Permit CITY OF TIGARD MECHANICAL PERMIT
Permit #: MEC2012 -00174
COMMUNITY DEVELOPMENT
Date Issued: 04/05/2012
T.1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1 S 05/201 8700
• Jurisdiction: Tigard
Site address: 12110 SW ANTON DR
Project: Newell Subdivision: ANTON PARK NO.2 Lot: 114
Project Description: Replace gas furnace.
Contractor: TEMP A CURE INC Owner: NEWELL, TRISHA J
15028 S CURTIS CT 12110 SW ANTON DR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE:
503 - 655 -8009 HONE: 503 -459 -9148
FAX: 503 - 723 -4466
FEES
Specifics:
Description Date Amount
Furnaces < 100K BTU 04/05/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/05/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/05/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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: 6,1J �/ Q L / C41 1
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.
Temp -A -Cure, Inc. 503 - 723 -4466 p.2
Mechanical Permit Applic S C \ C FOR OFFICE ESE ON I.1
City of Tigard / Permit Na: /'
Ira+ - " va. Receiv qAA eek0 /7
13125 SW Hall Blvd., Tigard, OR 97223 pp P a 4 2012 Plan /a�.
Review C Phone: 503.71 &2439 Fate 503.598.19601' Pn Date/By: Other Permit
TIGARD Inspection Line 503.639 �y Dare Ready /By. nris 53 See Page 2 for
Internet: www.tigardor.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK • COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ 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 OF CONSTRUCTION RESIDENTIAL EQUIPMENT !SYSTEMS FEES*
® 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building Forsgedal info rnatkm use cbecMist
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION Heeling/cooling:
Air conditioning
lob site address: 12110 SW ANTON (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/va s) 1 46.75
City/ State/ZIP: TIGARD, OR 97223 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: NEWELL Heat pump
(requires site plan showing placement) 61.06
Cross street /directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 2332
• Unit heaters (fuel -type, not electric),
' in -wall, induct, suspended, etc. 46.75 1
Subdivision: Lot no.: Flue/vent for any of above 2.3.32
Other: _ 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32 •
REPLACE OLD GAS FURNACE WITH NEW 80% NAT GAS FURNACE Gas fi fo wat -3339
Flue veent nt for water heater or gas
fireplace % 23.32
Log lighter.(gas) -- -- - % 23.32
Wood/pellet stove , 3339 ,
_Wood ftreplace/msert 2332
® PROPERTY OWNER I ❑ TENANT Chimney /liner/flue/vent 2332
Other: 2332
Name: TRISHA NEWELL Environmental exhaust and ventilation:
Address: 12110 SW ANTON Range hood/other kitchen
equipment 3339
City/State/ZIP: TIGARD, OR 97223 Clothesldryer exhaust 3339
Single -dna exhaust (bathrooms,
Phone: (503)459 -9148 Fax: ( ) toilet compartments, utility moms) 2332
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 .
Business name: TEMP -A -CURE, INC Other: - 23.32
Fuel piping: _
Contact name: ALLEN HECKER $14.15 for first four, $4.03 for each additional
Address: 15028 S CURTIS CT Furnace, etc. I
Gas heal pump
City/State/ZIP: OREGON CITY, OR 97045 Wall/suspended/unit heater
Phone: (503) 655-8009 I Fax:: (503) 723 -4466 Water heater
Fireplace
E -mail: ahecker ®tempae ore-co m Range
CONTRACTOR Barbecue
Business name: TEMP -A -CURE, INC
Clothes dryer (gas)
Other:
Address: 15028 S CURTIS Cr MECHANICAL PERMIT FEES'
CityiState/ZIP: OREGON CITY, OR 97045 Subtotal
l Minimum permit fee ; 90.00
Phone: (503) 655 -8009 Fax: (503) 723-4466
Plan review (25% of permit fee) ;
CCB lic.: 97533 y /5-by State surcharge (1296 of ptamit fee) ' 10.80
7 TOTAL PERMIT FEE 100.80
a This permit application expires if a permit is Dot obtained within 180
Authorized
ggg �TT ��� days after it has been accepted as complete. 1
print �.... I Dat 4 4- • Fee methodology set by Tri-County Building Industry Service Board
r :ti&nBdiagWennitsllOGPerm¢Approc 03107/l2 440.4617T(111011COM/W®)
•
Temp -A -Cure, Inc. 503 - 723 -4466 p.1
15025 S. Curtis Court
Oregon City, 0897045 Temp -A -Cure, Inc.
503-655-8009
FaA/C.
To: City of Tigard From: Gina Wrisley, Ofc. Mgr
Fax: 503 - 598 -1960 Pages: 3 including cover sheet •
Phone: 503 - 655 -8009 Date: x i� C . �- (�— )6)
Re: Mechanical Permit CC:
❑ Urgent X For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
To Whom It May Concern:
Attached please find our mechanical application permit for the change out of a natural gas
furnace with a new unit. The address Is 12110 SW Anton, Tigard, OR 97223.
Please process this application and forward a copy of the permit back to our office via
facsimile S03- 7294466 or by email ahecke asgtemrsacure.com
If you have any questions regarding this application please contact the undersigned at the
number fisted above.
T.
CC), W�
Gina Wrisley, Office Manager
Temp- A-Cure, Inc.
Office: 503-655 -8009
Fax: 503 - 723.4466
ahecke,C)tempacure.com
wierw.tempacure.c Dan