Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 -00199
T f GA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2013
Parcel: 2S104AA09700
Jurisdiction: Tigard
Site address: 12955 SW KATHERINE ST
Project: Blank Subdivision: BELLWOOD NO.3 Lot: 117
Project Description: (1) gas furnace installation
Contractor: ADVANTAGE HEATING COOLING PLUMBING INC Owner: BLANK, BRUCE E
3106 NE 163RD ST GLASS, CINDY A
RICHFIELD, WA 98642 12955 SW KATHERINE
TIGARD, OR 97223
PHONE: 360 - 693 -5220 PHONE:
FAX: 360 - 693 -2273
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/15/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/15/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/15/2013 $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: )JuAiti/ , I A 0 C 7' Permittee Signature: Oki A pP0 cc" 77UA
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.
Apr. 11. 2013 1 : 22PM No. 0036 P. 2
Mechanical Yermlt Applica FOR OFFICE USE. ONLY
City of Tigard E EfVED Received sT Permit No : J CO _ q
-- " 13125 SW Hall Blvd., Tigard, OR 97223 DneBy y S �' �) 3
t; Phone: 503.718.2439 Fax: 503.598.1960 APR 1 1 2013 PlanReview
Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: runs: 0 See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method. f I (, Supplemental Information
gill DING DIVISION
TYPE OF WORK COMMERCIAL FEE" SCHEDULE — USE CHECFCLIST
Mechanical permit fees' are based on the value of the work
❑ New construction Ad dition/alteraiion/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead, and
Value: $ 3 ‘, oe
CATEGORY OF CONSTRUCTION RFSIDENTIAL EQUIPMENT /SYSTEMS FEES
41' and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special deformation use checklist
❑ Multi-family ❑ Master builder ❑ Other: Description Qty. J Ea Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 1 'ail $ 5 5,j 1 / ��'Ir. q� � ik c�'r, (requires site plan showing placement) 46.75
T 11 ' 77 `` (' 3 Furnace 100.000 BTU (duets/vents) / 46.75 111„,-'S City/ Stata/ZIP:
T:L _ l,V 972 Furnace 100,000+ BTU (ducts/vents) ' 54.91
Suite/bldg. /apt. no.: Project name; Q, (^l 0� Heat pump y
%j (requires site plan showinpplacetllent) 61.06
Cross street/directions to job site: Ductwork 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 fireplace/insert 33.39
I ' cane) liCe, ( l it Q (E . 4 " - Tp- Imo. A) ti,) Flue vent for water heater or gas —
GA 5 'rc.A RA A G fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
PROPERTY OWNER El TENANT Ot y/liner /flue/vent 2332
',� Other;
__ 23.32
Name: OF la a. t. O (() i{ Environmental exhaust and ventilation:
Address: j Range hood/other kitchen
"/ 5 � 1°e � - �d ! 33.39
equipment
City / State/Z1P: 1 .1-t�i 0 yak ` l7 a 3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone; ( ) I Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT 1 ❑ CONTACT PERSON Attic/crawlspace fans , 23.32
Business name: ADVANTAGE HEATING COOLING PLUMBING INC Other. 23.32
Fuel piping:
Contact name: TRISH SMITH $14.16 for first four, $4.03 for each additional
Address: 3106 NE 163RD ST Furnace, etc.
— Gas heat pump
City/State/ZIP: RIDGEFIELD WA 98642 Wall/suspended/unit heater ,
Phone: (360) 693 -5220 Fax: : (360) 693 -2273 _Water heater
Fireplace
E -mail: OFFICE@ADVANTAGEHCP.COM Range
CONTRACTOR Barbecue
Business name: ADVANTAGE BEATING COOLLNG PLUMBING INC Clothes dryer (gam
Other;
Address: 3106 NE 163" ST MECHANICAL PERMIT FEES*
City / State/ZIP: RIDGEFIELD WA 98642 Subtotal G _'J F
Phone: (360) 693 -5220 Fax: (360) 693 -2273 Minimum permit fee ($90.00) Q j}Q
Plan review (25% of permit fee)
CCB lic.: 79 -182 j h f( U State surcharge (12% of permit fee) f d .T2
TOTAL PERMIT FEE / Q0. 4 ,
Authorized signature: n Thus permit days�after it bas been ac pted as complete. within 190
Print name: TRISH SMITH 'i \ ! Date: LIl9 4 • Pee methodology set by Tri-County Building Industry Service Hoard
I: \Buddmg\Perrnits'MEC.PermitApp 03/07/12 440-461 /1 (11/02/COMP'eB)
Apr. 11. 2013 1:22PM No. 0036 P. 1
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Website: www.advantagehcp.com Email: office adv
Date: 9 1 9/
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Fax #: 563- 190
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