Permit Support Document (25) ,� CITY OF TIGARD 1 . (74 . 1, MECHANICAL PERMIT
1111
COMMUNITY DEVELOPMENT
�® MI Permit*: MEC2017-00800
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/13/2017
Parcel: 2S110DD02000
Jurisdiction: Tigard
Site address: 10485 SW CENTURY OAK DR
Project: LOVE Subdivision: SUMMERFIELD Lot: 27
Project Description: 10/25/2017: REPRINT permit to correct description of work to REPLACE AIR CONDITIONER. NC unit must meet
manutacturer's clearance requirements.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: LOVE, ROY&ARVALENE REVOCABLE T
13150 S CLACKAMAS RIVER DR 10485 SW CENTURY OAK DR
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE: (503)557-2220 PHONE:
FAX: 503-557-0919
FEES
Specifics: Description Date Amount
Air Conditioning 10/13/2017 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 10/13/2017 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/13/2017 $43.25
Occupancy Grp: Misc Administration Fee 10/25/2017 $45.00
Stories:
Fuel
Fuel Types: Electricity
Gas Pressure:
Total $145.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,/0" � , Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit ApplicatiQEGE1VED FOR OFFICE USE ONLY
City of Tigard •
m 13125 SW Hall Blvd.,Tigard,OR 97223
IN OCT 2 6 201 Plan Re VIVW.
, Datelly:
IR;acteelit7;!4/25 /7 ACi4/1?/' Penni'Nth'MEC2f)17431.°°
' I. Phone: 503.718.2439 Fax: 503.598.1960 Other Perant
Inspection Line: 503.639.4175 CITY Or- i 16ARD ,,,,,,,„,,,„il, ,
TIGAkD it!ii,; el see Page 2 For
Internet: www.tigard-or.gov BUILDII\IG DII/Lcu—h.
...,:,..,,3,)Notificd:Metbod: Supplemental Information
TYPE OF WORK ' ------- ----
COMMERCIAL,FFL:1F;;ISXIIEDULE"11 USE CHECKLIST
- " Mechanical permit it,e,S*are based on the value of the work
0 New construction 11b' Additiontalteratirmireplacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead.and profit.
Value:$
CATEGORY OF CONSTRUCTION = ,
., . , RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
tj.73 I-and 2-Family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 iMulti-family 0 Master builder 0 Other: DescriptionQty. Fa. Total
- '4013 SITE INFORMATIONANDLOCATION- - . Ilea tingl_c_ollIng:
i,,,,,i.„._. is,,,,,, _ ..,,, k,rls,„,,,,,,, An'CitiatiOunin _ 1 46,75
Job site address: 1(),Prteij QICNY -' j4 , . fir i VL.) Furnace 100,000 BTU(ducts vents46
) __.
.75
City/StateIZIP: 11 (.1„,t'il 4
4 Furnace 100,000+BTU(duets/vents) 54.91 I
Heat ititim 61.06
Suite/bldg./apt.no.: Project name:
Duct work 23.32
Cross streoldirections to job site: Hvdronic hot water s'stern .,_23.32
- ' ...._ ......_ „........
- • — Residential boiler(radiator or t
hydronie t 1,,1 ....
,........._ .., . _
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46 75 I
......- . - .
-- '
Flue/vent for any of above 23.32 1-j
. _
Other: _ 1 ___1__?„.:12-__. _—_-
Subdixision: Lot no.: --
..
--_,—.- Other fuel appliances:
. -
fax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK - Gas 10t...0KL. nsut 33.39
-,
i Flue vent for water heater or gas
Or all'ACNCY-DC.) 0 vval i . .- -m I- fireplace 23.32
, =,,,
w
'-tej rad ll Rcpti 4- Al r Condt lortrim Log lighter(gas) 23.32
- ------ Wood:pellet stove I ___ 33.39 I
,
Wood hire dacelinsert 23,32
Cliimneviliner/fluesvent 23.32
, - Other: /3.32
PROPERTY OWNER 0TENANT - --01
Environmental exhaust and ventilation:
Name: it LO Y C..1 Range hood other' kitchen -i
equipment 33.39
Address: 0 : * Clothes dryer exhaust 33.39
City/State/ZIP: Single-duet exhaust(bathrooms.
toilet com)ampons.utihts rooms) /3 12
Phone:(g56.)tia_in-1546 4.-1) Fax:( ) Attie/erawlspace fans 23.32
0 APPLICANT --- ' 0 CONTACT PERSON Other: 23.32 =
Fuel piping:
Business name:Same as Contractor -
$14.15 for first four;54.03 for each additional
Contact name:Diane Mason Furnace.etc.
Gas heat pump
Address: _
-- — ------- Wall/suspended unit heater
City/Slate/ZIP:
Water heater
_
_
Phone:( ) Fax: ,( ) Fireplace,
Range _ 1
E-mail:
Barbee U e
, ......... , ..._ . . .., ....
CONTRACTOR Clothes dryer(gas)
I
I 1
Business name:Tri Counq Temp Control Other:
- -- -. ... MECHANICAL PERMIT- FEES*
Address: 13150 S Clackamas River Drive
Subtotal
. . _
City/State/ZIP:Oregon City,OR 97045 _______Minimum permit fee($90.00)
Plan review(25%of penuit fie)
Phone:(503)557-2220 Fax:(503)557/0919 _ _ =_.__
State surcharge(12%1 of permit fee)
CCB lie.:72623 TOTAL PERMIT FEE 4,-
.
,„„.„..,.„..
"- ----1 This permit application expires if a permit is not obtained lvithin jiff--
days after it has been accepted as complete.
Authorized signature: A /1-4-161/ ) . ' t t * Fee 1 nelhodolouy set by Ili-County Building Industry Service Board
i......—___ I,
Print name:Diane Mason I Date: 1161/S ti
I Building P.mits NIT( PeruotApp 040113 tioc -T40–16 7t(I 1 02 MM.(iEB)