Permit CITY OF TIGARD MECHANICAL PERMIT
li g m COMMUNITY DEVELOPMENT Permit #: MEC2013 -00164
T f GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/26/2013
Parcel: 2S 112C 604900
Jurisdiction: Tigard
Site address: 15483 SW 82ND PL
Project: Rijken Subdivision: ASHFORD OAKS NO.2 Lot: 63
Project Description: (1) gas furnace replacement
Contractor: TRI COUNTY TEMP CONTROL INC Owner: RIJKEN, RONALD
13150 S CLACKAMAS RIVER DR 15483 SW 82ND PL
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE: 503 - 557 -2220 PHONE: 503 - 968 -7955
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/26/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/26/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/26/2013 $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 calling 503.232.1987 or 1.800.332.2344.
Issued By: /u /�� Permittee Signature: 7 , j 4 pal
/ 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.
Mechanical Permit APP"ca EIVED l Ou O1 1.1( 1 cL ()NI 1
g Received 1 3 CenmitNo.: i46 ( 3 -vq(�e�
City of Ti and Date/By:
I I 13125 SW Hall Blvd -, Tigard, OR 9 7223 Plan Review
0 Phone: 503.639.4171 Fax: 503.598.1 R 2 5 2013
Date/By: Other Permit
-r R./ow Inspection Line: 507.639.4175 Dare Ready/By. m: /, ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: 10 Supplemental Information
BUILDING DIVISION ,
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - -USE CHECKLIST
❑ New construction ® Addition/alteration /replacement Mechanical permit tees* 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 / SYSTEMS FEES*
® I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For specia[infonnarrou use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCA'T'ION Heatingleoeling
n Air conditioning
Job site address: 16 ��. (requires site plan showing placement) 46.75
City /State/ZIP: Ti6ard 7 Furnace 100,000 (du s/ven s) l 46.75 -
Furnace 100,000+ BTU (duetslvents) 54.91
Suite/bldgJapt. no.: I Project name: 1-leat pump 61.06
Cross street/directions to job site: Duct work 23.32
l-lydronic 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
Flue /vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Flue vent for water heater or Pcptact6a5 , fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert - 23.32
Chimney /liner /flue /vent 23.32
PROPERTY O � NER I ❑ TENANT Other: 1 T 23.32
Name: ' Z(j jitilt1 /'j N Environmental exhaust and ventilation
1�J tt�f l Range hood/other kitchen
Address: arlJ I N equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ) G�(�$'" l Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32 ,
Business name: Same as contractor Fuel piping
Contact name: Diane Mason $14.15 for first four; $4.03 for each additional
Furnace, etc. 1
Address: Oas heat pump _
City/State/ZIP: Wall/suspended/unit heater ,
Water heater
Phone: ( ) Fax:: ( ) Fireplace
E -mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: Tri County Temp Control
Other:
Address: 13150 S Clackamas River Drive _ MECHANICAL PERMIT FEES"
City/State/Z1P: Oregon City. OR 97045 Subtotal
Minimum penult the ($90.00)
Phone: (503) 557.2220 Fax: (503) 557 plan review (25% of permit fee)
CCD lie.: 72623 State surcharge (12% of permit fee)
TOTAL PERMIT FEE (OO► Q 5U
This permit application expires If a permit is nut obtained within 180
Authorized signature: /61/57103 d ays a fter it has been accepted as complete.
Print name: (�� M 1 v ` l Date: • Fee methodology set by Tri - County Building Industry Service Board
1. 1Buildioa1PermitslMEC .PermIlApp.doo 10/01/09 4404617T /02/COM/WEB)
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