Permit •
CITY OF TIGARD MECHANICAL PERMIT
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a .'.._ COMMUNITY DEVELOPMENT Permit #: MEC2012 -00551
.T I CARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/23/2012
Parcel: 2S104CC07400
Jurisdiction: Tigard
Site address: 13506 SW ASCENSION DR
Project: Selden Subdivision: HILLSHIRE WOODS Lot: 93
Project Description: (1) furnace installation and (1) A/C installation. A/C must maintain 5' side yard setback and approved rear yard
setback
Contractor: WOLFER'S, INC Owner: SELDEN, DON R & LUCIE A
290 YOUNG ST 13506 SW ASCENSION DR
WOODBURN, OR 97071 TIGARD, OR 97223
PHONE: 503 - 981 -4511 PHONE:
FAX: 503 - 981 -0801
FEES
Specifics: Description Date Amount
Air Conditioning 10/23/2012 $46.75
Type of Use: SF Furnaces >= 100K BTU 10/23/2012 $54.91
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 10/23/2012 $12.20
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $113.86
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�\ �, 1 / j t a u
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Call 503.639.4175 by 7:00 a.m. for the next available inspection date. � v�
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.
OCT /23/2012/TUE 09:19 AM MOLFERS HEATING FAX No, 5039810801 P. 001
Mechanical Permit Application FOR OFFICE I1SE ONLY
IL City of Tigard ��{ ,� � + i (O Permit No . e,,.p / 1- 5"d'
't 13125 SW Hall Blvd., Tigard, OR 97223 city „ f
° : Phone: 503.7182439 Fax 503.598,1960 OCT 2 3 2012 Da Review Other PermitiFit fa, 0 D hall
TI GAR n Inspection Line: 503.639 Date Ready/By; BI Sec Page 2 for
Internet; www.tigard- or.gov CfrY O T [[ • Notified/Method: Supplemental Information
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iS.Y>'{"TI' ����i�lyl.h I�wnleni L✓n '� " " j j ��uri'��..�: { 1!3. °II I .. •h' i� '„� Mechanical � ^'_''- .o. .,..... '•A �nwm.,,.. i �rv1P1
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.
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Value: S
■'! 1- and 2- family dwelling ❑ Commercial/'mdustrial ❑ Accessory building For special information use checklist.
[D Multi- family ❑ Master builder ❑ Other: _Description I Qty. 1 Ea_ 1 Total
m�nn c A a ,• mr, , qo 'Pik in 4 IA roll; � Heating /cooling:
/tel �'IS .1 ,�W �,i!n0' i F(I ,wr..�...n l.., e . C' ,, I C � � I � a _
. .. ..l , a�..t �.I " �e� •. ^"� Air conditionin
lob site address: � 9511.9 6 c riV , 4S,,,,n 'i i i (tequirplao showing placement) I 46.75
City/State/ZIT: / f Furnace 100,000 BTU (ductervents) _ 46.75
l �! y `l 1 Furnace 100,000+ BTU (duets/vents) I 54.91 q f
Suite/bldg./apt. Project Heat pump name: (requires site plan showing placement) 61.06
Cross Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) , 23.32
_ Unit heaters (fuel -type, not electric),
- -- wall, -in -duc suspended, -etc. —46.-75—
Fluc/vent for any of above 2332 _
Subdivision: Lot no.: .
Other: 23.32
Tax map/parcel " Other fuel appliances:
A.'4f7,147 N s_ c a s s Water heater L 2332
..,zj 46, 7 i7,'ce C Gas fueplacc/w 3339
/`f' Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 1 23.32
Wood/pellet stove 33.39 _
Wood fireplace/insert 23.32 ,
* -� r Chimney/liner/ftue/vent 2332
ME :::71.F.%.. e 'r ial. .I 41.4, i iii', r "a - `'gi i� Other.' 2332
Name: Ai - / , Environmental exhaust and ventilation:
Range hood/other kitchen
Address: 3 i i S J S 4P4 tee equipment 33 -39
ty /i ., ! or 12.3 Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phonc: i / Fax: ( ) toilet compartments, utility rooms) 23.32
r ,I • Mn . i ,�ii; _�. • ,, .� -,f',� .rw 7 ,. ,»:,,:."" §51 '� [ ' n ea° "' Attic/crawls ace
fans 2332
M" ew�'t��. . 'ham `",Y �' � �. ,S� p -
Business name: / /1JIfs _ �a fi Other. 23.32 -
r , ' / F uel piping:
Contact name: ( ! U c a , Y ( . . $14.15 for first four; $4.03 for each additional
Address: AO l/ Furnace, etc.
City/State/ZIP: ) / �� f • Gag hea�ump _
WalVsuspended/unitheater
Phone: 0315) o - 4G 1 I Fax:: ()3) S , — 6 i Waterheater
Fireplace
.r: i) W 0 1 r aline i 4
Range .
'. C /1 t Ow. ..: 4u - a '',A7,75t, Barbecue
Business name: I IIJ GGI � _ O Clothes dryer (gas) other:
Address: /J a . b / s'f• t, ?; . i ' t . i aftom>flmi.no;` o,4 , i
City/State/ZIP: W ��4 , , , , I1a7I Subtotal.10(•
y _ Minimum permit fee ($90.00)
Phone: (I jQ ) (Q f - 1.1611 Fax: is j gel - D ) I Plan review (25% of permit fee)
CCB lie.: 41p l • State surcharge (12% of permit fee) 7
� � TOTAL PERMIT FEE 1,3 •
Authorized signatur .. T his it apphrntinn canines Ira Hermit is not obtained wtahin 180
days nrter.it has been accepted. es complete.
Print name: , : c<1/
I I /'/ ' " - %r' Date: 0 • / 2"• / g- ' Fes methodology set by Tri -County Building Industry Service Board
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. A /C -HEAT 9vQ P - -- UI�T SITE PL I�
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FEET TO FRONT POPETY LINE . . .:.A_DDRESS:/7_ b_______ , . q e4 3 . . . •
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• PLEASE.REFA. APPLICATIONyWITH.SITE PLAN
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