Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2004 -00240
— I -- I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/5/2004
PARCEL: 2S 114AD -01900
SITE ADDRESS: 16622 SW 88TH PL
SUBDIVISION: WAVERLY ESTATES ZONING: R -12
BLOCK: LOT: 018 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm:
> 10000 cfm: GAS OUTLETS:
Remarks: AC install.
Owner: FEES
HJELM, ROXANNE Description Date Amount
16622 SW 88TH PL [MECH] Permit Fee 5/5/2004 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 5/5/2004 $5.80
Phone: 503 - 268 - 1524 Total $78.30
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
Phone: 503 Cooling Unt Insp
Final Inspection
Reg #: LIC 72623
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699.
Issued By: /�, ti Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
May 02 04 10:47p TriCounty Temp Cntrol 5035570919 p.1
Mechanical P • 4 icahon FOR OFFICE USE ONLY
., + R Received Mechanical _ �/
DateBy� ✓ Permit No.: . e.40.41 "(�
City of Tigard ` �� �1ooy Planning Approval Building
U
I3125 SW Hall Blvd. VA h' L Daf6 /B Permit No.:
Tigard, Oregon 97223
T Plan Review Other
Date/By: Permit No.:
Phone: 503- 639 -4171 Fa�j g �r; , , Post - Review Land use
Internet: www.ci.tigard.orr>ILpING _ i4''IJ'1 Date/B Case No.:
24 -hour Inspection Request: 503 -639 -4175 -.r Contact }t ® See Page for
Name/Method: 1 1 �' t Sapp[ementa Information.
1 TYPE OF WORK COMMERCIAL FEE* SCHEDULE USE CHE I KLIST
N ew construction Demolition Mechanical permit fees* are based on the total value of he work
R Add ition/alteration /replacement 0 Other: performed. Indicate the value rounded to
( the nearest d. liar) of all
CATEGORY 'OF CONSTRUCTION mechanical materials, equipment, labor, overhead and p ofit.
i Xil & 2- Family dwelling 1 0 Commercial/Industrial Value: S See Page 2 for ee Schedule
7 Accessory Building Multi - Family RESIDENTIAL EQUIPMENT /SYSTEMS FEE* S •I.1 DULE
❑ Master Builder Other: Description 1 Qty 1 Fee(ea.) Total
JOB SITE INFORMATION and LOCATION Reating/Cooli g
Job site address: Furnace - add -on air conditioning ** I , I 14,01
f ( �' 2 Z' ✓ � PL Gas heat pump 1 1=3.01
Suite #: 1 Bldg. /Apt. #: Duct work 14.01
Project Name: Hydronic hot water system I 14.01
Cross street/Directions to job site: Residential boiler
(for radiator or hydronic system) 14,0.
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) I 10.00
Subdivision: I Lot #: Repair units { ' 12.15
Tax map /parcel #: Other Fuel p ;;,
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Flue vent (water heater /gas fireplace) 10.00
Log lighter (gas) 10.00
Wood/Pellet stove 10.00
I Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
54PROPERTY OWNER ' I ❑ TENANT Other: 10.00
Name: V.CX flh1C ii
m. Environmental Exhaust& Ventilation
Address: 16)(02Z._,G'�� 1ft �� Range hood/other kitchen equipment 10.00
City /State /Zip: � a l
C lothes dryer exhaust
Single duct exhaust 10.00
J . J'
Phone: al.- 24 Fax: (bathrooms, toilet com artm
0 APPLICANT 0 CONTACT PERSON P ents,
utility rooms) 6.80
Name: TRt COUNTY TEMP CONTROL Attic/crawl space fans 10.00
Address: 13150 S. CLACKAMAS RIVFR DR. Other: I 10.00
City /State /Zip: OREGON CITY, OR 97045 Fuel Piping
"(55.40 for first 4. 51.00 each additional)
Phone: PHONE: :557 -2220 Furnace, etc. ..
E -mail: FAX- 1qn :3 �e- r -(fC'— Gas heat pump 31.1t Water heater heater **
CONTRACTOR
Water heater **
Business Name: Tri County Temp Control Fireplace .Y•
Address: • 13150 S S . Clackamas River Drive Range *.
City /State /Zip: Oregon City, OR. 97045 BBQ 4.*
Phone: 503 -557 -2220 Fax: 503 - 557 -0919 Oth dryer (,t as) **
Othee r: r: .*
CCB Lic. #: 72623 Total:
Authorized Mechanical Permit Fees
Signature: - �zt 9 ,art D -.2 , , — Subtotal: S
_ �(JL/l , � 1�����t� Minimum Permit Fee S72.50 S
l L Plan Review Fee (25% of Permit Fee) S
(Please print name) State Surcharge (8% of Permit Fee) S� ,r`
I
TOTAL PERMIT FEE �/ T
Notice: This permit application expires if a permit is not obtained within "Fee methode i `
o /y Building lndustrg.Sersi rd.
180 days after it has been accepted as complete. ' *Site plan required ed d for r exterior units.
A/C units.
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