Permit n CITY OF TIGARD MECHANICAL PERMIT
t . a • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00658
Date Issued: 12/13/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Parcel: 2S109AD03600
Jurisdiction: Tigard
Site address: 14503 SW 130TH AVE
Project: Bates Subdivision: WOODFORD ESTATES Lot: 28
Project Description: (1) gas furnace replacement, (1) flue /vent
Contractor: TRI COUNTY TEMP CONTROL INC Owner: BATES, SHERRI
13150 S CLACKAMAS RIVER DR 14503 SW 130TH AVE
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE: 503 - 557 -2220 PHONE. 503 - 598 -2390
FAX 503 - 557 -0919
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/13/2012 $46 75
Type of Use: SF FlueNent For Any of Above 12/13/2012 $23 32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/13/2012 $10 80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/13/2012 $19.93
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 �J/ /� At OUNC by calling 503 232.1987 or 1 800 332 2344
Issued By: /► / / Permittee Signature: O� A PP� e-4-
�SY'lil 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.
DEC -12 -2012 02:24P FROM: TO:5035981960 P.1
Mechanical Permit ApplicatRECE(V ED It l (►I.1 I( I.1.,I. oNI,\
Received ,
City of Tigard ce iv e l ' � - •
1,, ,
• 13126 SW Hall Blvd., Tigard, OR 97223 E DEC 12 2012 Plan Review
Phone: 503.639.4171 Fax: 503.598. Nolified/Mdhrnl: Supplemental Date/By: Other Permit:
inspection Line: 503.639 4175 VI OF I•IGARD Date Ready/By. 121 See Page 2 far
Internet: Www.tigard- or.gov 1!
7 1 1, r111 D B UILDING I !I V lslob" (0 Sa lemental 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 checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description i Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating /eooling
Air conditioning
Job site address: 1 (requires site plan showing placement) 46.75
City /State/ZIP: 18 g1224 Furnace 100,000 BTU (ducts/vents) 1 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydmnic hot water system 23.32
Residential boiler (radiator or
hydrunie) 23.32 , .
Unit heaters (fuel -type, not electric),
in -wall, in- - duct, suspended, etc. 46
Flue/vent for any of above 1 23 32
Subdivision: Lot no.: Other: 23.32
Tax map /parcel no.: Other fuel appliances
Water heater 23.32
DESCRIPTION OF WORK Gas fireplace 33 39
Flue vent for water heater or gas
- 'rn /1p fireplace 23.32
1 . W „ Log lighter (gas) 23 32
V Wood/pellet stove , 33 39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23
PROPERTY O I ❑TENANT Other. 23.32
Name: 5= bo it5 Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: v J' ter/ � 23.32 ( SOT,) E U M, I ` 0 I Fax: ( ) toilet compartments, utility rooms)
® APPLICANT ❑ CONTACT PERSON Attic/crawispacc fans 23.32
Other: 23.32
Business name: Same as contractor Fuel piping
Contact name: Diane Mason St4.15 for first four; $4.03 for each additional
Furnace, etc.
Address: Gas heat pump
City /State/ZIP: Wall/suspended/unit heater .
Water heater
Phone: ( ) Fax: : ( ) Fireplace
E -mail: Ran
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: Tri County Temp Control Other:
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES"
Subtotal
City/State/ZIP: Oregon City, OR 97045 Minimum permit fee (590 00)
Phone: (503) 557.2220 l Fax: (503) 557.0919 Plan review (25% of permit fee)
CCI3 lie.: 72623 — State surcharge (12% of permit fee)
TOTAL PERMIT FEET —
/77240
This permit application expires if a permit is not obtained within 180
Authorized stgnatuPC:� days after it has been accepted as complete.
[print name: p/iy 1[,.�
� � moo Dat : '4I 1I I • Fee methodology set by Tri -County Building Industry Service Board
. ,,. _..,...__.u.....:.,\unr_o..emAnn doe 10/01/09 440 - 4617r (11/021COM/WE6)