Permit (61) CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00081
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/02/2016
Parcel: 2S 103C B09800
Jurisdiction: Tigard
Site address: 12284 SW QUAIL CREEK LN
Project: VANDOREN Subdivision: QUAIL HOLLOW-EAST Lot: 56
Project Description: Replacing gas furnace,and installing an A/C unit. Placement of A/C unit must comply with manufacturer's
installation requirements.
Contractor: WESTERN HEATING&COOLING INC Owner: VANDOREN, MATTHEW&AMY
50618 COLUMBIA RIVER HWY 12284 SW QUAIL CREEK LN
SCAPPOOSE, OR 97056 TIGARD, OR 97223
PHONE: 503-543-5599 PHONE:
FAX: 503-543-3693
FEES
Specifics: Description Date Amount
Air Conditioning 02/02/2016 $46.75
Type of Use: SF Furnaces< 100K BTU 02/02/2016 $46.75
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 02/02/2016 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: �����-ittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE [ISE ONLY
Received
City of Tigard j�/� ��� Date/By: �V Permit No.: '
13125 SW Hall Blvd.,Tigard,OR 972223 �� y
Phone: 503.718.2439 Fax: 503.598.1 ��d1i i_ Plan Review
nj t � Date/By: Other Permit
a Inspection Line: 503.639.4175Date Ready/By: Juds ® See Page 2 for
Internet: www.tigard-or.gov ,Q ,����` Notified/Method: Supplemental Information
Mechanical permit fees*are based on the value of the work
❑New construction ddition/alteration/reocement performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
1-and 2-family dwelling E]Commercial/industrial ❑Accessory building For special information use checklist.
❑ ulti-family ❑Master builder ❑Other: Description Qty. I Ea. I Total
Heating/cooling:
Air conditioning 46.75 75
Job site address: QL Y-A Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: —Ti 6 r_� Furnace 100,000+BTU(ducts/vents) 54.91
Heat pum 61.06
Suite/bldg./apt.no.: Project na f e yj Duct work 23.32
Cross street/directions to job site: Hydronic hot waters stem 23.32
Residential boiler(radiator or
h dronic) 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
k
Gas fireplace/insert 33.39
Flue vent for water heater or gas
Y mow LA f M CIZ_ C_k'i S fireplace 23.32
Log lighter(gas) 23.32
LA e- 1 f Dy_\ LA t 0 Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
x Other: 23.32
141
Environmental exhaust and ventilation:
Name: 11Af 2 y1 Range hood/other kitchen
/
equipment 33.39
Address: ' QUAJ Lh Clothes dryer exhaust 33.39
City/State/ZIP: U 3 Single-duct exhaust(bathrooms,
/ toilet compartments,utilityrooms) 23.32
Phone:(5 )b 5-050(9 Fax:( ) Attic/crawlspace fans 23.32
Other: 23.32
r /� Fuelpiping:
Business name: r'yl Nn
$14.15 for first four;$4.03 for each additional
Contact name: la r(i N Furnace,etc.
Address: S 1 U 1` R;vff Gas heat um
Wall/sus ended/unit heater
City/State/ZIP:fol o0 6 q 70 J Water heater
Phone:(5)3 ) Fax: :(
(� .55 V 33 ) 3 3-344 Fireplace
E-mail: Range
l �� ����n fl Q� 2 y� QOI 1" (� Barbecue
Clothes dryer(gas)
Business name: wQ �n % �n� Other:
Address: ��� I� Wl - Subtotal
City/State/ZIP: 4a2dd -7� � Minimum permit fee($90.00)
1 �� Plan review(25%of permit fee) �.
Phone:(5 G- ) 3-'s Fax:( ) Sql State surcharge(12%of permit fee) / a
CCB lic.: q 7 TOTAL PERMIT FEE 10V U
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 Tri-County Building Industry Service Board
Print name: Gl 1Z e` b Date: 1'Pv ,A0 j
C\Building\PermitsVMEC_Pe itApp_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
12284 SW QUAIL CREEK LN, TIGARD, OR,
97223
Residential - Mechanical
699 Mechanical final
PASS - No C of O
MEC2016-00081
Jeff Grove
Violation Summary:
Inspector Contractor