Permit CITY OF TIGARD MECHANICAL PERMIT
• . COMMUNITY DEVELOPMENT Permit #: MEC2012 -00208
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012
Parcel: 2S 111 ACO2300
Jurisdiction: Tigard
Site address: 9170 SW PINEBROOK ST
Project: Newcomb Subdivision: PINEBROOK TERRACE Lot: 64
Project Description: Install new ductless mini split heat pump system. Unit must meet 5' minimum rear and side yard setbacks.
Contractor: ABLE HEATING & COOLING LLC Owner: NEWCOMB, WAYNE E & NANCY A
16285 SW 85TH AVE #105 9170 SW PINEBROOK ST
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503 - 579 -2250 PHONE: 503 - 620 -4765
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Heat Pump 04/26/2012 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 04/26/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/26/2012 $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 to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � Permittee Signature:
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.
R ' - '—' t— " 7: ‘dio' r
Mechanical Permit Application rc)IZ OFFICE 1:sE ONLY
City of Tigard APR 2 4 2 0 - c e e i ve d
. 13125 SW Hall Blvd., Tigard, OR 97223 �e>ey: as Perini, No.: eao42 -ooa4 f
Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGA' ., Cl
at
Other Permit:
T I C A i:13
Inspection Line: 503.639.4175 ,
Internet veww.tigard or .gov BUILDING D! Jig I 4 R eady / By: Ws: L Q See page 2 for
NotifiedMktlrod: I/ (.�[ Supplemental Information
TYPE OF WORK I COMMERCIAL FEE` SCHEDULE - USE CHECKLIST
❑ New construction Mechanical permit fees• are based on the value of the work
® Addition /alteration/replacement
performed. htdicatc the value (rounded to the nearest dollar) of all
El Demolition ID Other
mechanical materials, equipment, labor, overhead and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT /SYSTEMS FEES"
® I and 2- family dwelling ❑ Commercial/industrial 0 Accessory building For special Wormmion use checklist
❑ Multi- family ❑ Master builder
❑ Other: Description ! Qty. I Ea. 1 Total
JOB SITE LNFORMATION AND LOCATION Heating/cooling:
Job site address: 9170 SW PINEBROOK COURT Air conditioning
(requires site plan showing placement) I _ 46.75 46.75
City!SttlteiZlP: TIGARD, OR. 97224 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace I00,00D+ BTU (ducts/mats) 54.91
Suite/bldg. /apt. no.: I Project name: NEWCOMB Heat pump -
Cross street/directions to job site:
(requires site plan showing placement) 61.06
Duet work 23.32
Hydronic hot water system 2332
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type, not electric),
in-wall, in -duet, suspended, etc. 46.75
Subdivision: f 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
INSTALL NEW DUCTLESS MINT SPLIT HEAT PUMP SYSTEM Gas fireplace/insert 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
® PROPERTY OWNER ! ❑ TENANT Chimney/liner /flue/vent 23.32
Name: WAYNE AND NANCY NEWCOMB Other 23.32
Environmental exhaust and ventilation:
Address: 9170 SW PINEBROOK COURT Range hood/other kitchen
equipment 33.39
City/State/ZlP: TIGARD, OR. 97224 Clothes dryer exhaust
Phone: (503)620-4765 F ( ) gle -duct exhaust (bathrooms, 33.39
Single-duct
❑APPLICANT I ! toilet compartments, utility rooms) 23.32
❑ CONTACT PERSON Attic /trawlspace fans 23.32
Business name: 23.32
Contact name:
Fuel piping:
$1415 for first four, 5403 for each additional
Address: Furnace, etc. •
City/State/ZIP: Gas heat pump
Phone: ( ) Wall/suspended/unit heater
I Fax: : ( ) Water heater
E-mail: - Fireplace
Range
CONTRACTOR Barbecue
Business name: ABLE HEATING & COOLING LLC Clothes dryer (gas)
Address: 16285 SW 85 AVE SUITE 105 Other J
MECHANICAL PERMIT FEES`
City /State/ZTP: TIGARD, OR. 97224 Subtotal 46.75
one: (503) 579 - 2250 I Fax: (503) 620
Minimum permit fee ($90.00) 90.00
C CB lie.: 184392 Plan review (25% of permit fee)
State surcharge (12%ofpermit fee) 10.80
TOTAL PERMIT FE E 100.80 ✓
Audloriz d signatur e: This permit application eapires if a permit a not obtained within too
days after it has been accepted us complete.
Print name: KELLY WT TE I Date () 4 - 2012 • + • Fee methodology set by Tri -County Building Industry Service Band
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