Permit q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 -00057
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/28/2013
Parcel: 2S103BB02200
Jurisdiction: Tigard
Site address: 12175 SW 124TH AVE
Project: Haynes Subdivision: BROOKWAY Lot: 22
Project Description: (1) furnace installation
Contractor: OREGON HEATING & AIR CONDITIONING Owner: HAYNES, DALLAS M & RACHAEL E
19300 SW 118TH AVE 12175 SW 124TH AVE
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 691 -9699 PHONE:
FAX: 503 - 691 -8556
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/28/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/28/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/28/2013 $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: JtI Q J Permittee Signature: D} /-9L/ n 4-7701(-1
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. V l
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.
01/24/2013 17:51 503-691-8556 OREGON HEATING PAGE 01/02
Mechanical Permit Apphica VED FOR OFFICE USE ONEN
City of Tigard Received
Date/By; i A Er 1 C r PennitN° 3-
11 . 13125 SW Hall Blvd., Tigard, OR 97223 JAN 28 2013
Flan Review Other Permit
Phone: 503.639.4171 Fax: 503.598.1960 Date/By•
TiciA RD Inspection Line; 503.639,4175 CITY OF TIGARD Date Ready/BY:
ri , 1 10 S 2 for
Internet: www.figard
BUILDING DIVISION Ndifiedalletx4: la" Supplemental information
•
- ___.---- •
TYPE Oil': WC/RIC ' ' • ': ' , • . , COMA/IMMO • FEE salTIE: - 41SE cKEcittak
Mechanical permit fees* are based on the value of the work
El New construction 'Addition/alteration/replacement Performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition i:1 Other: mechanical materials, equipment, labor, overhead, and profit
Value: $
cATEGORV: ok.'rOSSTRi..r,Ofir461 , , : 0. - ::: i , ".2 , !. i', ::', ., „, •
-----!--, - ' -''' '- ,, :, iiEsiD01* Wtr101 107461,.:
rir 1- and 2-family dwelling 0 Corninercial/industrial 0 Accessory building ,
For special information use checklist,
0 Multi-family ID Master builder 0 Other: Description j Qty. I Ea_ 1 Total
srrE :11NroftmAjiOS,k 'AND LOCATION .. : ', :::::', - , :. :, ...: Heating/cooling
,......-. • — , Air conditioning
Job site address: / i 75 s i,i 42 i i Ai A 0.2„ re .uires - site .lan showin . lacemen 46.75
-
e d City/State/ZIP: T g 27 Furnace 100 000 BTU duets/vents In. 46.75 4 if ..,
T 4j c ipp 4 _
I ' `i Furnace 100,0001-BTU (ducts/vents) Ill 54.91
Suite/bldg./apt- no.: i l Pr* nalUe: / /- 0 o 2a neat .0 , . 61.06
Cross ace/directions to job site: . Duct work III 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
. . dronic 2332
Unit heaters (fuel-type, not electric),
in-wall, in-duct suspended, etc. 46.75
- :
- - Flue/vent for any of above 23.32
Subdivision: 1 Lot no.:
: Other 23.32
Tax map/parcel no.: : Other fuel appliances
: ..:::'• ::: : : ...': :: T . :' : ' * L,.': ,;:.':,:,.;):4;5:-.....,,,,‘;,;4 Water heater 2332
Gas fireplace 33.39
..tl I FT, rhait
: . Flue vent for water heater or gas
fireplace ' 2332
— Log lighter_(gas)___ 2332
Wood/pellet stove 3339
• :
Wood keplacermsert 2332
: Chimney/liner/fine/vent 2332
0 pRoptii.TY , OWNER 1 :;• ':..: :.'.' Y '' .: . '''. : ,: •.:....;; . If •PIA; • -. ' ::... ' :" : • other ...
23.32
Nam; D 1 Environmental exhaust and ventilation
- Range hood/other kitchen
Address: /2 1 7 41 i i2sa: 4, 4,1iipment 33.39
City/State/ZIP: /7 te t 0A; I 7Z23' Clothes dryer exhaust 33.39
i cs / Single exhaust (bathroomS,
Phone: (5-.7) 37 . 75 - Fax: ( ) toilet compartments, utility rooms) 23.32 _
: 0' cOract, h , , : ,. :. Attic/crawlspace fans 23.32
- Other: 2332
[ Business name: Or," Heap', . Fuel piping
,
Contact mine: 24 t
;*.i _ $14.15 for first four; 54.03 for each additional
Furnace, etc.
Address' ifyclo sh, ilea 6 e Gas heat punlp
City/State/ZIP: n ir a „ fair oR 11‘)6.2 Wall/suspcndedhunt heater
Water heater
Phone: (Sq ) CV - 96.11 Fax: ( ) -
! ----------- Fimplace
P-mail: Range
' '• .- ...', CONTRAeTok:...4: :':, . '.-:... Barbecue •, . • • - . .
Clothes dryer ()
Business name: 0 un H eth ; -
Other
Address: /9700 „Si fire4 -44/1c: ' , ' , 1 mama' nisi ,,
Cit 7 , r." '? Subtotal 4,6_73--
Minimum permit fee ($90.00) /0 -
Phone: (S ) cli,_ 4 1 491 , Fax: ( ) Plan review (25% of perrait fee)
CCB lie.: /7 / 2 c State surcharge (12% of permit fee) / 0.. lik2
, _....
..._..-- - TOTAL PERMIT FEE /o o.
This permit appikation expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete
..- .7 f - . ..••• :II . .... Mita. - .
'"-- • Pee methodology set by Tri-Coonty Building industry Service Board
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12175 SW 124TH AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
02/25/2013 00:00
MEC2013-00057
PASS - No C of O
Electrical minor label348073
Violation Summary:
Inspector Contractor