Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2012 -00350
T [ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/09/2012
C
Parcel: 2S104CD04800
Jurisdiction: Tigard
Site address: 13923 SW MISTLETOE DR
Project: Rothstein Subdivision: HILLSHIRE ESTATES Lot: 48
Project Description: (3) A/C and (3) furnaces. A/C must be within the 5 minimum side yard setback and approved rear yard setback.
Contractor: RA SCHWARZ HEATING & COOLING INC Owner: ROTHSTEIN, LORRAINE
15078 SE BRIGHTWOOD AVE 13923 SW MISTLETOE DR
PORTLAND, OR 97015 TIGARD, OR 97223
PHONE: 503 - 668 -3399 PHONE: 503 - 718 -1584
FAX: 503 - 344 -4900
FEES
Specifics: Description Date Amount
Air Conditioning / 07/09/2012 $140.25
Type of Use: SF Furnaces < 100K BTU 07/09/2012 $140.25
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 07/09/2012 $33.66
Occupancy Grp:
•
Stories:
Fuel
•
Fuel Types:
Gas Pressure:
Total $314.16
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 503.232.1987
' or 1.800.332.2344. �
Issued By: Permittee Signature: DLL tKT _/ji 4_ f/
!/v.j -
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.
07/5/2012 09:09 p 10:+1 (503) 5981960 FROM:5033999900 Page: 2
•
Mechanical Permit ApplicatilFIECplvE , FOR OFFICE: 1.;.SE ONLY
IP .cceived
City of Tigard on.
Date/By: cot( Permit pia, 00 AP
'I 13125 SW Hall Blvd., Tigard, OR 97223 JUL 0 5 2012 e
lig
' . 6 • Phone: 503.7182439 Fax: 503.598.1960 D w Other Pe
1. ' I )'. rmit:
TIGARD
Inspection Line: 503.639.4175 Date Ready/By: I ' • 0 See Page 2 for
•
Internet: www.t gard-or.gov CITY OF TIGARD Notified/Method: I at Supplemental Information
BUILDING DIVISIO . ..
: •
TYPE . ' .:
Of WORK . ' -. •-• ' - '-: ..-. :CoMMAItc1.4.
. - • Mechanical permit fees* are based on the value of the work
0 New construction D!4Wdition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit
0 Demolition 0 Other: Value: $
< - - • .. CATEGORY. OF- CONSTRUCTION. . . . . .. ..
RESIDENTIAL EQUIPMENTI,SySTEMS:FEES .
. .
1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
0 c,1 _
ulti-family 0 Master builder 0 Other: Description For special Information use checklist
I Qty. 1 Ea. I Total
•
,. . . . JOB. SITE . INFORMATION. AND LOCATION : Heating/cooling:
•
..
Air conditioning
Job site address: I 3C1 2, S1,3 ili I i iile - 10e r* D" . t VC, (requires site plan showing placement) 46.75 11026
rn
Fuace 100,000 BTU (ducts/vents) 46.75 11105
City/State/ZIP: --r, , Ca- - 7 z23 Furnace 100,000+ BTU (duets/yeas) 54.91
Suite/bldg/apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to jot site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel not electric).
in-wall, in-duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other 23.32
Tax map/parcel no.: . Other fuel appliances:
Water heater 23.32
• DESCRIPTION OF.w9.0e.. . . . . .
-- I re viac / 2) R [ c cti-cS Gas fireplace/insert
, Flue vent for water heater or gas 33.39
•i(kaiC tk-1 v 9
fireplace
' Ll- , replace
tog lighter (gas) 23.32
kf ACP
23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
XPROPERTY OWNER I . 0 TENANT . . Other: Chimney/liner/fluevent 2332
23.32
Name: L orrc c t , l e . . j 1 ....c , c ±S=L1_ - ei:n Environmental exhaust and ventilation:
-
Address; 1 '3...rq L-- i; v-e Range hood/other kitchen
equipment 33.39
City/State/ZIP: t ‘ 4, oc.... ci -722_3 Clothes dryer exhaust 33.39
I
Single-duct exhaust (bathrooms,
Phone: (S03 1 I I ) _, I 6i Fax: ( ) toilet compartments, utility rooms) 23.32
::• - APPLICANT • : • ' 0 RSON• _ Attic/crawlspace fans
23.32
Business name: g_ rl gc hiJetfz, 14 ea 4-i' A- ECIDI ti 1 9 , Ze
,-- Other:
• Fuel piping:
23.32
Contact name: 9 schtt4(z_ _ $14.15 for first four; $4.113 for each additional
Address: (5 o 7 f, Sr k 4 0 9 3 el 14A. Furnace, etc.
Gas heat pump
City/Ste/ZIP: L A) a (4. 0/ T7....)0 7 Wall/suspended/unit heater
Phone: (5-9.3) 7-q Fax: : ( 503 ) 3 Elq L./1e) Water heater
Fireplace
E-mail: Q_ % a/ ff 1/00 vz_.4-icci--ii • c 0,---) Range
.. . .. - 'CONTRACTOR. - • . ... . . . Barbecue
t
13usiness name: fA C ■C ea, d el SI Clothes dryer (gas)
Other: . . . 1
I
os -
Address: 0 IS sr (9 . • .1 '14 1,7c : •. : . - ..MECIIANICALPERMIT.FEETS}
City/State/7.T. P*. I\KL kt.Z4ti..1,ux I ea_ ce 73-c, 7 Subtotal
,
Minimum permit fee ($90.00) 19
Phone: ( 59) (0 6 ,p,.. 23 9 9 I Fax: ( 5D-y 31.N._ Lt goo Plan review (25% of permit fee) la
ur6.CEI lie.: ( qa3 ib 3 -- State surcharge (12% of permit fe%
TOTAL PERMIT FEE - t
This permit application expires if a permit is not obtaine within 180
A ittltoril f lO h i AP - 4° . 41° \ .... days after it has been accepted as complete.
Print nam 11 , 4 2-
AIL - 4617MN:4022-PANIMIEM . *' M ' Fee methodology set by Tri-County Building Industry Service Board 3 (4.1(i sx
-....
I Allui !ding Pc, mitsVAEC-PerrnitApp sue 03 312 440-4617T ( I 1/02/COMAVER)
AIR CONDITIONER PLOT MAP
COVERED PATIO
Retrofit AC
BASEMENT/ FURNACES
Retrofit AC LOCATED IN CLOSET
New AC Addition
3 Furnaces / 2 Existing, 1 New
CO El
13923 SW Mistletoe Drive
Porltand, Oregon 97224
R.A. SCHWARZ HEATING AND
F. GARAGE COOLING, INC CCB #190383
a
PH. 503 - 668 -3399
0
0
O
•!1
O
07/5/2012 04:09 p T0: +1 (503) 5981960 FROM:5033444900 Page: 1
- Fax Transmission
To: City of Tigard From: R. A. Schwarz Heating and Cooling, Inc
Fax: +1 (503) 5981960 Date: 7/5/2012
RE: Mechanical Permit Application Pages: 4
Comments:
Please see attached Mechanical Permit Application.
Thank you,
Deborah Schwarz
R.A. Schwarz Heating and Cooling, Inc
503- 668 -3399
503 - 344 -4900 fax line