Permit II CITY OF TIGARD MECHANICAL PERMIT
III COMMUNITY DEVELOPMENT Permit#: MEC2014-00680
T IC;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/17/2014
Parcel: 2S 102AB00913
Jurisdiction: Tigard
Site address: 12115 SW 92ND AVE
Project: Campbell Subdivision: KIMBERLY ADDITION Lot: 13
Project Description: Installation of gas furnace
Contractor: COLUMBIA NW HEATING Owner: CAMPBELL,TRACEY A&
PO BOX 622 VALEU, RONALD E JR
SCAPPOOSE, OR 97056 12115 SW 92ND AVE
TIGARD,OR 97223
PHONE: 503-543-3624 PHONE: 503-453-9518
FAX: (503)543-6285
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 12/17/2014 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 12/17/2014 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 12/17/2014 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N. . . ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or dir- questions to O C by calling 503.232.1987 or 1.800.332.2344. -
Issu=d By: / (/ Permittee Signature: "1'
Call 503.639.4175 by 7:00 a.m.for the next available ins.- ion date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applica IOR OI-I I( II I .I-: OBI
City of Tigard CIFI"'FD RecC1°`d I Permit No.: )
13125,SW Hall Blvd.,Tigard,OR 97223 Date/By: ���f� l E „ / -��p go
Phone: 503.718.2439 Fax: 503.598.1960-=L' 1 U l4 Date/By:Review Other Permit:
DateBy:
TI�, R D Inspection Line: 503.639A175 Date Ready/By tens ® See Page 2 for
Internet: www.tigard-or.gov �/� ' Notified/Method: Supplemental Information
lUILDIrftreng
TYPE OF WORK ioN COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
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. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 1US Cirixxid Furnace 100,000 BTU(ducts/vents) ' 46.75 4(015
City/State/ZIP: 110\04-A I O R 611223 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: Duct work 23.32
Cross street/directions to job site: 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
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
�((�� Furnace Flue vent for water heater or gas
ns l t rxl Oc �,!1,as Furnace, 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 OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: - y Y v A ( . t' i Range hood/other kitchen
equipment 33.39
Address: 12115 Sk,\ T2�A Clothes dryer exhaust 33.39
City/State/ZIP: -r o ' O� Q�223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(Sep )(15-13_ 518 Fax:( ) Attic/crawlspace fans 23.32
tit APPLICANT ❑ CONTACT PERSON Other 23.32 _
Fuel piping:
Business name: 504,m2.... Coaka r $14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address: - -
Wall/suspended/unit heater _
City/State/ZIP: Water heater
Phone:( ) Fax: :( ) Fireplace
Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Business name: Ci d°rn1a.a- N W \ean 0 Other: MECHANICAL PERMIT FEES*
Address: &12._ .
�( Subtotal (p,15-
City/State/ZIP: 3O f — C CjQ5(p t Minimum permit fee($90.00) Q,O0
Plan review(25%of permit fee)
Phone:(953) 54'5_ 5(n2y Fax:( ) `"-,313-C6�s surcharge(12%of permit fee) (Q gb
-1 State surchaz ,
CCB lic.: q L TOTAL PERMIT FEE
C� I 1� /C�D /� This permit application expires if a permit is not obtained 180
days after it has been accepted as complete.
Authorized signature: / ..(.. 4 ) • Fee methodology set by Tri-County Building Industry Service Board
Print name: �d�- 1`VLJ SOV1 Date: I2-.)1.19
I:\Building\PennitsUMEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12115 SW 92ND AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
January 26, 2015 at 10:02:20
AM
MEC2014-00680
David Young
Minor label # ELS 445463
Violation Summary:
Inspector Contractor