Permit •
CITY OF TIGARD MECHANICAL PERMIT
m COMMUNITY DEVELOPMENT Permit #: MEC2012 -00264
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2012
Parcel: 2S110DA07600
Jurisdiction: Tigard
Site address: 10555 SW LADY MARION DR
Project: Carruth, Kayla Subdivision: ERICKSON HEIGHTS Lot: 37
Project Description: Install Furnace
Contractor: SPECIALTY HEATING & COOLING INC Owner: CARRUTH, JAMES H & KAYLA B
7500 SW TECH CENTER DR SUITE 130 10555 SW LADY MARION DR
TIGARD, OR 97223 TIGARD, OR 97224
PHONE: 503 - 620 -5643 PHONE: 503 - 598 -0461
FAX: 503 - 681 -0793
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/21/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 05/21/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/21/2012 $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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i , . Permittee Signature: D J -q No e 4-77 og
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.
MAY /18 /2012 /FRI 08:45 AM FAX No, P 5/ .002 l
Mechanical Permit Application FOR OFFICE USE ONLY
IN City o Date.iB 5. ) 4-11 9� PennitNo.Ai�' „„;-• VD, , 4
13125 SW Ha Tigard ll Blvd., Tigard, OR 972 Plan Rev iew
F Phone: 503.7182439 Fax: 503.598.1 6 EC, I ���° Date. By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready By: lads: E7 See Paso 2 for
Internet: www.tigard- or.gov MAY 1 8 2012 Notined lethod: iiy Supplemental Information
TYPE of w4bdl OF TIGARD COMMERCIAL FEE* SCHEDULE - USE CHECKLIST I
��j�� Illii� Mechanical permit fees* are based on the value of the work
I=] New construction ddition / &IftWttCf�� l�replabritttenE�ON performed, Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATECORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special Information tsechecklist
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty, I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION
Heating/cooling:
Air conditioning
Job site address: ( requires site plan shaving placement) 46.75
Furnace 100,000 BTU (ducts. vents) + 46.75
City/State/ZIP: Carruth, Kayla R12156 Furnace 100,000+ BTU (ducts'vents) 54.91
Suite/bldg. /apt. no.: 10555 SW Lady Marion Dr Heat pump
Tigard, Or. 97224 (requires sire plan showing placement) _ 61.06
Cross street/directions to • Duct work 23.32
- (503)598 -0461 Hydronio hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
• in -wall, in -duct, suspended. etc. 46.75
Subdivision; Lot no.: Flue/vent for any of above 2332
- _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
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39 _ _
Wood fireplace/insert 23.32 _
'PROPERTY OWNER I ❑ TENANT Chimney/liner /flue /vent 23.32
Other. 23.32
Name: _ (f_,1'I...e, 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 Anic/crawlspace fans 23.32
Business name; Other: 2332
— Fuel piping:
Contact name; S14.15 for first four; $4.03 for each additional_
Address: Furnace, etc.
Gas heat pump .—
City /State /ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace -
E-mail: Range
CONTRACTOR Barbecue
Myer yer
Business name: Specialty HeatingS Cooling Inc Clothes (Ras) -
- Other. -
Address; 7500 SW Tech Center Dr Suite #130 MECHANICAL PERMIT FEES*
City /State/ZIP: Tigard, OR 97223 Subtotal '44.'1 S'
Phone: (503) 620-5643 I Fax: (503) 598 -0718 Minimum permit fee (590.00) X3.2
Plan review (25% of permit fee)
GCB lie,: 66578 {1 State surcharge (12% of pennit fee) 104j
TOTAL PERMIT FEE in .819 _ <
Authorized signature; V " � U
- � This permit appllcadon espires it a permit is not obtained within t8
days after It has been accepted as complete.
Print name: PZ Date: f L • Fee methodology set by'fri- County Building Industry Service Board
I: Building P2rmiis MEC•PtnniIApp.doc 04 04 10 +I0-4617 I I 1 02 COM WEal