Permit CITY OF TIGARD MECHANICAL PERMIT
1 4 • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00511
T I GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/09/2012
Parcel: 1 S 134BD06100
Jurisdiction: Tigard
Site address: 11475 SW SPRINGWOOD DR
Project: Hassell Subdivision: ENGLEWOOD NO.2 Lot: 149
Project Description: (1) gas furnace replacement and (1) heat pump replalcement
Contractor: ABLE HEATING & COOLING LLC Owner: HASSELL, JAN
16285 SW 85TH AVE #105 11475 SW SPRINGWOOD DR
TIGARD, OR 97224 TIGARD, OR 97223
PHONE. 503 - 579 -2250 PHONE 503 - 481 -6010
FAX 503 - 620 -3980
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/09/2012 $46.75
Type of Use: SF Heat Pump 10/09/2012 $61.06
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 10/09/2012 $12 94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $120 75
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 ^ D r M J: `p
Issued By: Permittee Signature: o 1 ' .. r �C._ o
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 Application R . SE O' s1,1
� I FOR OFFICE i
City of Tigard Ta ceived
13125 SW Hall Blvd., Tigard, OR 97223 OCT O 8 bail Review
'� C l / 1 7— g.( Permit tYo.:� /SG �1 )_- JJ7 5
Phone: 503.718 2439 Fax: 503.598.1960 v v 20 �2 Plan Rnvew L�
Inspection Line: 503.639.4175 J)atelBy Other Permit:
TIGARD rtsp Uue Rcad Y �B
Internet. www.tigard- or.gov CITY �1'1l3 TIGARD Y /twig l @ See Page 2 for
IGA tD NotitiedMethod: �' G Supplemental informa
BUILDING Ons'
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction ® Addition /alteration /replacement
[3 Demolition performed. Indicate the value (rounded to the nearest dollar) of all
❑ Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value. $
RESIDENTIAL EQUIPMENT /SYSTEMS FEES'
® 1- and 2- family dwelling ❑ Commercial /industrial 0 Accessory building
❑ Multi - family For special lnjomealioar�sechecl�lisG
❑ Master builder ❑ Other: Description j Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heatiop,/cootiug:
Job site address: 11475 SW SPRINGWOOD DRIVE Air conditioning
(requires site plan showing placement) 46.75
City /State/ZIP: TIGARD, OR. 97223 Furnace 100,000 BTU (ductswents) 1 _ 46 75 46.75
Furnace 100,000+ BTU (ducts/vents) 54,91
Suite/bldglapt. no.: I Project name: HASSELL Heat pump
Cetus streetldirections to job site:
( site plan hewing pl 1 61 06 61.06
I Duct work 23.32
Hydronic hot water system 23 32
Residential boiler (radiator or
hydrontc) 23 32
U heaters uc
io- vvall in - du t (fel -type, y suspen denot d ele etc tric), ' 46 75
Subdivision: I Lot no.: Flue/vent for any of above 23.32 J
Tax map/parcel no.: Other- 23.32 r
Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
REPLACE EXISTING GAS FURNACE AND HEAT PU!11P Gas ftreplace/insett 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
I
Name: JAN HASSELL Other 23.32 I
_ Environmental exhaust and ventilation:
Address: 11475 SW SPRINGWOOD DRIVE Range hood/other kitchen I
equipment 3339
City /State Z1P: TIGARD, OR. 97223 Clothes dryer exhaust
33.39
- Phone: (503)481-6010 I Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
❑ APPL]C.41VT
❑ CONTACT PERSON Atuderawlspace fans ' 23.32
J 23.32
Business name: Other.
Contact name: Fuel piping:
514.15 for first four; S4.03 for each additional
L Address: Furnace, etc.
City /State/ZIP: Gas heat pump
- Wall/suspended/unit hearer
Phone: ( ) - I Fax: : ( ) Water heater
E-mail: Fireplace
Range
CONTRACTOR Barbera
Business name: ABLE HEATING & COOLING LLC Clothes dryer (gas)
Address: 16285 SW 85" AVE. SUITE 105 Other:
City/State/zip: TIGARD, OR. 97224 MECHANICAL PER111T FEES'
Subtotal f 107.81
Phone: (503) 579 -2250 I Fax: (503) 620 -3980 Minimum permit fee ($90.00)
I CCB lie.: 184392 Plan review (25% of permit fee) '
State surcharge (12% of emit fee) ) 1_.94
TOTAL PERMIT FEE J 120.75
Authorized signature: �� This permit application P pplghone :pimsifa permit o
lJ�i pe obtained within ISO
Print name: KELLY WIL days after it has been accepted as complete.
[Date: ] 0 I " Fee methodology set by Tn - County Building Industry Service Board
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Air Conditioning Site Plan
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77gard. CR 97224
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CC8#184392
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