Permit CITY OF TIGARD MECHANICAL PERMIT
$ COMMUNITY DEVELOPMENT Permit #: MEC2012 -00331
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2012
Parcel: 2S 104AD06000
Jurisdiction: Tigard
Site address: 12932 SW SEVILLA AVE
Project: Sheldon Subdivision: WALNUT CROSSING Lot: 7
Project Description: (1) Heat Pump
Contractor: HYBRID HEATING & AIR CONDITIONING CO. Owner: SHELDON, CHARLOTTE M
PO BOX 329 12932 SW SEVILLA AVE
CORNELIUS, OR 97113 TIGARD, OR 97223
PHONE: 503 - 357 -5663 PHONE: 503 - 524 -2272
FAX: 503 - 357 -0668
FEES
Specifics: Description Date Amount
Heat Pump 06/27/2012 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 06/27/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 06/27/2012 $28.94
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.
ll
Issued By: " Permittee Signature: Oki ,4 )u 94T old. I'
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.
Mechanical Permit 4pplieatit,-J.. FOR OFFICE t :ONL\
City of Tigard `' ` :CE'D Received �j ,
• 13125 SW Hall lvd.. Tigard, OR 97223 De[CISy' v� a I I a- Pern No. ���'�
Phone: 503.639.4171 Fax: 503.598.1960JUN a n ew
l • • it l� inspection Line: 503.639.4175 6 Z ��2 Other Permit:
Internet; www.LIgatd -0r.ppv Date Ready/8y;' MI ® See Page 2 for
G RD NotiPed/Method: Supplemental Information
Cl OF TI
. • TYPE OF 7 ' it r i
COMMERCIAL:.FE>Ew'. SCHEDULE - USE.fCtECYfLTST
ID New Construction la Addition /alteration /replacement Mechanical pennir fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑Other.
— m e materials, equipment, la bor o verh ead and profit
CATEGORY CONSTRUCTION - Value: Valu $ —
Ei I- and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
/ SY5CEMS FEES*
0 Multi For special lnforrnarion use checklist.
Y ❑ Master builder 0 Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: `a Air conditioning •
/ 9 e S �Q V I I f ) OL' 4).. ,_, (reeuires site plan showing Placement) 46,75
City/State/ZIP: ! ' Q a 1 'e" � 7a , 3 Furnace 100,000 BTU (ducts/vents) 46.75
I U Furnace 100.000+ BTU (ducts/vents) r 54,91
Suite/Mg. /apt. no.: oject name: 5b ki0A.,
Heat pump / 61.06 37W
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).
_— in -wall, in -duct, suspended, etc. 46.75
Subdivision: i Lot no.: Flue/vent for any of above 23.32
Other; 1 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater • 23.32
Gas fireplace _ 33,39
t a , d - ■ . ► /.._i p., , ;' Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) w - 23.32
Wood/pellet stove 33.39
Wood fireplace/insert • 23.32 '
Chimney/liner/flue/vent 23.32
g PROPERTY OWNER 1 Cl TENANT
Name: l Y1 Other. 23.32 •
Q _ (S� LP,,, c,Qn Environmental exhaust and ventilation _
Addre 9 3 a C � (,(� i Jill y I Range hood/other kitchen
? __the_ equipment 33.39
City/State/ZIP: I 1 � � d � 9 7a 2-3 Clothes dryer exhaust 33.39
Phone; 1 3 Single -duct exhaust (bathrooms.
) J� �,y Fax; ( ) t compartments, utility rooms) 23.32 •
0 APPLICANT . ❑ CONTACT PERSON Anic /crawlspacc fans 23.32 .
Business name: 23,32
- Fuel pipiu
Contact name: S14.15 for first four: S4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall /suspended/unit heater
Phone: ( ) Fax :: ( ) Water heater
E-mail: Fireplace
_- Range
CONTRACTORiJ - J Barbecue
Business name: [ �� bYi Cl 11-€.41/417r
e,pd7 r"tQ Z Ale („a ✓1 e / -f t ✓1! other
e s dryer (gas)
Address: �`� P. 0../3120( 3Q, (� .. • MECHANICAL PERMIT FEES"
City/State/Z1P: & erNo. I t u_ ? ® q 1 3 subtotal 6 /. • 36
Phone: Minimum permit fee ($90.00)
(503) 3' 7_ � / _ Fa x; Icp j. ) '3 Plan review (25% of permit fee)
CB lie.: 1 (7/a 70 3 rP State surchar (12% of permit fee) /a, 3®
TOTAL PERMIT FEE 10 t1.en
• This permit application expires if a permit Is not obtained within 180
Authorized signature: Kit- •
days after it has been accepted as complete,
Print name: f Ck �_ �` 1�� n y I Date: z, 1 ' Fee methodology set by T ri- County Building Inducey Service Board
l:lauildingtPamiu C_Permita 14/01 /09 (� lit .6 ! 4 40.46177 (I 1/O /COM/Wsa)
•
Hybrid Heating & Air Conditioning
McClenny /RHC
• Refrigeration / Heating/Cooling
P.O. Box 329 -230 Baseline- Cornelius, Oregon 97113 Office 503- 357 -5663 Fax 503 357 -0668
.5/`Q_ \ ��r�
sITE PLAN
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NOTE — Please show the following on the site plan:
Lecattcn of Indoor Unit and Outdoor Unit 4 181111°— •
Indicate how the flue will be run (thru the roof — out the sideweil — etc)
!r. ica :s with toted liha how linasat will be run and approx. distance
Indicate how the condensate will be run
•
•
Hybrid Heating & Air Conditioning •
McClenny RHC
P. O. Box 329 •
Cornelius, Or 97113
Phone: 503- 357 -5663
Fax: 503- 357 -0668
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Fax
✓' i `'' � Y '`I From: Hybrid Heating & aC eak
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• Pages incl. Cover. y
Fax: 5 D ` S% , - 19Gz5 cc:
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