Permit CITY OF TIGARD MECHANICAL PERMIT
. = COMMUNITY DEVELOPMENT Permit #: MEC2012 -00155
Date Issued: 03/27/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S 27/201 4600
Jurisdiction: Tigard
Site address: 12523 SW 114TH TER
Project: Mohr Subdivision: WALNUT GROVE Lot: 15
Project Description: Replace furnace.
Contractor: SPECIALTY HEATING & COOLING INC Owner: MOHR, CAROL
7500 SW TECH CENTER DR #130 12523 SW 114TH TERR
TIGARD, OR 97223 TIGARD, OR 97223
•
PHONE: 503 - 620 -5643 PHONE:
FAX: 503 - 681 -0793
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/27/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/27/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/27/2012 $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: 40137 Permittee Signature: Of e- - I-77
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.
MAR /26/2012/MON 03:52 PM FAX No. P. 002
Mechanical Permit A li f FOR OFFICE', t:SI. ONLY
City of Tigard '��� Received S A 7 / , 2 „h A PenuitNofyEZ 0 1 .Dos"',
i lii
S 't 13125 SW Hall Blvd., Tigard, OR 9 _ Plan Review
Phone: 503.718.2439 Fax: 503.598.1Q�o q ` 7 2012 DateiBy: • Other Permit:
.11UAkI0 Inspection Line: 503.639.4175 IVlhn DateReadyiBY: Ila Q See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
• CITY�`�G ®IIVAisilDotI
tyre . 0 n/alteration/replacement ` : COMMERCIAL. FEES SCREDDLE USE CHECELIST. .
Mechanical permit fees* are based on the value of the work
1:1 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.
Value: S •
• CATEGORY: OP. •CONSTRUCTION • • RFSIDENTSALEQUIPMENT /SYSTEMS FEES" .•
Er( `- and 2- family dwelling O Commercial/industrial ❑ Accessory building Foe special Information use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. _ Ea. Total
`
. JOB !SITE INFORMATION, AND LOCATION . IleatinpJcooliog:
Air conditioning
Job Site address: (requirea sire plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 1 46.75
City / State/ZIP: Mohr, Carol R12093 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt, n: 12523 SW 114 Terr Heat pump
Tigard, Or. 97223 (requires site plan showing placement) 61.06
Cross street/direc Duct work 23.32
( 503 ) 780 - 9070 Ilydronic hot water system 23.32
Residential boiler (radiator or
' hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other. 23.32
Tax map /parcel no.: Other fuel appliances:
• . • ' . • • : DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39 _
Flue vent for water heater or gas
fireplace 23.32
/i � Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert , 23.32
❑ PROPERTY OGyiVER. I Chimney /liner /flue/vent 23.32
❑ Other. 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: ( ) • Fax: ( ) toilet compartments, utilirooms) 23.32
❑ APPLICANT . ' . El CONTACT PERSON Attic/crawlspace fans 23.32
Business name; Other. I 23.32 491.
A-..._,... Fuel piping:
Contact name: 514.15 for first four; 54.03 for each additional
Address: Furnace, etc. ,
Gas heat pump .
City/ State/ZIP: Wall/suspended/unit heater _
Phone; ( ) Fax: : ( ) Water heater
' - Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: Specialty Heating & Cl dryer (gas) Cooling Inc -
Other:
Address; 7500 SW Tech Center Dr Suite #130 M.E�ANICAL PERMIT FEES*
City/State/ZIP: Tigard, OR 97223 Subtotal
Minimum permit fee ($90.00) ' , at
Phone: (503) 620.5643 Fax: (503) 598-0718
Plan review (25% of permit fee)
CCB lie.: 66578 State surcharge (12% of permit fee) /0 r t o
I TOTAL PERMIT FEE /00. P**"
This permit application expires it a permit Is not obtained within 180
Authorized signature: + days after It has been accepted as complete.
Print name: i /`.� V+�. I Date: 3/a41/ it • Fee methodology set by Tri- County Building Industry Service Board
I: !Lapin,: Permits MEC- PermuApp * .dot 09 09.10 440.4617, (I 1.02 COM WEB)