Permit CITY OF TIGARD MECHANICAL PERMIT
s • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00627
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2012
Parcel: 1 S133DA06000
Jurisdiction: Tigard
Site address: 12950 SW GLACIER LILY CIR
Project: Altenhofen Subdivision: AMART SUMMER LAKE Lot: 82
Project Description: (1) gas furnace removal and replacement and fuel piping
Contractor: A ACTION APPLIANCE & HEATING INC Owner: ALTENHOFEN, DEAN
18245 SW TV HWY 12950 SW GLACIER LILY CIR
ALOHA, OR 97006 TIGARD, OR 97223
PHONE: 503 - 649 -3524 PHONE: 503 - 332 -3016
FAX: 503 - 649 -6095
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/03/2012 $46.75
Type of Use: SF Fuel Piping 12/03/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/03/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/03/2012 $29.10
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. A
Issued By: 61/U /► // Perm ittee Signature: old AWL L 4 n D &L
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.
12/03/2012 15:31 FAX ���t1 f j001 /002
Mechanical Permit Applica 7l. IVED FOR OFFICE USE ONLY
City of Tigard e l B _ 3 I a -- ..3;c- Permit No.: juetol �erep Al 13125 SW Hall Blvd., Tigard, OR 97223 '- U 3 2012
= Plan Review
Phone: 503.639.4171 Fax: 503.598. 960 Other Permit:
Inspection Line: 503.639.4175 �I TYOFTIGARD
Date/By:
I G A R D spne: . Date Ready/By: 121 See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: in Supplemental information
TYPE OF WORK COMMERCIAL FEE' SCHEDULE -- USE.CUECKLIST
❑ New construction Addition/alteration/replacement Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
ID Demolition ❑Other:
mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: S
1A(. 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT /SYSIEEMS FEESf
For special information use checklist.
Multi - family ❑Master builder ❑Other Description I Qty. I Ea. ' Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: � \/ G 1 � ��
�� ^ l r
�� Au conditionin
� ) 1f ( re q u i res site plan showin placement) 46.75 J � �
City / State/ZIP: 22 Furnace 100,000 BTU (ducts/vents) I 46.75 `I �'
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldgJapt no.: 1 Project name: Heat pump 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: 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
T p Gas fireplace _ 33.39
1 `rYZ Ol/p r ) Q cC_ 9QS Flue vent for water heater or gas
fireplace 2332
-L.-m(1 -L.-m(1 (-
Loog g lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplacefinsert 23.32
PROPERTY OWNER l 0 TENAN Chimney/liner /flue/vent 23.32
T 23.32
Name: 1 an A 1-- f -- J + �^ Environmental exhaust and ventilation
Address: gag ? . S + ` Range hood/other kitchen
_ equipment 33.39
City/State/ZIP:T a ` ! q1 2 Clothes dry exhaust 33.39
30 ! compartments, Single-duct exhaust (bathrooms,
Phone��j) 5 Fax: ( ) toilet comptmt utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Other: 23.32
A- ACTION HEATING & A/C Fuel piping
Contact name: a 15 for first four, $4.03 fo reach additional , ,t .
18245 S.W. T.V. HWY Furnace, etc. ALOHA, OREGON 97n08 Gas heat pump 144.•
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: A_ACTION. HEATING & A/C Clothes dryer (gas)
Other.
Address: 18245 S.W. T.V. HWY
MECHANICAL PERMIT FEES "'
City/State/ZIP: ALOHA, OREGON 97005 Subtotal
^- - 49 S Minimum permit fee ($90.00)
Phone: ( ) �l�C ' _ -5a Fax:� � 6
`.� Plan review (25% of permit fee) •
-
CCB lie.: ic State surcharge (12 %of permit fee) fn
TOTAL PERMIT FEE , 1v�i
Authorized signature: This p er mit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
I Print name: r3 wax I Date: i 1 Z . Fee methodology set by Tri- County Building Industry Service Board
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