Permit IIII CITY OF TIGARD MECHANICAL PERMIT
3 . COMMUNITY DEVELOPMENT Permit #: MEC2011 -00011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2011
Parcel: 1 S 133DA07700
Jurisdiction: Tigard
Site address: 12624 SW SNOWBRUSH CT
Project: COFFEY Subdivision: Lot: 0
Project Description: Furnace replacement
Contractor: TRI COUNTY TEMP CONTROL INC Owner: COFFEY, JOEL R AND ALINE P
13150 S CLACKAMAS RIVER DR 12624 SW SNOWBRUSH CT
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -2220 PHONE:
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/05/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/05/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/05/2011 $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. .
1
Issued By: Permittee Signature:
L.
Call 503. . 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.
JAN -4 -2011 09:21A FROM: TO: 5035981960 P.1
Mechanical Permit Annlicatia CEIVED Received Data 1 1111 (I) I ,, I I ,) 11\1 )
City Tigard Dat : Ii Zl Permit No.: V ... ( — ( 11
13125 SW W Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503398.1960 J 0 4 2011 Plan Review
Detdey: Other Permit:
Inspection Lino 303.639.4173 Date Ready/By: la See Pagel for
Internet www.tigard -or. CITY OF TIGARD Notifisd/Melhod r 9u oe pplemeeht tnrerwd
TYPE oF .DING DIVISION
COMMERCIAL FEE* SCHEDULE - -USECHECKLIST
❑ New construction ® Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
❑ Dtmtol ilon performed. Indicate the value (rounded to the nearest dollar) atilt
❑ Other: mechanical materials, equipment, labor, overhead and profit.
CATEGORY OF CONSTRUCTION Value: S
® I- and 2- titmily dwelling ❑ Commercial /industrial ❑ Accessory building 'RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ Multi- family ❑ Master builder 0 Other: For speck,' tglormoa!las rase checklist.
Description I Qty. I Ea. I Total
GOBI SffE INFORMATION AND LOCATION Heatttlg/coe4ng
Job site address: 1 Z 92-4- V' f 6 no sb rUS ! Cl– • Air conditioning - (requires sito plan showing placement) , 46.75
City /State/ZIP: T (� q- Furnace 100,000 BTU (ducts/vents) _ 46.75 'P 7 r
lJ Furnace 100.000a BTU (ducialvents)
Suite/bldg./apt. no.: -I Project name:
Heat pump 61 91
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 2332
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fiuel -type, not electric).
in -gall, in.duct, suspended, etc. 46.75
Subdivision: no.: Flue/vent for any of above I . 23.32 p- , 1.
Other. 23.32
Tax map /parcel no.: Other fuel appliances -
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Flue vein for water heater or gas
• PCPt r .1i 1 rn/±I /tp, fireplace 23.32 • t`/ Wli�, wl t IYJIA IV Log liahter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
PROPERTY OWNER I ❑ TENANT Chi yniner /fluelvent 23 32
l .tlJJ I vv Ether. 23.32
Name: 7 Environmental exhaust and veotladon
Address: & L Range hind/other kitchen
equipment 33.39
City/Slate/ZIP: Clothes .diver exhaust _ 33.39
Single-duct exhaust rooms,
• Phone: (Be) 524 — 0743 Fax: ( ) toilet compartments, room) 23.32
® APPLICANT CI CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Same as contractor Other: 32
Fuel piping
Contact name: Diane Mason 514.15 for tun four, 54.03 for each addIdonal
Address:
Furnace, etc.
Gas heat pump
City/State/ZIP: WallUsuspendcd/unit heater
Phone: ( ) I Fax: : ( ) Water heater
E-mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: TN County Temp Control
Clothes dryer (gas)
Other
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES*
City /State/ZIP: Oregon City, OR 97045 Subtotal
Phone: (503) 557.2220 I Fax: (503)557.0919 Minimum permit fee ($90.00) 6 70 (a()
Plan review (25% of permit fa)
CCB lie.: 72623 State surcharge (12%ofpermit fee) 8 i
IU 0
TOTAL PERMIT FEE
y �y ,�
Authorized signature: </��1.(/I/r `CJ This penal, d y a alter It has been a u osnpluoe. within ISO
Print name: V (Q= moon l Date: I 411 ) 1 • Fee methodology an by Tri•County Building Industry Service Board
linulldIe %PmwI&M5C_- PannBApp.doe leltIPot 4404617r (1 11WIXOM/WED)