Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00266
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012
Parcel: 2S102CA00923
Jurisdiction: Tigard
Site address: 13200 SW VILLAGE GLENN DR
Project: Cosa Subdivision: VILLAGE GLENN Lot: 23
Project Description: Replace gas furnace and NC Must meet 5' minimum side yard setback and approved rear yard setback
Contractor: A TEMP HEATING & COOLING INC Owner: COSA, MARIANA
16000 SE EVELYN ST 8150 SW 80TH AVE
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97223
PHONE: 503 -650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Specifics: Description Date Amount
Air Conditioning 05/22/2012 $46.75
Type of Use: SF Furnaces < 100K BTU 05/22/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/22/2012 $11.22
Occupancy Grp: •
Stories:
•
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
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: .1 ��,,(� / ,( e tt Permittee Signature: DM A PPLi Li e.1 TI AL
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.
I
Mechanical Permit Al nlicatiRECEI ?I ED i-<,r, 0I.I Ic ,: i',"r (;.t.,
City of Tigard MAY 21 2012 ROCOIVed
» - I I,- str PoamtNo .. 00Witor
.10 13125 SW Hall Blvd, Tigard, OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 Plea Raview
Inepeotion Lino: 303.639.4175 CITY OF TIGARD n� r °` Paten:
Internet: www,tigoid.er.gov BUILDING DIVISION Natificam SUP ; I Information
.. . - .. cam:.1*P- s
❑New construction ►: Addi .:. ,]
Mechanical tree' are based on the value of the work
0 New c Demolition
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other: cal materials. alinement labor, ovinbsad. end Profit
r i ir,Frrni, il.YOT al s l s'
� N 1- a nd 2- family dwelling ❑ Commercial/industhal ❑ Accessary building Fa spacial Wa ma rear accent - "
❑ Multi- family El Master builder 0 Other -
on I Qty_ F Ea. I Total
•
• JO8' SITE • O.N• AND.1DCA2'ION Heatimrie+►olinge
— Air conditioning
Job site address: 13 Zr7 v S U ' �, & IC pl ,aaamn t
j n H ��� �� � � 46.75 . 35
1 ' c 0 Q ZZ3 rttettas 4, 100,000 BTU (do�hvantt) 46.75 .,
City /state/ZIP:
Flamtce 100.000+ BTU (due s/v mrs) 54.91
Suite/bl Project name: C,, sew Hem pump
(nxluaos sillm shaWiEli placcmmt) 61.06
Cross shoot/directions to job site:
Duct work
23.32
�_ liydrome hot water syutean 23.32
Residential boiler (radiator or
. hyvdronio) 23.32
Umt heaters (fuel-type, not atonic),
in -wall. in - duet, suspended. etc. 46.75
Subdivision: I tin.: Flue/vent for any of above 23.32
•
Oth
Tax map/parcel no.: - a 23.32
deur Ind *Mittman
r
heater S
s: ar: a •: , , a 2332
wah Flu. J s i I 1 t� / , . s d rA &CQ.. r C ( f 1.0-au v fireplace
for water boate of gas 33.39
/ti ' fireplace
-E j is - Log lighter (tom) 2
Wood/pellet stove 33.39
". :
23.32
hnedBttd
. . ..:.... .
- . . . .:. . .L"1.� "J1P,4'lE'�;.. `"roc . • . . 2332
Name: /�� C Other: 23.32
1" 6 9�r 1 A A 0� l 0 S d. &Miran:meld exhaust and vo n:
Address: 1. r o .SCAr V , I roe N ik r Range hood/odierkitahen
intult 3339
City /Stata/ZIP - x, L n / , (� .1 Clotho dryer exhaust 33.39
Phone: ( ) p� ( ) Single dart m�mast(bathroomx,
toilet alibi. rooms) 2332
. •. ' '... . . . M*3 �ICL..$ERS . ' At tio/+anwlspace fans '. 2332
Business name:
Other: 2332
"— A-TEMP MATING AND COOL1140y INC Pad rte:
Contact name: 16000 SE
'�-- Evelp St. 81418 for tiara four SUB for each additional
Address: dame, OR
5013fS0.;A14 ' axe.
City/State/ZIP:
v
wawauspandedlimii beater
Phone: ( ) 1 Fax:: X ) 654 1.41 0 Wax heater •
E-mail:
lace
CAiTI�g' ." Berbeouo
Business name: A C' O ff LJNti, INC �
other
Address: 16000 SE Evelyn St. —--
Clewtnwm, OR 97015 €ant p jP e .-
City/State/ZIP:
wip.SA14 _ Subtotal q 3_ �
Phone: ( ) ,� (� Fax: (5 p ?�) La54 2� q — Minimum permit mit fun (590.00)
CCB lie.: 4 , / — Plan review (25% ofpermit fee) .
+ + Sore sunbargo (12% of permit fee) . 1 . r_ z /
Authorized ' 1�_ DOTAL PERMIT Li not o d0
• . ' ..r nth Dawn apps expires Its parmi! Is nt within 1 -
deys niter k nee been accepted as compere*.
Print name: ./ , r .MIIIMil Date; 'Z • Fee methodology set by Tri.Co+aay Building Industry Service Board
islauimonsaeaa ;tarac,Pcs„dtApp.doa o&QWto 440 4617r(t a2/1Y1Ma1V¢e)
Z0 39Vd 9NI1G3H dW3l d 066ZL95£0S £b:01 ZZOZ /ZZ /50
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A-Ternp-Heating t Cooling, inc.
Prepared by ?
SIfE pi_
C ustomer Name: 7 :it Mak r Ack, ( 2 , s 9 A ddress: /3247 67 _ _ C
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I Cystorrier Phone:
Property Bouridary Ln
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F A -TEMP
HEATING 8 COOLING, INC.
www.atemphsating Dorn
A 16000 S. E. Evelyn Street (503) 650 -5014
Clackamas, Oregon 97015 FAX (503) 557 -2990
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ATTN: f C 14 DATE: 3 I 1 2 -
PHONE: TIME:
T FAX: # OF PAGES:
E URGENT
OR REVIEW
PLEASE REPLY
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