Permit CITY OF TIGARD MECHANICAL PERMIT
8 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00621
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/2012
Parcel: 2S104AA09000
Jurisdiction: Tigard
Site address: 12200 SW 127TH AVE
Project: Bradford Subdivision: BELLWOOD NO.2 Lot: 95
Project Description: (1) gas furnace removal and replacement
Contractor: AAA HEATING & COOLING INC Owner: BRADFORD, JOHN F AND
5017 NE GRAND AVE DONETA L
PORTLAND, OR 97211 12200 SW 127TH
TIGARD, OR 97223
PHONE: 503 - 284 -2173 PHONE: 503 - 590 -9312
FAX: 503 - 284 -1552
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/06/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/06/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/06/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 Notific- •• I 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 - estions to • • C by c -lling 503.232.1987 or 1.800.332.2344.
Issued ' , / Permittee Signatur
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.
Fr om. RECEI / , 12/06/2012 14:21 #r081 P.002/003
Mechanical Permit Application DEC 0 6 2 *x 012 I()lt ()1 I It I I 'I (1.1.1
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[ A / , �W ((/
City of Tigard Received
Date/By. nRe a e l PermitNo.:
IL 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF f t/� •
� Phone. 503 718.2439 Fax. 503.598.1960 CITY 1 VF ffv71 • I Plan Review
BUiLDiNG D1VIS1C`g ateRy Other Permit
Inspection Line: 503.639
T I G A R n ate Ready/By: Tuns ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: 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: S
CATEGORY OF CONSTRUCTION • RESIDENTIAL :EQUIPMENT / SYSTEMS FEES*
® I- and 2- family dwelling El Commercial /industrial ❑ Accessory building r For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION fleating/cooling:
Air conditioning
Job site address: 12200 SW 127 Ave (requires site plan showing placement) 46.75
City /State/LTP: Tigard OR 97223 Furnace 100,000 BTU (ducts/vents) 46.75 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Bradford 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:
DESCRIPTION OF WORK Water heater 23.32
Gas fueplace/insert 33.39
Remove /replace gas furnace
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 23.32
Other: _ 23.32 _
Name: John and Donneta Bradford Environmental exhaust and ventilation:
Address: 12200 SW 127 Ave Range hood/other kitchen
equipment 33.39
-
City /State/ZIP: Tigard OR 97223 Clothes dryer exhaust 33.39
- Single -duct exhaust (bathrooms,
Phone: (503)590 -9312 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: AAA Heating and Cooling, Inc. Other: 23.32
Fuel piping:
Contact name: Felicia Gomez $14.15 for first four; $4.03 for each additional
Address: 5017 NE Grand Ave Furnace, etc.
Gas heat pump
City /State/ZiP: Portland OR 97211 Wall /suspended/unit heater
Phone: (503) 501 -5504 Fax: : (503 -) 284 -1552 Water heater
Fireplace
E - mail: gomez.feliciam4ijgmail.com Range
CONTRACTOR Barbecue
Business name: AAA Heating and Cooling, Inc. Clothes dryer (gas)
Other:
Address: 5017 NE Grand Ave MECHANICAL PERMIT
City/State/ZIP. Portland OR 97211 Subtotal 46.57
Minimum permit fee (590.00) 90.00
Phone: (503) 284 -2173 Fax: (503) 284 -1552
Plan review (25% of permit fee)
CCI3 lie.: 222 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80
Authorized signature: This application expires if a permit is not obtained within Igo
g (SW \ \ 11 I l (� s permit days after it has been accepted as complete -
Print name: Felicia rl IrIli) ez Date: 11/30/12 I e Fcc methodology set by Tri- County Building Industry Service Board
1 \Building1PermiisNEC- PvmiiApp doc 07/07/12 440 -4617T (11 /02/CO(0/WEB)
From: 12/06/2012 14:21 #061 P.001/003
FAX COVER SHEET h<0 t 130 /(2_
A A Heating & Cooling. Inc.
