Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2012 -00420
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/09/2012
Parcel: 2S112BC01900
Jurisdiction: Tigard
Site address: 14715 SW 84TH CT
Project: Ause Subdivision: HAMBACH PARK Lot: 3
Project Description: (1) furnace replacement and (1) NC installation. NC must be within 5' of side yard setback and approved rear
yard setback
Contractor: WOLCOTT PLUMBING Owner: AUSE, DAVID
1075 W HISTORIC COLUMBIA RIVER HWY 14715 SW 84TH CT
TROUTDALE, OR 97060 TIGARD, OR 97224
PHONE: 503 - 667 -1781 PHONE:
FAX: 503 - 667 -9891
FEES
Specifics: Description Date Amount
Air Conditioning 08/09/2012 $46.75
Type of Use: SF Furnaces < 100K BTU 08/09/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 08/09/2012 $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 � a /� f ,
Issued By: C�l Permittee Signature: i�' pkg./4- i 1 / 01...
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.
08/09/2012 07:12 5036679891 WOLCOTT PLUMBING PAGE 01/02
Mechanical Permit Application FOR OF TICE 11 V ONLY
City of Tigard KEIVED Received �fI9 ►y 901-- Perron pia App
Permit No.:
N 2: .
13125 SW Wall Blvd., Tigard, Mon Review
Phone: 503.718.2439 Fax: 503.598.1960 IOnrd13y: Other Pcnnit:
T I c; A R n Inspection Line: 503.639,4175 p, I i 1 ) 0 9 ?012 Date Rendy/By: IN El Sec Pone x for
Internet: www.tigard- or.gov Nolified/Method: Supplemental Information
CITY OFTIGARD
ril.!' 1ha:..�i'{' ' I � ,111,1 h 1 -i:R I.:�TUt �� b. f � r�nu ,�� vlr .UI'rXr 1
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il,Kii lN;� li f i ' i .1 (I(f1 " r l i j a :t',l &R i' ' till 1' l t t I'' +. i1 I ii mnn�fnt . ,i <:.p ,
I i ,,.,J., '4 j. ;l� �_ � � .0 rdrlalf�;l�rv�'iJutul� �illj� ;.t� 1 � tl In m • 'o ..,..r� ,•
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Mechanical permit fees arc based on the value attic work
0 New construction ® Addition /alteration /replacement performed. Indicate the value (mundcd to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead. and profit.
1. 1 , >ti 11 4 ' I A 1° { p r Value: $
1e�µi „ „ ' „' j. „ ,.. ,, ,,„ AlIttlio .. t•n , :,4 ., � A, - nt Al t ¶ i 1 !1` ' .41 1 !I '
,r 1 , u:(; c . 1C ml, , ' , I , f IAellRil bTAM Ph IWid� 111 i ll , .leVA I t o a1 • ! ail It 1 (A, a � n i 6:airA li4a`l it • 1 • � • J ? 1 I' ,
® I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building _ a i use ` li';. � '
FY g ,For special Information use checklM,
❑ Multi - family ❑ Master builder ❑ Other: Description I QtY• I Ea. Total
''. P ' `n;l; 9) rll .. , I � l .� r� 1 -� �, C f� 1 I�. r n�g�f�i 9rylanprlUpit�r11R1! Ii�1Q'�(� tl 1 � J 1 II,- Hiinq:
'�� 1i�1' .I L'`i;il�n a ��J Rl�. •• " r, tLidMnln' Aiy,'. 1i1.' trpR', auvu!in ?�.�il',., I:il lli'd, ycE�i l' Air conditioning
Job site address: 14715 SW 84" cr. Q uires site plan showing placement) 1 46.75 46.75
Furnace 100,000 BTU (ducts/vents) 1 46,75 46.75
City / State/ZIP: TIGARD /08/97224 Punmcc 100,000+ BTU (ducts/vents) 54.41
Suite/bldg. /apt. no.: Project name; Heat pump
• (requires site plan showing placement) 61.06
Cross street/directions to job site: F1ALL 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: Lot no.: Flue/vent fore of above 23.32
-- - Other, 23.32
Tax map /parcel no.:
Other futl_aPDlianeeR:
i'� r } l . + r r • f r l� 'l I i ,1 t o : R 1 �. 1 mum _ r l r^ v - "
. 1.N i 1 i ll =lily.1..,-,111 i i ; j it j , 1, , �I e <: a imi c r I re 't , + ' Water healer
i• lq:il$:: .. r1 .. ..,...,•+td» M rl }�irl (! I�� {l�A�fiBt i# ..ri - 23.32
REPLACE FURNACE - INSTALL NEW AC Gas fireplace/insert 33,39
-• Flue vent for water heater or gas
fireplace 23.32
- Log lighteilgas) 23,32
Wood /pellet stove 33.39
Wood fireplace/insert 23.32
�h 1 .
