Permit CITY OF TIGARD MECHANICAL PERMIT
°'' ,- COMMUNITY DEVELOPMENT Permit #: MEC2013 -00269
Date Issued: 05/22/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1 S134CA00604
Jurisdiction: Tigard
Site address: 12015 SW NORTH DAKOTA ST
Project: Slavens Subdivision: PANORAMA Lot: 3
Project Description: Installation of ductless heat pump system.
Contractor: ABLE HEATING & COOLING LLC Owner. SLAVENS, GREGORY A & KOPPER D
16285 SW 85TH AVE #105 12015 SW NORTH DAKOTA ST
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 579 -2250 PHONE: 503 - 590 -5177
FAX: 503 -620 -3980
FEES
Specifics: Description Date , Amount
Heat Pump 05/22/2013 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 05/22/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/22/2013 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Permittee Signature:
Issued By: s e3/c./ / �i ° i ° G �
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Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
May 20 13 01:09p Able Heating & oli 5036203980 p.1
Mechanical Permit A tica ft'CEIED
PP FOR OFFICE USE ONLY
City of. Tigard MA 2 0 2 D S�2 ,1 /3 � le ' ao i3 -40,26 9
1 Permit IVo
III e 13125 SW hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.59$ 1pyQ, p ay. Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 l i t Y OF TIGARD Data Ready/By: 1u i�� e for
Internet www.tigtud-or.gov BUILDING DIVISION Nolified/Metliod / Supp Page nental 2 Information
TYPE OF WORK COMMERCIAL FEE• SCHEDULE — USE CHECKLIST l
❑New construction ®Addition/alteration / replacement Mechantwl permit fees' are based on the value of die work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
N 1- and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
r] o Far apeclol frtfvmrarlon use the ttbY
❑ Multi - family ❑ Master builder ❑ Other: Description En. • Total
_ 11
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Job site address: 12015 SW NORTH DAKOTA ST
Air conditioning 46.75
Furnace 100,000 BTU (duos vents) 46.75
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City/ Statc/Z]P: TIGARD, OR. 97223 Furnace 100,000+ BTU (daasJvents) 54.91
Heat pump I 6L06 61.06
Suitebldg. /apt- no.: J Project name: SLAVENS Duct work 2332
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler (radiator or
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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
Other: 23.32
Subdivision: Lot no.: Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas ftreptacefirts`^rt 33.39
Flue vent for water heater or gas
INSTALL NEW DUCTLESS HEAT PUMP SYSTEM fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.19
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Wood fireplace/insert 2332
Chimney /lineriflue/rent 2332 I
Other. , 23.32
® PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name: KOPPER SLAVENS Range hood/other kitchen
equipment 33.39
Address: 12015 SW NORTH DAKOTA ST. Clothes dryer exhaust 33.39
City/State/ZIP: TIGARD, OR. 97223 Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
Phone: (503)590 - 5177 Fax: ( ) Attic /crawlspacc fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
- Fuel piping:
Business name: 514.15 for first four; $4.03 for each additional
Contact name: Furnace, etc.
Gas heat pump
Address: Wall /suspended/unit heater
City /Stale /ZIP: Water heater '
Fireplace
Phone: ( ) J Fax: : ( ) Range
E -mail: Barbecue
CONTRACTOR Clothes dryer (gas)
Other.
Business name: ABLE HEATING & COOLING LLC
MECHANICAL PERMIT FEES*
Address: 16285 SW SS AVE. SUITE 105 Subtotal 61.06'
City/Star /Z1P: TIGARD, OR. 97224
1 Minimum permit fee ($90.00) 90.00 .
I Plan review (25 %of permit fee)
Phone: (503) 579 - 2250 ✓ Fax: (503) 620 -3980 State surcharge (12% of permit fee) 10.80 /
V CB lie.: 184392 I TOTAL. PERMIT FEE 100.80 ,/ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: / % • Fee methodology set by Tn- County Building industry Service Board
Print name: KELLY WILOITE I Date: 5 - 20 - 13
I :\Buildirs/Pemtiis\MEC_PermitApp 090IL3.doe 4404617r(t1/02/COM!WEB)