Permit CITY OF TIGARD MECHANICAL PERMIT
' '! COMMUNITY DEVELOPMENT Permit #: MEC2012 -00007
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/11/2012
Parcel: 1 S134CB06100
Jurisdiction: Tigard
Site address: 12450 SW NORTH DAKOTA ST
Project: LI Subdivision: ANTON PARK Lot: 23
Project Description: Furnace replacement.
Contractor: FIRST CALL INSTALLATION COMPANY Owner: LI, LI
13150 S CLACKAMAS RIVER DR SHEN, RONGKUN
OREGON CITY, OR 97045 12450 SW N DAKOTA ST
TIGARD, OR 97223
PHONE: 503 - 231 -3311 PHONE:
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/11/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/11/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/11/2012 $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.
Issued By- Permittee Signature: /
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 -10 -2012 09:55A FRDM: 70:5035991960 P.1
Mechanical Permit Applica R ECE wit it (Ihi.lt l I SI... ONI.\
City of Tigard Dale i la id-
I
/By: g:11111/ PermitNo.: 18 -; _ ` , _wok r
• (3125 SW Hall Blvd., Tigard, OR 97223 � 1 0 2 012 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 Date/By Other Permit:
1 - t A it I - ) inspection Line: 503,639.4175 CITY OF T lGA D Date Ready /By: l� e Paget for
Internet: www.tigard-or.gov t Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE -. USE CHECKLIST
❑ New construction ® Addition /alteration/replacement Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES* \
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For speciesl information use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: I2.4'V0 6W 14or-{ ____ Air conditioning pl
n
(requires site plan showing placement) 46.75
City/State /ZIP: T/?22) Furnace 100,000 BTU (ducts/vents) 1 46.75 ii r , 75"
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23,32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
h -wall, in -duct, suspended, etc. _ 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32 •
'Fax map /parcel no.: Other Nei appliances
DESCRIPTION OF WORK water heater 23.32
ppppp��Q�Onnnn�In^Q Gas fireplace 33.39
t LQL . 'tsar Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
' Wood fireplace/insert _ 23,32
Igt PROPERTY OWNER ❑ TENANT Chimney /liner / Fue/vent 23.32
I Other: 23.32 __
Name: U U Environmental exhaust and ventilation
Address: Range hood /other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
(5 ) 4V F ax: ( Single-duct compartments, (bathrooms, rooms)
Phone: ) toilet t cam partm artments , utility roo 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans , 23.32
Other: 23.32
Business name: Tri County Temp Control
Fuel piping
Contact name: Diane Mason $14.15 for first four; $4.03 for each additional
Address: 13150 S Clackamas River Drive Furnace, etc. ,
Gas heat pump
City/State/ZIP: Oregon City, OR 97045 Wall /suspended/unit heater
Phone: (503) 557.2220 Fax:: (503) 557.0919 Water heater
Fireplace
E - mail: Range
CONTRACTOR Barbecue
Business name: First Call Installation Clothes dryer (gas)
Other:
Address: 13150 S Clackamas River Drive MECHANICALPERMITPEES*
City /State /ZIP: Oregon City, OR 97045 Subtotal ' L( G , 75'
Phone: (503) 557.0230 Fax: (503) 557.0919 Minimum permit fee ($90.00) y(f .CIt7
Plan review (25% of permit fee)
CCB lie.: 182714 State surcharge (12% of permit fee) i ,\" '
TOTAL P FEE ( �J �
Authorized signature: This p ermit application expires if pee mMsT permit is not obtained within 1g0 0
days after it has been accepted as complete.
1
Print name: Diane Mason I Date: 1(t I L IL I ` Fee methodology set by Tri- County Building Industry Service Board
B P
I,\ uilding \ermiu\MBC- PermiiApp doe 10/01/09 440.4617T (11102/COM/WEl1)