Permit ■
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CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00393
TIGARD DATE ISSUED: 7/25/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S1036A 00128
SITE ADDRESS: 12045 SW 116TH AVE ZONING: R - 4.5
SUBDIVISION: LERON HEIGHTS NO. 2 LOT: 042 JURISDICTION: TIG
PROJECT: BROWN
Project Description: Replace air conditioner.
CLASS OF WORK: ALT 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:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
STEVE BROWN Description Date Amount
12045 SW 116TH
TIGARD, OR 97223 [MECH] Permit Fee 7/25/200E $72.50
[TAX] 12% State Surchar 7/25/200E $8.70
Phone: Total $81.20
Contractor:
TRI COUNTY TEMP CONTROL
13150 S. CLACKAMAS RIVER DR
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -557 -2220
FAX 503 -557 -0919
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 or 1.800.332.2344.
Issued By:
C . " `� Permittee Sign i ,: f/�i(ci--'.,
Call 503.639.4175 by 7:00 a.m. for inspections that busine . day.
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.
JUL. -25 -2008 12:53P FROM „��-t T0: 5035981960 P.1
. Mechanical Permit �; d lw>F� IJJ FOR OFFI('F. USE ON I.,1
Cl of 5 2 V
Tigard 008 Received Q? Q a e -
g Date/By. Permit No : G
II
v 2 13125 SW Nall Blvd., Tigard, OR Obi- � � c_ �� • ���
Phone: 503.639.4171 Fax: 503,598.1960 ARD D at t e/By.
/By Other Permit:
D
i 1 li A R a Inspection Lin 503.b39.4175 C ITY OF `T ICI Date Ready/By ® See Page 2 for
Internet: www tigard- or.gov O DIVISION Notified/Method Supplemental Information
BIJILDI
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are hated nn the value of the work
El 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.
CATEGORY OF CONSTRUCTION Value: $
1- and 2-family dwelling ❑ Commercial/industrial e ❑ Accessory building
For special information use checklist.
Multi- family ❑ Master builder ❑ Other: ENTIAL EQUIPMENT / SYSTEMS FEES*
Description Qty. i Ea, Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address 2e14 SW 1 ; 4+1. C I Air conditioning or heat pump
vu (requires site plan showing placement) 14.00
City /State /ZIP: i (J r 4 i Furnace 100,000 BTU (ducts /vents) 14.00
Q Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14,00
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
t`►-� l� e.,�
q iir na i pm - fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
f1 PROPERTY OWNER ❑ TEN, Chimney/liner/flue/vent 10,00
Other: 10.00
Name: I i ' Mi 1 ` Environmental exhaust and ventilation
Address:
Range hood /other kitchen
equipment 10.00
City /State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
%APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: Other. 10.00
Fuel piping
Contact name: vane, `, ,.C) V1 $5.40 for first four; $1.00 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP:
Wall /suspended/unit heater
Phone: ( ) F x:: ( ) Water heater
- Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name:�1 C �XJ / Clothes dryer(gas)
yy � / �r � / 1 �p Other
Address: 13150 S. tt I lI VI► Vcr j 7 Y V MECHANICAL PERMIT FEES*
City/State /ZIP: w O, I (^ oe -4-'r4 Subtotal
Phone: ( 557 +�} '”` Fax: ( ( '"� O qn Minimum permit fee ($72 50)
Plan review (25% of permit fee)
CCB lie.: 12423 State surcharge (12% of permit fee)
�� �// GC TOTAL PERMIT FEE $h in II S O
A uthorized signature;
This permit appticatiun expires It o pee n rmit is nor obtained within R
f � days after it has been accepted as complete.
Print name: J) l al C M J Date: • Fee methodology set by Ts-County Budding industry Service Board
I \BuildmglPermits\MEC- PermitApp. doe 01/19/07 440.4617T (I1 /02/C0M/WEB)
J�JL -25 -2008 12:53P FR9M: T0: 5035981960 P.2
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