Permit CITY OF TIGARD MECHANICAL PERMIT
11 4 s • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00674
T L G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/19/2012
Parcel: 1 S133DD11300
Jurisdiction: Tigard
Site address: 11879 SW 125TH CT
Project: Mercer Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 150
Project Description: (1) gas furnace replacement
Contractor: ABLE HEATING & COOLING LLC Owner: MERCER, ERIC ALLEN & JANINE M
16285 SW 85TH AVE #105 11879 SW 125TH CT
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 579 -2250 PHONE' 503 - 524 -0867
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/19/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/19/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/19/2012 $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 ' 1 / Permittee Signature: 0 }1 AP CiTiQ
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.
RECEIVED
Mechanical Permit Application DEC 1 8 2012 I (iI< ()1 i 11 I l ti I: UPI l
City Tigard Received Perna No.
1:IN
t31 of Ti SW Hall Blvd., Tigard. OR 97223 CITY OFTIGAR ' � �l "R e I a I a- -1-- iUEL' Zvi a ob4 ?LF
Phone: 503.7182439 Fax: 303. 598 . 196 OBUILDING DNISI I IC :view y: other Permit
: I , . k r , inspection Line: 503.639.4175 pare Ready/By: lutix to See Page 2 for _
Internet: www.tigard- or.gov Notifed/Method 1(4. Stipptemental inform *boo
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST 1
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 i
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® I- and 2 -family dwelling 0 CornmerciaUindustrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other Description 1 Qty. I Ea. [ Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 11879 SW 125 COURT (requires
site plan showing placement) 46.75
Furnace 100,000 BTU (duets/yenta) I 46.75 46.75
City/Starr /LIP: TIGARD, OR. 97224 _ Furnace 100,000+ BTU (dace/vents) • 54.91
Suite/bldglapt. no.: Project name: MERCER Heat pump
(requires ate 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 ekctric),
in -wall. in-duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
1 Other. 23.32
Tax map/parcel no.: Other fuel appliances: _
DESCRIPTION OF WORK • Water heater 23.32
Gus vent f w ater 33.39
REPLACE EXISTING GAS FURNACE
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) . 23.32 , .
Waod/pelkt stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER I ❑ TENANT Chimney /liner/flue/vent
23.32
Other _ 23.32
Name: ERIC AND JANINE MERCER Environmental exhaust and ventilation:
Address: 11879 SW 125 COURT equipment m
hood/other kitchen I 3339
City / State/ZIP: TIGARD, OIL 97224 Clothes dryer exhaust 33.39
Single exhaust Phone: (503)524 Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other 23.32
Business name:
Fuel piping:
Contact name: 514.15 for first four, $403 far each additional
Address: Furnace, etc. .
Gas heat pump _
City /State/ZIP: WaWsuspended/unitheater .
Phone: ( ) f Fax:: ( ) Water heater -
E-mail: , Fireplace
Range
CONTRACTOR Barbecue
Business name: ABLE HEATING & COOLING LLC Clothes dryer (gas)
i _
Other:
Address: 16285 SW 85 AVE. SUITE 185 MECHANICAL PERMIT FEES'
City/State/ZIP: TIGARD, OR. 97224 Subtotal 46.75
Phone: (503) 579-2250 Fax: (503) 620 - 3980 Minimum permit fee (590.00) 90.00
Plan review (25% of permit fee)
COI lie.: 184392 State surcharge (12% of permit fee) 10.80
./ TOTAL PERMIT FEE 100.80
f This permit application expires if a permit is not obtained within ISO
�r�/ J / ( �� days after it has bees accepted as complete.
I Print name: KELLY WI LHTTi I Date: 12 - 18 - 12 • Fan tsethodology set by Tri County Building Industry Service Board
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