, ge v l l p Chimne /liner/fluc/vcnt
`.I i; 4N4 :Ehk0 i, c • .. I $1110,11,1 4.1' l t�.]> i.�l d .1 i 3,1it l( p. Y. 23.32
'i Mil: •IM��1'�i1 I 1Fl ' + Other. 23.32
Name: Environmental exhaust and ventilation:
Addtt ss: Range hoo /other kitchen
equipment 33.39
City / State/ZiP: Clothes dryer exhaust 33.39
Single -dull exhaust (bathrooms,
Phone: ( ) Fax: ( )
toilet compartments, utility moms) 23,32
N ]�� {{,� ��Iy�I��JJ��;�1ppi���ry�I {��{���tt
1I" �`' �i�pil�; r�; iJltn� _ : •,• r�ix,.• o i 7.51Gi''`I . 'Y �1' non' It 1C n i I ll ) ' Aic
tt/crawlS ac fans ,
t r... r,nr.nr i.� 1 { hl. cmn � 1 �.� � 23.32
Rosiness name:
Other. 23.32
- Fuel piping:
Contact name: 514.15 for first roar; $4.03 for each additional
Address: Furnace. etc.
Gas heat pub
City / State/ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace -.
:p'l r 1 i t r, Range
1:11 , I1 h �..ittyl�I", Ilr �r(�a( + {1�{, �.�J��� t �� , � ) � 1 t] r �[ i { ,I�� i, 1t F[4'��!!I atutcc
J ,I 1 ;IpV: �.II1�111:(;�in�i4'�if':Y.S ll. tlrlUl ` ^ �la 1 "NI1 ^•'1•I`•'c'f�(1'JI' fiILL rRt Oil {t 1 A{f + " r7fu V Wtle
Business name: WOLCOTT PLUMBING Clothes d e as
Other:
Address: 1075 W HISTORIC COLUMBIA RIVER HWY
A js �� t g, t},�Ii�d r -lt( } s
City/State/ZIP: TROUTDALE /OR/97060 Subtotal 93.50_
Phone: (503) 667 -1781 Fax: (503) 667 -9891 Minimum permit fee ($90.00)
Plan review (25% of permit fcc)
i (CCR lie.: 112220 State surcharge (12 %ofpermit fee) 11,22
- TOTAL PERMIT FEE 104,72
Authorized signature: ( �f. , This permit npptieation expire; it a perm 1s not obtained within 180
days Mier it Imo heen accepted as complete -
I Print name: DENNIS I... DUNNING Date; 8/8/2012 " Free methodology set by TO-County Building Industry Service Board
i:\ Building \PermIu \MEC•PcrmihApp.daa 03N7/13 4411.017't(I1/02/C0M/WP14)
•
e ° Building Division
Development Code Provision Review
TIGARD Residential Projects
Building Permit No: /vt tC O /0 CO92 0
CWS Service Provider Letter Received: Yes ❑ No ❑ N/A ❑
Routed Plans:
Original Plan Submittal Date:
1st Revision Submittal Date: ❑ Site Plan Only
2 ^d Revision Submittal Date: ❑ Site Plan Only
To the Applicant:
Each review type must be approved. If the plan is not approved, please revise and resubmit three (3) copies to the
Building Division. Only checked (✓) items are approved. Items not approved and those listed in the notes must be
revised prior to re- submittal. For questions please contact the appropriate staff person(s) listed above each section.
Staff: please check items along left only if approved.
Planning Review (contact auk' Fye at 503 - 718 - . / or @tigard- or.gov)
Land Use Case No. Name
❑ Zoning Ie- y S
❑ Setbacks:
Front Rear Side Street Side Garage
❑ Maximum Building Height Actual Building Height
❑ Visual Clearance
❑ Easements
❑ Sensitive La ds T e: /
Notes: it do oh a.ht/4 --, Sl% fait Se- 444
Original Plan: Approved ( Not Approved ❑ Date: 4J 5� Jo /i YF
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Engineering Review (contact Mike White at 503 - 718 -2464 or MikeW @tigard - or.gov)
❑ Actual Slope:
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
(Review Continues on Page 2)
Page 1 of 2
City Arborist Review (contact Todd Prager at 503- 718 -2700 or todd @ tigard - or.gov)
❑ Street Trees
❑ Protected Trees
Notes:
Original Plan: Approved ❑ Not Approved ❑ Date:
Revision 1: Approved ❑ Not Approved ❑ Date:
Revision 2: Approved ❑ Not Approved ❑ Date:
Permit Coordinator Review (contact Albert Shields at 503 - 718 -2426 or albert @tigard - or.gov)
❑ Conditions of Approval Prior to Issuance of Building Permit
Notes :
Original Plan: Date Sent to Applicant:
Revision 1: Date Sent to Applicant
Revision 2: Date Sent to Applicant
Okay to Issue Permit: Yes ❑ No ❑
Date Routed to Building:
Page 2 of 2
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08/09/2012 14:53 5036679891 WOLCOTT PLUMBING PAGE 02/02
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08/09/2012 14:53 5036679891 WOLCOTT PLUMBING PAGE 01/02
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WOLCOTT
PLUMBING
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To City of Tigard From Dennis L. Dunning Ext. 307
ATTN: SHIRLEY
Fam 503 - 598 -1960 Date: August 9, 2012
Phone: 503-718-2439 Paqest 2
Re: MEC 2012 - 00420 CC:
Urgent X for Review Please Comment Please Reply Please Recycle
Shirley: Documentation for your review. Please contact me if you have any
questions.
Thanks, Dennis
Office 503467.1781 • Fax 503.667.9891 • 1075 W Historic Columbia Rim Hwy • Troutdale, OR 97060
OR CCB0 112220 WA LIC41 WOLCOP 936BC