Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2012 -00598
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
Parcel: 1S133AD14900
Jurisdiction: Tigard
•
Site address: 12654 SW SORREL DOCK CT
Project: Lawrence Subdivision: SUMMER LAKE Lot: 30
Project Description: (1) furnace installation
Contractor: SPECIALTY HEATING & COOLING INC Owner: VERGUN, LAWRENCE M & ANDREA
7500 SW TECH CENTER DR SUITE 130 12654 SW SORREL DOCK CT
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 620 -5643 PHONE: 503 - 524 -9392
FAX: 503 - 681 -0793
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/20/2012 $46.75
Type of -Use: SF 12% State Surcharge - Mechanical 11/20/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/20/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
•
Total $100:80
Required Items and Reports (Conditions)
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. n
Issued By: � 2 "' - c9 fit' `^'�.' Permittee Signature: DM � PPL.I ) ot■N
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
From: 11/19/2012 11:21 #124 P.002/002
RECEIVE Mechanical Permit Application I oiz of Fact I �i O\l ,
NOV 19 2012 R ecen
City of Tigard ed y e SO ‘1,- Permit No.�t.gea
(pg,...DD. 178/
II
a 13125 SW Hall Blvd., Tigard, OR 97223 CITY DatdB
C :a: Phone: 503.718,2439 Fax: 503.598.196 TIGARD Plan Review Other Permit:
D ate / B y:
'f I G A It O, Inspection Line: 503.639.4175 BUILDING DI /ICI Date Ready /By: kris: ® See Page 2 for
- .• Internet: www.tigard- or.gov
BUILDING LJ1 V J Notified'Method: n k, Supplemental Information
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Kaf ::. 's _, .0 . -ya z c.:. _y,� .i . , . :- - l . ,,�.. -.I" : z "',: . :43 " MIVIERC143:FEE. SCHEDUI ,
S: 3 C$ECIC 447= `'
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Mechanical permit fees* are based on the value of the work
❑ New construction I Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
u r u e.:. ;a c. = ° F :-.,- s� Value: S
s. .;, v ;: e'':• aC4' PEGOR !',�UF�CUNSTRUC�'iUIY" - =W g- _ „s sr, ;A ' -l- - - * * s:f ,
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--. � . ` -= ; EQI) IRMENJ '�IeSYBTEMS'EEFS!�_a;r;��
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist
❑ Multi - family ❑ Master builder El Other: Description I Qty. I Es. I Total
m•; xa Y .,. f: Hcatinp/
JOB SPlE.=1liFORti"gtION AND-:I,ergt..0 r, -_=
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Job site address: i 2.k, Esli t -' `!)' q 4 ,� r 0 O cA 4 ( j (requires she plan showing placement) 46.75
City/State/ZIP: t, � l/ Furnace 100,000 BTU (ducts'vents) i 46.75
y l J -J (' ",. 1 • _ Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldgJapt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
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, 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:
./ °t. -r;:.a;3!"0 ?:M g.t. - �' }s „e, � y :' `;, Ti " ::,,n -; >,,-' I Water heater
'r'<a; ? v
< .45 gtv � 4 : '1;*,ID-- -iTI01 _Vy:Oi± *WORK.? ' w Apat.;y�: ;;;VR 4tt i ea 23.32
Gas fireplace'insert 33.39
Flue vent for water heater or gas
) l - ��_ fireplace 23.32
�� ' IV6 tv t ,rr Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
:i�< ' ; ®' i` r r �" ° ^/s- g f i<ii �., y � 7,k ;,, Chimney /liner /flue /vent 23.32
� q�PRUPERTY„ OVI! IVEIL`�- �,�� =.,a'- .�.__.. Y, 7'ENAV7` r:`���_.` -: s�
"�:: Other: 23.32
Name: L c �4 J j_ Environmental exhaust and ventilation:
Address: Range hood'other kitchen
equipment 33.39
City /State/Z1P: Clothes dryer exhaust 33.39
Phone: 13q1..._ Fax: Single -duct exhaust (bathrooms,
hone:
( ) S � y ^ ( ) toilet compartments, utility rooms) 23.32
-i r4 'iJtl= � M t"-- .._� >r..wi^n.a
V.0302410-12 r* IG41 - ;: - •,, ; ; ® URX0. :0*00Nnaf Anic%rawlspane fans 23.32
Business name: Other. 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City,'State/ZIP: Wall/suspendecrunit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
:,s3 ,'.:`'' "- -; ., _? s r - CO2i1TLtACTOR'{ -'' ` e .., .. t .: ,; s' Barbecue
_. ..� Y�".-. .. %.��- :-r.�. .- __.. ... �3hi -.ti _- �5�.. va•. ai�c�° �.. .�.` -. 1:.7Ss�� B
Business name: Specialty Heating & Cooling, Inc Clothes dryer (gas)
Other.
Address: 7500 SW Tech Center Dr #130 `-r ; rr-• -,n:
nit '��`'°� I YIECAAIVICAL.P , *- `;'`��''"
�:x� -� "�t ER = +.,.
City/State/ZIP: Tigard, Or. 97223 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 620 -5643 Fax: (503) 598-0718
Plan review (25% of pem3it fee)
CCB lie.: 66578 ' State surcharge (12% of permit fee)
TOTAL PERMIT FEE /01)• /� This permit application expires if a permit is not obtained within ISO
Authorized Signature: / days after It has been accepted as complete.
Print name: Andrea Dripps Date: r / -1 it L • Fee methodology net by Id-County Building Industry Service Board
t: t3uilthng \Permits MEC- PamitApp.doc 03 07/12 440.46 I rr ( 1 i 02,COM/WEB)