404617r (11/02/COM/WEE)