Permit CITY OF TIGARD MECHANICAL PERMIT
III �� COMMUNITY DEVELOPMENT Permit#: MEC2013 00597
• • :-, Date Issued: 10/09/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104CA03300
Jurisdiction: Tigard
Site address: 13616 SW LAUREN LN
Project: Subdivision: HILLSHIRE Lot: 33
Project Description: Installation of NC. Placement of A/C or heat pump units must comply with the manufacturer's clearance
requirements.
Contractor: HEATCO INC Owner: ARIFIN, LESLIE
4201 SE BOARDMAN AVE 13616 SW LAUREN LN
MILWAUKIE, OR 97267 TIGARD, OR 97223
PHONE: 503-539-9772 PHONE:
FAX: 503-653-6991
FEES
Specifics: Description Date Amount
Air Conditioning 10/09/2013 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 10/09/2013 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment-Mechanical 10/09/2013 $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: Permittee Signature: O4/ /9-//G/e'4T/o, /
,,, i1Zetzt. ...... ..____
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.
Oct 07 13 08:14a Jennifer Endres 5036536991 p.1
r
Mechanical Permit Applica 'I"...-',. FOR OFFICEirSE ONLY E ,r Received
City of Tigard t " Date/Bc: At/c7/43 4/ Permit Noy yer.219/3 -do S97
• 13125 SWI-fall Blvd.,Tigard,OR 97223 nrT 7 2013 Plan Review '
2 Phone: 503.639.4171 Fax: 503.598.1960 1.1 Date/By: Other Permit:
'TIGARD Inspection Line: 503 639.4175 Date Ready By: 71e,, 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Natified/Method: . ' Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE` SCHEDULE—USE CHECKLIST
❑New construction ddition/alteration/replacement Mechanical permit fees*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. r
CATEGORY OF CONSTRUCTION Value:S
RESIDENTIAL EQUIPMENT 1 SYSTEMS FEES*
W-and 2-family dwelling ❑CommerciaL'industrial ❑Accessory building -
For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling 1 Air conditioning or heat pump i t sC�
Job site address: t(/)1 SO.) ( (;�U�,;,� �'l 1
Srequ:res site plan showing placement) 14.00
City/State/ZIP• w, kviGi t ��� (—7 z Furnace 100,000 BTU(ducts/vemsl 13.00
^/ Furnace 100,000+BTU(ducts/vents) 17.90
Suite/bldg./apt.no.: Project name: K ///1•_I Gas heat pump 14.00
ICross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler(radiator or
hydronic) 14.00
l
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended.etc. 14.00 '
Subdivision: Lot no.: FIue/vent for any of above 6.80
Other 10 00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
i Gas fireplace 10 00
'11 A A—(c , tv tIA • ■ tv ,-L. 014.,11 Flue vent for water heater or gas
fireplace 10.00
Log lighter(gas) 10 00
Wood/pellet stove 10.00 .
Wood fireplace/insert 1000
Chimney,7iner/flue/vent 10 00
1:1 PROPERTY OWIVFR I ❑ TENET Other: 1 10.00
Name: AR/ft AI Environmental exhaust and ventilation
/ Range hood/other kitchen
Address: equipment 10.00
City/StateiZIP: Clothes dryer exhaust 10.00
Single-duct exhaust(bathrooms,
Phone:( ) Fax: ( ) toilet compartments,utility rooms) 6.80
', APPLICANT ❑ CONTACT PERSON Attic`crawlspace fans 10.00
( Other: 10.00
Business name: i ecL4o 141,,L( , Fuel piping
Contact name: T kck1 6- Ave,%s $5.40 for first four;$1.00 for each additional
BO K__, u� Furnace,etc. _
Address: J Gas heat pump
City/State/ZIP: C) tic. (9 (jc,f (le 01-7 4 Walllsuspendedfunit heater
Phone: j) ,57)i—C) 1'72 Fax::67),-) 4)53_ Loge(' Water heater
Fireplace
E-mail: G ) Lou() ) covil -f. n eL
Range
CONTRACTOR Barbecue
Business name-1,ea-f ..7. y1..c • Clothes dryer(gas)
Other:
Address: ?0. .K g ,2„. MECHANICAL PERMIT FEES*
City/StaterZIP: Cal< CtiZ C. Cl/ LI I Subtotal
�3 j r 9-7-7 IS Plan permit fee($72.50)fee)
hone: r_, Fax:(93) ti) //��1 G Plan rzvievv(25°.b of permit fee)
CCB lie.: f 3 55 5 State surcharge(12%of permit fee)
TOTAL PERMIT FEE 00 J'O a—"
( , This permit application expires If a permit is not obtained within 790
Authorized si lure: Imo-`r days after it has been accepted as complete.
Print name: on tl I/ N 4!e) Date: I0 --7—( - Fee methodology set by Tri-County Building Industry Service Board
I'Bu:IdirgPermtts'iSEC-Perttitapp doe 01:19 07 440-se Ti'(I 1/02/COt.t'WEa1