Permit •
CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2012 -00400
T [ G ARO 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/02/2012
Parcel: 1 S125DC01500
Jurisdiction: Tigard
Site address: 7145 SW VENTURA DR
Project: Gondek Subdivision: WASHINGTON SQUARE ESTATES Lot; 5
Project Description: (1) install furnace
Contractor: SPECIALTY HEATING & COOLING INC Owner: GONDEK, CORY R
7500 SW TECH CENTER DR SUITE 130 7145 SW VENTURA DR
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 620 -5643 PHONE: 503 - 245 -8671
FAX: 503 - 681 -0793
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 08/02/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 08/02/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 08/02/2012 $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: .PLud- Permittee Signature: b)\) APPu , v1J
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.
JUL /30/2012/MON 08:17 AM FAX No. P. 002
Mechanical Permit A lieati FOR 014 ICE USE ONLY
III City of Tigard Date• — 1 3 I 13. Sr P N Ce2jl a_ 004 AP'
4 13125 SW Mall Blvd., Tigard, OR 97223 Plan Review
I ! Phone: 503.718.2439 Fax: 503.598.1960 JUL 3 0 2012 pate. By; Outer Permit:
TI G A R D Inspection Line: 503.639 pate Ready By: /era: lig Sec Page z for
Internet: www.tigard-or.gov
CITY VFTIGARD Noti(ed'htethod; la, Supplemental Information
NUM
TYPE OR WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees" are based on the value of the work
❑ New construct ion ' Q. iivddition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other; mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
QLrftf d 2- family dwelling ❑ Commercial /industrial ❑ Accessory building Forspedal information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/eooling:
Air conditioning
Job site address: uires site Ian showin lac eme n t) 46
Gondek, Cory & Lenaire R12268 Furnace 100,000 BTU toners vents) 46.75
City/State/ZIP: 7145 SW Ventura Dr _ Furnace 100,000+ BTU (ducts'vents) 54.91
Suite/bldg./apt. no Tigard, Or. 97223 Heat pump
(requires site plan slwtvin2 placement) 61.06
Cross street/directi (503)245 - 8671 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: fo[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
s _e_
fireplace _ 23.32
Log lighter (gas) 23.32
Wood/pellet stove . 33.39 ^
Wood fireplace/insert 23:32
PROPERTY OWNER I ❑ Tr NANT Chimney /liner /fluc/vcnt 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: ( ) Far: ( ) toilet compartments, utility roams) ` 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Other. 23.33
Fuel piping:
Contact name; 514.15 for first four; $4.03 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 & Cooling Inc Clothes dryer (gas)
Other.
Address: 7500 SW Tech Center Or Suite #130 MECHANICAL PERMIT FEES*
City/State/ZIP: Tigard, OR 97223 Subtotal
Minimum permit fee ($90.00)
tone: (503) 620 -5643
P Fax: (503) 598 -0718 Plan review (25% of permit fee)
CB lie.: 66578 State surcharge (12% of permit fee)
j T hl TOTAL PERMIT FEE / OD_ WO
Authorized signature: L/ �.-- s permit application expires if p permit is not obtained within 180
days after II has been accepted as complete.
� _ ..,.
Print name: ! Date: 0 I. • Fee methodology set by Tri- C'ounly Building Industry Service Board
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