Permit CITY OF TIGARD MECHANICAL PERMIT
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s . COMMUNITY DEVELOPMENT Permit #: MEC2012 -00335
T [GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2012
Parcel: 2S112CC04000
Jurisdiction: Tigard
Site address: 15765 SW 80TH AVE
Project: Shaefer Subdivision: BURNHAM TRACT Lot: PTS 68
Project Description: (1) A/C and (1) Furnace A/C must meet 5' side yard setback and approved rear yard setback
Contractor: WOLFER'S, INC Owner: SCHAEFER, SHERYL M
290 YOUNG ST 15765 SW 80TH AVE
WOODBURN, OR 97071 TIGARD, OR 97224
PHONE: 503 - 981 -4511 PHONE: 503 - 230 -5969
FAX: 503 - 981 -0801
FEES
Specifics: Description Date Amount
Air Conditioning 06/28/2012 ' $46.75
Type of Use: SF Furnaces < 100K BTU 06/28/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 06/28/2012 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
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Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,, r
Issued By: Permittee Signature: D id - PPU�! D � 1 .
_AI , 3.1Aa±____ Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. "VVJJ
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
JUN /27/2012/WED 09:20 AM WOLFEAS HEATING FAX No, 5039810801 P. 001
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Mechanical Permit Applic 7� FOR cl ICE USE O Ll'
City of Tigar Z n a fe a-� �I ?/ Permit No)J 8f ,'. ,
14 13125 SW Hull Blvd Tigard, OR 97223
• Plan Review
p . Phone: 503.718.2439 Fax: 503598.19 �� N 27 7 2 0 2 DatWBy: OtherPennit:
� Ready/Ry
Inspection Line: 503.639.4175
1 l l;n k l> See Pago 2lbr
Internet www.tigard-or.gov C / C y n p Notified/Method: Supplemental information
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i e ,.... 4 °m .i 1:. -,:. 'J Mechanical based 0nt}1 V81 �. .. . .
;52 � (..,. �.,- -,� , z.� ,..� -rte .... .....
permit fees* are the value of 11$ work
❑ New construction 7 :1 Addition/alteration/replacement • performed. Indicate the value (rounded to the nearest tfullar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
1'. ' v c.,Y u Jc o a c o �1 t 5 N •-• w • • , - a-�� Value
'-:.;.' ` w ^, , ` �e^iI.c.. e'M Ma 1 . . . r .! ,. : "�' • � A � i MME ?'''' �ry •• ,r< e...:-
..i I- and 2- family dwelling ❑ CommerciaUndustrial ❑ Accessory building For special ir{forma ion use checklist
El Multi- family 0 Master builder ❑ Other: Description I Qty, I Ea. Total
. , .�''� r ^"i• t q `f "i" iiii a Crii a a c' o " �r.z:i7:7 a4 ,t, Beating/cooling: ... .
5Yw.`- r6 „` u 7 � ), ..,4 ar, A _. - J!:'' �� .__ ;,.; A ir conditioning
Job site address : / 7z, t ' j4 J • vki ) ti (requires site Elan showing placement) 1 46.75 4(0.
City/State/ZII' Q.C~�i /7�f Orl + Furnace 100,000 BTU (duetalvents) 46.75 4 (pr1
V , y Furnace 100,000+• BTU (duraslvenu) 54.91
Suite/bldgJapt no.: II I Project name: Heat pump
l ireauires site plan shuwine placement) 61.06
Cross stmt et/directions to job site: Duct work 23.32
Hydronic hot water system 2332
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 Other fuel appliances: •
:fi -, ",, •:
i 'wiles t' + .. 4.` ri c•`� - - _ Water heater 2332
� " �/' Gas fireplace/insert 33.39
/J.FSlL /._g / y w/�L Flue vent for water heater or gas
fireplace 23.32 .
Log lighter (goal__ 23.32
Wood/pellet stove 33.39
Wood fireplacemsert 23.32
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G,^ .,l9 ? f-1 1r • ° .•dB {�,"4"y+.�. �i_ ti -�-, l,a � �5 r r M� Ot (Jllmllaynlnar P.lVC7lt 2332
G ......: , nu..w.,mi...._. ., ., i -a, m� her:
Name: /77 � I Z l .! Environmental exhaust and ventilation:
� �� or .1
- Range hood/other kitchen 4
Addre>IS: t/
equipment 33.39
City/State/ZIP: ! E � ,/ / 97 Clothes dryer exhaust 33.39
Phone: ( ) � / r• v4/ Fax ( ) toilet compartments, mentents (bathrooms,
roc
tomprts, ulity rooms) 23.32
t---+ , . .' , (, �� o b nr ,. .4 <; 0' j , rY:ca fCi' i t • o ., ,. AtticJcrawls fans _ I 23.32 • `+^ u�: X 1.1 ' � "' h 11 h,Jn•4.++r ...w nt.r.. Sr "rt... 4 h . bTiAx..wn
�E M , Other . 23.32
Business name:
/ /.." ,. )Fuel piping:
Contact name: ' / . ! j . $14.15 for Treat four; $4.03 for each additional
Address: /Ai Q j / ., _ 1 / Furnace, etc.
Gas heat pump
1 , Q / f i, 1 , i 1 / r / Waltsuspended/unit heater •
one: ( 5wyy�� ) - 1 b 1 ....4s t 1 Fax: : (5D5)q : 1 - OE 1 Water heater
S � N 0Vecy lShea 1 COM • Rantze e
E -mail: �7 • •
n,ri -V -� 4^rr .... _ . ` ' ,. .., s `8 i. ,_. _ - � :._ , r . . w rn = . ,, . ..w _„ ,, { r! Barbecue
Y'� ^4 Mqy +I• W A•�. _ ....�..C� �M1 � 'SJ....1I�l. �'}, ..ls J_YiY.
Business name: Y V C 1 • -Vine Clothes dryer (teas)
CJ `�' �� Other: .
- • dress:
City/State/ZIP: .me. Subtotal �'?�,$O
Ph • e: ( ) g am; ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
+ �� State surcharge (12 %.of permit fee) 1 • Z?'
�-W TOTAL PERMIT FEE LOS} •'1 x
.-� 'Ibis permit application expires if a permit Is not obtained within 180
Authorized signature: _ " days after it has been accepted as complete.
Print name: l A/ C��/' q . K1 J Date: { • � , I ` Fee methodology set by Tri Cocnty Building industry Service Board
A/C --HEAT PUMP - --UNIT SITE PLAN
FEET TO BACK OF-PROPEtri LINE W • L=
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w • ' ' • . FEET TO FRONT PROPERTY LINE .
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i - • . A DDRESS : b5 sup . . e�- Q'12Z� . ;
l • PLEASE .REFAX APPLIC WITH -SITE PLAN
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