Permit •
CITY OF TIGARD MECHANICAL PERMIT
C.OMMUNITY DEVELOPMENT Permit #: MEC2012 -00591
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/14/2012
Parcel: 2S110AD09200 •
Jurisdiction: Tigard
Site address: 14817 SW 109TH AVE
Project: Shearer Subdivision: BRAMBLE BEND Lot: 4
Project Description: Replace furnace and heat pump. Placement of heat pump must maintain 5 side and approved rear yard setbacks.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: SHEARER, MICHAEL A & SHALA B
13150 S CLACKAMAS RIVER DR 14817 SW 109TH AVE
OREGON CITY, OR.97045 TIGARD, OR 97224
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PHONE: 503 - 557 -2220 PHONE: 503 - 590 -4440
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
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Furnaces < 100K BTU 11/14/2012 $46.75
Type of Use: SF Heat Pump 11/14/2012 $61.06
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/14/2012 $12.94
Occupancy Grp:
Stories:
Fuel
Fuel Types: Electricity
Gas Pressure:
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Total $120.75
Required Items and Reports (Conditions)
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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 • - . o OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue. By: / / Permittee Signat 41IP ,
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. •
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RECEIVED
NOV 1 4.2012 '
Mechanical Permit Applicat � �
o CITY melt tit I It 1. .I ti \I.,
City of Tigard " " +�- C1 I ' t /B / E / :
Date/By: Permit No.: tige,642 GO j}
• 13125 SW Hell Blvd, Tigard, OR 97223 Plan Reviow
Phone: 501639.4171 Fax: 503.598.1960 Ottx> Pamir
Dyr/By:
l l t: n u t t Inspection Line: 503.639.4175 Dye Ready/By. Hair fa See Page 2 for
Internet: www.ligard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction ® Addition/alteration/replacement Mechanical permit fees' we based on the value ofthe work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Vn11e' S
® 1- and 2- family dwelling ❑ Commercial/industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES•
❑ Accessory building
❑ Multi- family ❑ Master builder ❑ Other: For special igformalion use checklist_
Description kry. Ea Tote!
J08 STI'E 1NFURMA' ION AND LOCATION He
Job site address: `�1 {e Nam Air conditioning
(requires site plan showing placement) 46.75 ,_ City/State/ZIP: T.N�I IL.L� Furnace eu
ace 100,000 BTU (du/venu) 46.75 1/4„ .75
Suite/bldg./apt. no.: VV Project name: Furnace 100,000+ BTU (ducts/vents) 54.91 ��,//
Heat pump 1 61.06 rd. Cep
Cross street/directions to job site: 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, indusi, suspended, etc. 46.75
Subdivision: I 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
Rtflaw to l f _, '1 Gas fi ent t for 33.39
♦�, "- 1 �j �,! (,�J / �,(/lX1 Flue vent for water heater or gas
fireplace 2132
- Log lighter (pas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert - 23.32
Chimney /liner /flue/vent 23.32
PROPERTY OWNER I ❑ TENANT Other. _ 23.32
Name: tit; it o( Environmental exhaust and ventilation
v est Range hood/other kitchen
A
Address: s it0
equipment 33.39
City /State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( 3) Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attie/cmwlspace fans 2332
Business name: Same as contractor Other. 23.32
Fuel piping
Contact name: Diane Mason 514.15 for Brat four; 54.03 for each additional
Address: Furnace. eta
Gas heat pump
City /StatefZFP: Well/suspendedlunit heater
Phone:( ) f Fax::( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Trl County Temp Control Clothes dryer (gas)
..--. Other:
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES.
City /State/ZIP: Oregon City, OR 97045 Subtotal /0 Z
Minimum pump fee (590.00)
Phone: (503) 557.2220 ' Fax: (503) 557.0919
Plan review (25% of permit fee) , n q y
CCB lie.: 72623 Slaw surcharge (12% of permit fee) l M A
j�� TOTAL PERMIT FEE {
Authorized signature: �"��- 02 01 ° 47-81)
�b permit appgratloo expire Ira permit u not obtained whittle 100 �� /1 A D '(ans moon I * 12 I ster h
by n b accepted yBuildi as I camp Se KK � 1C/
loos e
Print name: Date: I1� � (� Fee methodology set by TriCounty Building Industry Service Board
1 lBuitdingWererluN(EC•PnmihApp Ow 10 IA9 4404617T (I u02/COMIWED)
T'd 096186S£OS:01. :14021d li£2:0T 2102- bT -f10N
•NOV -14 -2012 10:41A FROM: ,T0:50 P.1
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