5017 N.E. Grand Avenue
Portland, Oregon 97211 -3803
Phone: (503)284 -2173
Fax: (503) 284-1552
Email: aaacooling @aol.com
Website: aaaiaq.com
Date: 11 12
To: CA
o - 1 Fax: 503' 5 (Ckv
From: Fe__.\\CAo, 6 eL Pages: (cover included)
RE: me.V .flkr0 perm ` npp I +`.
Message:
•
From. 11/30/2012 12:21 #050 P.002/003
Mechanical Permit ApplicatiREcEIVED FOR OFFICE I SF: ONLY
City of Tigard Received
Y g Date/By: / et/ 3 J- sr Permit No. / e a.o a b da
� _ 420 l
• 131 SW Hall Blvd., Tigard, OR 97223 Plan Review
"sC/
.114 Phone: 503.718.2439 Fax 503.598.1960 DEC O 2012 Date/By: Other Permit:
T I G A It I> Inspection Line. 503.639 Date Ready/By. Ready/By. fads: Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: See e mental Information
BUILDING DIVISION Ti r i Supplemental
TYPE OF WORK : • • ' . . • . . ". . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees" are based on the value of the work
❑ New construction 0 Addit ion / 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 Qty. I Ea. _ Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 12200 SW 127 Ave (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75 46.75
City /State/ZIP: Tigard OR 97223 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Bradford 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: 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
Remove/replace gas furnace Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
- Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
0 PROPERTY OWNER ❑ TENANT Chimney /liner /tlue/vent 23
Other: _ 23 32
Name: John and Donneta Bradford Environmental exhaust and ventilation:
Address: 12200 SW 127`' Ave Range hood/other kitchen
equipment 33.39
City /State/ZIP: Tigard OR 97223 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)590 -9312 Fax: ( ) toilet compartments, utility rooms) 23.32
0 APPLICANT • ❑ CONTACT PERSON Attic/crawlspace fans 23.32 •
Business name: AAA Heating and Cooling, Inc. Other: 23.32
Fuel piping:
Contact name: Felicia Gomez S14.15 for first four; $4.03 for each additional
Address: 5017 NE Grand Ave Furnace, etc.
Gas heat pump
City /State /ZIP: Portland OR 97211 WalL/suspended/unit heater
Phone: (503) 501 -5504 Fax: : (503 -) 284-1552 Water heater
Fireplace
E - mail: gomez.feliciam(gmail.com Range
CONTRACTOR Barbecue
Business name: AAA Heating and Cooling, Inc. Clothes dryer (gas)
Other: 1
Address: 5017 NE Grand Ave MECHANICAL PERMIT FEES"
City /State /Z1P: Portland OR 97211 Subtotal 46.57
Phone: (503) 284 -2173 Fax: (503) 284 -1552 Minimum permit fee (590.00) 90.00
Plan review (25% of permit fee)
CCB lie.: 222 /� State surcharge (12% of permit fee) 10.80
SCE fri / ° z / 69- t v TOTAL PERMIT FEE 100.80
Authorized signature: / e- 6 - f f/ g- / 2/ .//2- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Felicia M Gomez / I Date: 11/30/12 1 • Fee methodology set by Tn- County Building Industry Service Board
Ill tuitdingWermits\MEC- PermiiApp doe 01/07/12 /'e " /
�7�'�� .440 -461 Tr (l l /02JCO.M/1VGa)
From: 11/30/2012 12:21 #050 P.001 /003
FAX COVER S11EE7'
A A Heating a Cooling, Inc.
5017 N.E. Grand Avenue
Portland, Oregon 97211 -3803
Phone: (503) 284 -2173
Fax: (503) 284-1552
Email: aaacooling @aol.com
Website: aaaiaq.com
Date: 1 kCA
To: ("* W aCdd
CA10e - 1 \tSV(l Fax: 503 5c-k - I GI�Q
From: F4j■C1(X Pages: g G.) (cover included)
RE: _ C h - , ` . n 1 C t \ per p p I'� , _ _
Message:
•