Permit IN CITY OF TIGARD MECHANICAL PERMIT
: - COMMUNITY DEVELOPMENT �® Permit #: MEC2013 -00273
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2013
Parcel: 2S 103AA02300
Jurisdiction: Tigard
Site address: 12260 SW 106TH DR
Project: Mirpourian Subdivision: CLYDESDALE Lot: 4
Project Description: Installation of ductless mini -split heat pump. 6/5/2013: REPRINT permit to correct site address /parcel.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: MIRPOURIAN, MARZLEH
13150 S CLACKAMAS RIVER DR 12270 SW 106TH DR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -2220 PHONE: 503 - 758 -5654
FAX: 503 - 557 -0919
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: OTR 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)
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: Permittee Signature: Q L� /! 770 „,"
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.
CITY OF TIGARD MECHANICAL PERMIT
11111 - COMMUNITY DEVELOPMENT Permit #: MEC2013 -00273
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2013
Parcel: 2S103AA02400
Jurisdiction: Tigard
Site address: 12270 SW 106TH DR
Project: Mirpourian Subdivision: CLYDESDALE Lot: 5
Project Description: Installation of ductless mini -split heat pump.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: MIRPOURIAN, MARZLEH
13150 S CLACKAMAS RIVER DR 12270 SW 106TH DR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -2220 PHONE: 503 - 758 -5654
FAX: 503 - 557 -0919
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: OTR 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)
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: / - / _ Permittee Signature: Pu 6,1-77e/\/
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 -21 -2013 07:47A FROM: TO:5035981960 P.1
Mechanical Permit A Ilea l t)lt ('III( I 1 'NI IE.► 1
City of Tigard �' --- CEIVED D + By �® !! ►1 permit N f (,� p -/ i�73
I I 13125 SW Hail Blvd., Tigard, OR 97223 Plan Review Other Permit:
' Phone: 503.639.4171 Fax: 503.598.1 f'AY 2 1 2 013 rtrte/ny'
I 1 `tit 1 Inspection Line: 503.639.4175 Date Ready/By. la See Page 2 for
Internet www.tigard- or.gov Notified/Method: Supplements! Information
CITY OFTIGARD MI
TYPE &.(4ING DIVISION COMMERCIAL FEE* SCUEDULE - USECF[ECK7.IST
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
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE 1 INFORMATION AND LOCATION Heating/cooling
Job site address: 1 O 1w .Y. try �� Air conditioning Air conditioning
, Flt 1 J site plan showing placement) 46.75
City /State/ZIP: fi r---1 4 -
j Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg. /apt. no.: 1 Project name: Heat pump , 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 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
Water heater 23,32 _
DESCRIPTION OF WORK Gas fireplace 33
4 n-/I I l d 1/' ,'') }t-�i ` � ' p Flue vent for water heater or gas ^
11 fJf ct utMl. fireplace
Log lighter (gas) 23.32
Wood/pellet stove 3339
Wood fireplace./insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER ''ry /� 1a., t �,, ❑ TENANT Other: - 23.32 ,
Name: Yi �"1� MI �ty Environmental exhaust and ventilation
Range nd/nthu kitchen
Address: equipment 33,39
Clothes dryer exhaust 3339
Ciry /State/ZIP: Single -duct exhaust (bathrooms,
Phone: (Sees) IN 56)54. Fax: ( ) toilet compartments, utility rooms) 23.32
CONTACT PERSON Atticicrawlspace fans 23.32
® APPLICANT Other: 23.32 ,
Business name: Same as contractor Fuel piping .
Contact name: Diane Mason 514.15 for first four; S4.03 for each additional
Furnace, etc.
Address: Gas heat pump .
City /State/ZIP: _ Wall/suspended/unit heater _ _
Water heater
Phone: ( ) I 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'
Subtotal
City / State/ZIP: Oregon City, OR 97045 Minimum permit fee ($90.00)
Phone: (503) 557.2220 Fax: (503) 557.0919 Plan review (25% of permit fee)
4 J_/CCBlie.:72 623 �f State surcharge (12% of permit fee) J, ) v/ TOTAL PERMIT FEE
�7 )9711-112149.1) T is permit application expires it a permit Is not obtained within 180
Authorized signature: D I t'"4' days after it has been aeeepted as complete.
Date: t � 13 1 • Fee methodology set by Tri -County Building industry Service Board
I Print name: e mean I
11auildinalPermhs \ME'C- PeimitApp doc 10/01/09 4.40.46171' (I I/OYCOMAYEa1