Permit a CITY OF TIGARD MECHANICAL PERMIT
8: -- COMMUNITY DEVELOPMENT Permit #: MEC2012 -00668
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/17/2012
Parcel: 2S103BA00300
Jurisdiction: Tigard
Site address: 11565 SW WALNUT ST
Project: Lindquist Subdivision: LERON HEIGHTS NO.2 Lot: 28
Project Description: (1) gas furnace removal and replacement
Contractor: A ACTION APPLIANCE & HEATING INC Owner: LINDQUIST LIVING TRUST
18245 SW TV HWY BY LINDQUIST, MARVIN T & JACKI S TR
ALOHA, OR 97006 12070 SW TURNSTONE AVE
BEAVERTON, OR 97007
PHONE: 503 - 649 -3524 PHONE: 503 -475 -4385
FAX: 503 - 649 -6095
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/17/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/17/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/17/2012 $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.
Issued By: / ` j / Permittee Signature: 9 /f / 4- fo,u
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.
12/14/2012 15:20 FAX Z001 /002
Mechanical Permit Annlicat CE jE
D rule OFFICE USE ONLY
1 Y Receive
City of Tigard Date/By: AI°../ � (/ e _ r' ` /�+- -( ry v e e -•
11111 13125 SW Hall Blvd., Tigard, OR 9722 1 ,l Plan Review r"`
= Phone: 503.639.4171 Fax: 503.598.1 11' ,
Date/By: Other Permit
TI G :\ R D Inspection Line: 503.639.4175 CITY Date Ready/By: In ® See Page 2 for
Internet: www.tigard or.gov 1 Y TiG A Notified/Method: Supplemental Information
BUILDING DNrc
X Additiorila1tetionIre p 1ace mcnt TYPE OF WORK COMMERCIAL FEE* SCHEDULE - IS E . CHECKLIST
1,:j New construction ra Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other' mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT /3!iF'Eb`
l -and 2- family dwelling ❑Commercial /industrial ❑Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. j Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address :V\ (] /� S
Air conditioning
�\ �� J �,{ { (requires site plan showing placement) 46.75
City / State/ZIP: I l (-{ Q 1 2, 3 Furnace 100,000 BTU (ducts/vents) i 46.75 `y'1D
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
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
�ONA- l , k l 4 Gas fireplace f gas
• Flue vent for water heater or
O fireplace 23.32 • II Log lighter (gas) 23.32
Wood/pellet stove 33.39 _.______4
Wood fireplace/insert 23.32
p ( P ROPERTY OWNER I ❑TENANT - Chimney /liner /flue/vent 23.32
It 23.32 23.32
Name: 4
q, , _ A • S Environmental exhaust and ventilation
1 C � Range hood/other kitchen
Address: � `�S 01 y e ui ment 33.39
City/State/ZIP: rX • , -I =40 ` �' Clothes dryer exhaust 33.39
Phone Single -duct exhaust (bathrooms,
'� 4 4 � 5 F ax: ( ) toilet compartments, utility moms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: — Other: 23.32
A- ACTION HEATING & WC Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
1824 5 S.W. T.V T.U i
Address: Al OHA, OREGON 91006 Gas heat e etc.
Gas h pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E-mail: Fireplace I
Range
CONTRACTOR Barbecue
Business name: A- ACTION HEATING & WC _ Clothes dryer (gas)
- .VII... other:
Address: 18245 . _
ALOHA, OREGON 9100G MECHANICAL PERMIT FEES*
City /Slate/ZIP: Subtotal
Phone:. ( -I q —,s15 Fax .)3 C1 — &) permit fee)
—
Plan review (25% of permit fee)
CCB lie.: -- )5_,3 State surcharge (12% of permit fee) y
TOTAL PERMIT FEE 1
Authorized signatu C
\b This permit application expires if a permit is not obtained within 180
da ys after It has bees accepted as complete.
Print name: j` . A. s - . Date: t ' Fee methodology set by iti - County Budding Industry Service Board
l.' iuildi. Pcrmita\ MEC- PcrmilAno.doc 115/01/09 440-4517T (II 4 • Ell)