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Permit
1 111- , CITY OF TIGARD MECHANICAL PERMIT 2 COM MUNITY DEVELOPMENT Pe rmit #: MEC2012 -00190 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/17/2012 Parcel: 2S110BD03700 Jurisdiction: Tigard Site address: 11881 SW ELEMAR CT Project: Magdelain Subdivision: ASPEN RIDGE Lot: 2 Project Description: Install heat pump. Unit must meet 5' minimum rear and side yard setbacks. Contractor: TRI COUNTY TEMP CONTROL INC Owner: MAGDELAIN, BONNIE 13150 S CLACKAMAS RIVER DR 11881 SW ELEMAR CT OREGON CITY, OR 97045 TIGARD, OR 97224 PHONE: 503 - 557 -2220 PHONE: 503 - 624 -9324 FAX: 503 - 557 -0919 FEES Specifics: Description Date Amount Heat Pump 04/17/2012 $61.06 Type of Use: SF 12% State Surcharge - Mechanical 04/17/2012 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/17/2012 $28.94 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 t to o � / OUNC by calling 503.232.1987 or 1.800.332.2344. �{�/ _/ Issued By: �(/ _ Perm � ittee Signature: BA/ 19-71)/614- t?�77 �ON 1 � 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 Applies jj j atiu ()l I I( I 1 ()NI , - + EIVED Received City of Tigard DB t!,• �'/ ' • 13125 SW Hall Blvd., Tigard, OR 97223 p� . NJ I Phone: 503.639.4171- Fax: $03.598.1969, R 1 7 2012 Dote/By: OtbesPermit: I I , :� i e I Inspection Line: 503.639.4175 Date Ready/By: © 0 See Page 2 for I haer let: www.dgard-or.gov CITY OF TIGARD Notlfied/Method: Supplemental Information :.,.:', = - _ 3,. _ , ; .(DIVISION CO11 t011AJi..fE' ',S( ED .us..c* ',' ❑ New construction ® Addition/alteration/replacement Mechanical Permit fees* are based on the value of the work performed. _Indicate the value (rounded tuihe nearest dollar).of all ❑ Demolition ❑ Other: mechanical materials. equipment, labor, overhead, and profit. :,. ' : - . _CATEGORY: OF CONSTRUCTION- - Value: $ RESIDENTIAL touniiii ivT i SirortNS OgEO► ' i ® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special trormatiau use the rertlle. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea_ I Total _ _ ..:: - JOB SITE INFORMATION :-AND LOCATION - - lieatiee/eoeling Ab Qat ir conditioning n b site address: lit?) Air conditioning Aon Bile in silencing placement) 46:75 City/State/ZIP: - f toga Fumace 100,0000 BTU (ducts/,) 46.75 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg./apt. no.: I Project name: Heat pump I 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,1induct, suspended, etc. 46.75 Subdivision: I Lot no.: Flue/vent for any of above 23.32 Other; 2332 Tax map /parcel no.: Other fuel appliances .:,- , ' - DESCRi BON,OF ...wpm . , Water heater — 23.32 Gas fireplace 33.39 Flue vent for water heater or gas aft IILIA.l ,,,,,,, 1 fireplace 23.32 B ` 1 1(��iU (j,(I j TItJ Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 - ROPERTY;-OWNE14, ! - I - • O N ,!-' `` Chimney/1iner/flue/vent 23.32 TE l G f V �(] d � fl Ether: 23.32 Name; Ef f u b Enviroameotel ezhaast end ventilation ) WIC) Address: J -Range hood/other kitchen equipment 33.39 City /State/ZIP: - Clothes dryer exhaust .. 33.39 Phone: (o �,� .2 1 Fax: ( ) toilet to ilet duct exhaust ((bathrooms, , ) QL compartments, utility rooms) 23.32 ' ®' ¢)?PL,iC • - " :- CONTACT `Pl;OSON ' Attic/crawlspace fans 2332 _ Other. 23.32 Business name: Same as contractor Fuel piping Contact name: Diane Mason $14.15 for first four; $4.03 for each additional Address: Furnace, etc. Gas heat pump City/State/ZIP: WalUsuspcndcd/unitIattler . Phone: ( ) I . Fax:: ( ) Water heater Fireplace E- mail: 1$e CONTtfi�CC Barbecue - _ .. Business name: Tri County Temp Control Clothes -dryer (gas) . - , Other: Address: 13150 S Clackamas River Drive - y • MECHANIC* . FM214 J 04E8 City/ State/ZIP: Oregon City, OR 97045 Subtotal 4s/P Mini mum permit fee ($90.00) hone: (503) 557.Z2Z0 I Fex: (503) 557.0919 Plan review (25% of permit fee) CCB lie.: 72623 State surcharge (12% of permit fee) nil tny{ Q / • , a Glfi!' TOTAL PERMIT FEE tr1J V► U ✓ Authorized signature: 'G - Th is per mit application expire if a permit is Bat obtained sdlthln 180 days after it has been accepted as complete. Print name: D I Qne �A �aSo 411412._ n I Date: j • Fee methodology set by Tri- County Building Industry Service Board IlauIlilineermjtVMffiGPmmliApp.doc i0/0I/09 440.461T(I1PoT/COM/Wag) T'd 096T86S €OS:01 :WOiyd 13L0 :60 2102 -9T -add APR -16 -2012 09:0BA FROM: TO:5035961960 P.2 ' D N a -4 3 m • i z Cl) c- c i o i i d i Z i "tn i m