Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00284
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2012
Parcel: 1S135DC04900
Jurisdiction: Tigard
Site address: 9350 SW TANGELA CT
Project: Grimes Subdivision: TANGELA Lot: 4
Project Description: Install ductless mini -split heat pump Must meet minimum 5' side yard setback and approved rear yard setback
Contractor: TRI COUNTY TEMP CONTROL INC Owner: GRIMES, AMY L
13150 S CLACKAMAS RIVER DR KILLION, BEVERLY A
OREGON CITY, OR 97045 KILLION, JACK T JR
9350 SW TANGELA CT
TIGARD, OR 97223
PHONE: 503 - 557 -2220 PHONE: 971- 221 -5509
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Heat Pump 06/04/2012 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 06/04/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 06/04/2012 $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: JilAd W U Lt Permittee Signature: 0 A) A P
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.
5 k
Mechanical Permit Annlica> C E I V E D l l i l l ( 1 l . l t ( I I .I ( ) l . \
City of Tigard Permit '0 • i , /1- 001iSt
• 13125 SW Hall Blvd., Tigard, OR 972 PIm Review
Phone: 503.639.4171. Fax 503.593.19 IM l 3 0 2012 Date/By: other Permit:
i i t . ., i , i , Inspection Line: 503.639.4175 Date Ready/By: 0 See Page 2 for
Internet www.tigerd -or.gov CTf Y OF TIGARD Notified/Method: 1(1 o Supplemental Information
C 1 k 1 I
- - „6 ,.TYPE.OF WORK ` . ;,• COMMERCIAL FEE±--: sQIF ,1it7I; E , � 41SE C11EC�1irI�I5T-
❑ New construction - ® Addition/alteration/replacement Mechanical permit fi esr are based on the value of the work
perfotmed.Indicate the value (mundedtnthe.nearest dallar).ofall
❑ Demolition ❑ Other. , mechanical materials, equipment, labor, overhead, and profit.
CA1'I�CQRX Ol's CONST1iUC`170N Value: $
:'•
RESIDENTIAL EQUIPM$ MIS' rEM3°FEES* -
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For specta!lxiforaratloxiure checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I La. I Total
308.SITE 1NVOR1YfAVION•AND. LOCATION ' Heating/coaling
� ,,, I Won r/ . Air conditioning
connin , 46:75 -na Job site address: 9 ab `�' lJLJo li Air c n site nin showing placement) City /State/ZIP: a1 Furnace 100,000 BTU (ductslvents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt no.: I Project name: Heat pump 1 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; in =duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Other 23.32
Tax map /parcel no.: Other fuel appliances
! D ON OP WORK Water heater - 23.32
e a/ 1' . ctucti JV1J ►t `i1 1i I+ t lmt �np Flue fireplace for 33.39
'
` 1 Flue vent for water heater or gas
fireplace 2332
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert - 2332
' < : `` ,I . . _ ,[�_ ` EN Chimney /linerlChimney/liner/flue/vent 23.32
;PROPERTY OWNER A,, Other. 23.32
Name: 6 f J V d _ Environmental exhaust and ventilation
Address: I y N Range hood/other kitchen
equipment 33.39
• City / State/ZIP: . Clothes dryer exhaust . 33.39
Single -duct exhaust (bathrooms,
Phone: (In 1. ) 224- fO9 Fax: ( ) toilet compartments, utility rooms) 23.32 .
® AP)pJf4eork . . d CONr s 1','PERSO)!i Attic/crawlspace fans 23.32
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: Wall/suspended/unit heater
- Phone: ( ) I • Fax:: ( ) Water heutgr • :
Fireplace -
E -mail: Range
.: - - CONTRAC'1'Ok Barbecue
• Business name: Tri County Temp Control Clothes dryer (gas) , .. , ,
Other:
Address: 13150 S Clackamas River Drive : 1l+ CI1ANIC1 L PE1t1HItYE•S• _ .
' City/ State/ZIP: Oregon City, OR 97045 Subtotal _
, Phone: (503) 557.2220 I Fax: (503) 557.0919 Minimum permit fbe ($90.00)
/ Plan review (25% of permit the)
✓ CCB lie.: 72623 State surcharge (12% of permit fee) Ann /
kQ L /) TOTAL PERMIT FEE I R D� • 17
Authorized signature: I , �/ 7 l Thin permit application expire II a penult Is not obtained Within 180
days after It has been accepted as complete.
I Print name: D I O �y�p moon oon I Date: (e l i, J r 12, I • Fee methodology set by Tri -County Building Industry Service Board
•
1:1Du1I ing /enolu\MBC-PermltApp.doe 10/01/09 44046171(1I/o2COM/WBB)
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MAY -30 -2012 09:21A FROM: TO:5035981960 P.2
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