Permit •
CITY OF TIGARD
MECHANICAL PERMIT
''1 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00369
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2012
Parcel: 2S104BC06600
• Jurisdiction: Tigard
Site address: 14255 SW WALNUT LN
Project: Pounder Subdivision: BAILEY WOODS Lot: 2
Project Description: (1) NC installation Must be within the 5' side yard setback and approved rear yard setback
Contractor: TRI COUNTY TEMP CONTROL INC Owner: POUNDER, GAYLAND
13150 S CLACKAMAS RIVER DR 14255 SW WALNUT LN
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -2220 PHONE: 503 - 358 -6691
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Air Conditioning 07/17/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/17/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 07/17/2012 $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: Permittee Signature: O), r 44U CAT/ D LI
_____,JLheiLdilkt_ 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 Applica ti , i t iu ()IAA( I I itiI (y\ I.)
Received Permit N /
City of Tigard ti Dele/By. 't 1 `l 1 N .k i�oZDI al� D
. • 1 3125 SW Hall Blvd., Tigard, OR 97223 JUL j g 2 01 2 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DotdBy: Other Permit:
I 1 c 7 A R i) Inspection Line: 503.639.4175 CI Date Ready/By: RI See Page 2 for
Internet: www.tigard- or.gov V OF T�p
BUItd11WC niiftSfpn+ Notified/Method: kin SSupplemental loformadoo
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment labor, overhead, and profit
Value: S
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building . For special ctrmartorr use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
14 2.5,36‘41 � )„ (requires iti pl
Job site address: (�dl + Air ( requires site conning showing placement) 46.75
ty i i /L� 4 122
Ci / State/LLP: 1 `� "lllL6,b Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suile/bldgJapt. no.: 1 Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
llydronic 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 fud appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Flue vent for water heater or gas
inita ll air (Li/AH10110e 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: t I land Obtju'1[dci" Environmental exhaust and ventilation
Address: l 11 V Range Iwd/olhtt kitchen
equipment 33.39
City /State/ZIP: _ Clothes dryer exhaust 33.39
Single-duet exhaust (bathrooms,
Phone: (0)) Wg• -(Lceq I Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other. 23.32
Business name: Same as contractor
Fuel piping
• Contact name: Diane Mason S14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Fax::
Phone: ( ) ( ) Water heater Fireplace
E - mail: 'Range
CONTRACTOR Barbecue _
Business name: Tri County Temp Control Clothes dryer (gas)
Other:
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES"
City /State/ZIP: Oregon City, OR 97045 Subtotal
Phone: (503) 557.2220 I Fax: (503) 557.0919 Minimum permit fee ($90.00)
/CCB review (25% of permit fee)
✓ CCB lie.: 72623 Stale surcharge (12% of permit fee)
� TOTAL PERMIT FEE
a�
Authuri signature: G 441002---- Thb permit application aspires tr o permit Is not obtained within 180
days after It has been accepted as complete
Print name: vane, Mahon I Date: qribg... • Fee methodology set by Tri -County Building Industry Service Board
1.\BuildingWermits\MEUPermitApp ace 10/01 /09 440-4617T (I 1/02/COM/WED)
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SITE PLAN
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