Permit 1 y p CITY OF TIGARD MECHANICAL PERMIT
4 s • • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00568
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/31/2012
Parcel: 2S110AD00600
Jurisdiction: Tigard
Site address: 10625 SW CANTERBURY LN
Project: Fish Subdivision: LANG HILL Lot: 6
Project Description: (1) gas furnace replacement
Contractor: ABLE HEATING & COOLING LLC Owner: FISH, TABITHA
16285 SW 85TH AVE #105 10625 SW CANTERBURY N
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 579 -2250 PHONE: 541 - 450 -8376
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/31/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/31/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/31/2012 $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� 1 by calling 503.232.1987 or 1.800.332.2344.
»,�UUY
Issued By: �l ,J� / `�) Permittee Signature: DK l c) p e AT J
uu� Call 503.63 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 ApplicatioRECE VE I FOR OFFICE USE ONLY
City of Tigard .
Permit
I N
13125 SW Hall lvd., Tigard, OR 97223 OCT 31201 D tcBy' ( 0 1 3 1 1 /y Ur MEG�I�. DO SGS
= Plan Review
Phone: 503.718.2439 Fax 503.598.1960 p
Other Permit:
TIGARD Inspection Line: 503.639 Y/1� pFT ,gy Dale Ready.B kris: Ia See Page 2 for
Internet www.tigard -or.gov BUILDtNG �V' �SICP Notified/Method: r1 cp Supplemental Information
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: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
® 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use dreckl&rt
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 10625 SW CANTERBURY LANE (requires site plan showing placement) 46.75
' Furnace 100,000 BTU (dacts/vents) 1 46.75 46.75
City /State /ZIP: TIGARD, OR. 97224 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: FISH' Heat pump
(requites site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 2332
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 for any of above 23.32
Other. _ 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
REPLACE EXISTING GAS FURNACE, Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/petlet stove 33.39
Wood fireplace /insert 23.32
® PROPERTY OWNER 1 ❑ TENANT Chimney/liner/flue/vent 2332
Other. 23.32
Name: TABITFIA FISH Environmental exhaust and ventilation:
Address: 10625 SW CANTERBURY LANE Range hood/other kitchen
equipment 33.39 ;
City /State/ZIP: TIGARD, OR. 97224 Clothes dryer exhaust 33.39
Phone: (541}f50 -8376 p ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 2332
Business name:
Other. 23.32
Fuel piping:
Contact name: SF8.15 for first four, $4.01 for each additional
Address: Furnace, etc. I
Gas heat pump
City/State/ZIP: Wall /suspended/unit heater
Phone: ( ) I Fax:: ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: ABLE HEATING & COOLING LLC Clothes dryer (gas)
Other:
Address: 16285 SW 85"' AVE. SUITE 105 MECHANICAL PERMIT FEES*
City /State/ZIP: TIGARD, OR. 97224 Subtotal 46.75
Phone: (503) 579 - 2250 Fax: (503) 620 - 3980 Minimum permit fee (590.00) 90.00
Plan review (25% of permit fee)
CCB lie.: 184392 /0944 p State sur harge(12 %ofpermitfee) 10.80
TOTAL PERMIT FEE 100.80
Authorized Signature This permit application expires if a permit Is not obtained within 180
days after ft has been accepted as complete.
Print name: KELLY AIT I Dale: 1031 -12 I • Fee methodology set by Tri- County Building Indw Service Board
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