Permit CITY OF TIGARD MECHANICAL PERMIT
I ' ' COMMUNITY DEVELOPMENT Permit #: MEC2012 -00409
T t GA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/02/2012
Parcel: 1 S133DD05500
Jurisdiction: Tigard
Site address: 12769 SW WINTER LAKE DR
Project: Greenwood Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 94
Project Description: (1) air conditioner install Must be within 5' side yard setback and approved rear yard setback
1 REPRINT 8/7/12 correcting proper form"
Contractor: A TEMP HEATING & COOLING INC Owner: GREENWOOD, ROBERT & SHIRLEY REVO
16000 SE EVELYN ST LIVING TRUST
CLACKAMAS, OR 97015 -9519 BY GREENWOOD, ROBERT A & SHIRLEY
. 12769 SW WINTER LAKE DR
TIGARD, OR 97223
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Specifics: Description Date Amount
Type of Use: SF Air Conditioning 08/02/2012 $46.75
Class of Work: OTR Type of Const: 12% State Surcharge - Mechanical 08/02/2012 $10.80
Occupancy Grp: Occupancy Load: Minimum Fee Adjustment - Mechanical 08/02/2012 $43.25
Stories:
Project Valuation: $0.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0-3 HP:
Furnaces >= 100K BTU: 3-15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $100.80
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces:
Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
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'. , I
Issued By: Permittee Signature: al 4 ppuC4 i 7Qil(,
_____A
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. '
•
CITY OF TIGARD ELECTRICA ESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00409
T I G AR O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/02/2012
Parcel: 1S133DD05500
Jurisdiction: Tigard
Site address: 12769 SW WINTER LAKE DR
Project: Greenwood Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 94
Project Description: (1) air conditioner install Must be within 5' side yard setback and approved rear yard setback
Contractor: • TEMP HEATING & COOLING INC Owner: G' ENWOOD, ROBERT & SHIRLEY REVO
1:400 SE EVELYN ST ING TRUST
CLA KAMAS, OR 97015 -9519 :Y GREENWOOD, ROBERT A & SHIRLEY
12769 SW WINTER LAKE DR
TIGARD, OR 97223
PHONE: 503 -. I -5014 PHONE:
FAX: 503 - 557 -299
FEES
Descripti. Date Amount
Specifics: Air Con dinning 08/02/2012 $46.75
12% ate Surcharge - Mechanical 08/02/2012 $10.80
Min' urn Fee Adjustment - Mechanical 08/02/2012 $43.25
Type of Use: SF
Class of Work: OTR
Total Number of Systems:
Audio & Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: Total $100.80
Required Items and Rep. • s (Conditions)
This permit is issued subject to the regulations •ntained 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. T s 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 yo 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 , ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 orr �
Issued By: �,f�, J . Permittee Signature: 0P4 K ('F'L/ `• 1 / f
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
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 Applicat_d[ECEIVED POI: OF I( I( t "`l.. l 111
City of Tigard I � tcIB d $ E Permit No C�I�_ t)0
13 125 SW Hall Blvd, Tig Oft 97223 A li r nut .
_ A 1 Z 0 2 Ylea I�o Otter Permit:
1 Phone: 503.718.2439 Fes: 503.598.1960 ne,rlBy:
i ' i ,, ; ,., ,, , ., Inspection Lee: 503.639.4175 CITY OF TIGARD D m /By: sae Pugs 2 for
Internet www.tigard- or.gov Nauned /Metho s Iurormatten
:..
BUILDING DIVISION •
Mechanics] permit focal are bused on the value of the work.
❑ New construction Addition/altetation/replacensmt perterraed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other medtanical materials. equipment labor. overhead, and Profit
.:. - Valle: $ De
•. . 4 1!.t y [
• IF t':OP1b`3'BI1CTION . E
1t13.S� ®19TIAFi EQUIPM!${11T 1:b�'SFEI1<B Fl;lyB'
• $f 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building Far special l mu ar maid
Q Multi - family ❑ Master builder ❑ Other: Description I Qty. J Ea. I Total
. .. JOB SITE I$ OE1t!IATION AND LOCATION Igetrtineicoallag: /
• Air conditioning f 46.76 6.
Job site address; r _ (roquiree oho plan ahvwmo plaooamnt)
L� `I f I S 1 . ✓% L! r V I Fllttlaee 100,000 BTU (ducts/vents) 46.75
City /Stata/ZlP: • 0 4. / 9 / (:: - 7-?�3 urn 00
Face 100,000+ BTU (duets/vents) • 54.91
Suite/bldg./apt. . no.: Pwject uamc:_6 (& (Gut Beat pump
(men= site ptm a6owiuq 01M.rmeart) 61.06
Cross street/directions to job site: Duct work , 23.32
1'Iydroalic hot water system 23.32 '
Residential boiler (radiator or
hydreolo) 23.32
Unit beaters (fuel-type, not electric),
in -wall, in- dua etc. 46.75
•
Subdivision: I Lot Floc/volt It for any of above 23.32
m Other. _ - 23.32
Tax ep/parcel no.: .. Ocher reel appliances: .
.:..:> tON::.QP wo Water heater 23.32
) Gas fireplace 33.39
' Cc / Z O Ill al k C c / 0 .r\ Q C t n . Flue vent for water heater or gas
fireplece 23.32
Loglighter (gas) 23.32
Wood/pellet stove 33.39
Wood &apiece /insert 23.32
. .., .. ...., ... - .. per' fue /v ent
. ; E►itOift[.`. a13 siT8` ; • _ _ 23,32
e himney/]i /
� .'Q.1.,E$AN eJthcr
'Name: l30 r _ _
�p � r 0 1 ,, ` .p Pavliomneninl exhaust rod ventilation;
_
-
Address: 1Z,...\.1 / y V w A ' �� P. O t'. , oquit memtdlotluskitchon 33.39 ,
City /State/ZIP: ( J 0 � Clothes dryer exhaust 33.39
I w Single -duct exhaust (bathrooms,
Rue toilet Phone: ( ) ) compartments. o ) , 23-32
era is
:Al'XCABI __ O
` Attid w a fans 23 32
Business name: - a ;!∎ , f • n: : ... _ - Fuel piping:
Contact name: 16000 S � p St $14.15 for lima tour; $4.03 for each additional '
—
7015 Corneae, -. eae, ate. Gas heat pump
City /State/ZIP: Wall/amspaaded(unit heeler
Water beater
Phone: ( ) Fax: : l)2�) 6 2 Fireplace ,
Range _ .
CONTRAQlfOl . ' due .
Clothes dryer (gas)
Business name: ATER fEA'U G AND COOLTNO,DIC_— _o
Address: 16000 SE Evelyn St. MECI3ANICAL PEWIT FEES'
•:11 : `: ' i
City/State/ZIP: 5 Minimum permit fee $90.00) Q 6
(l:.(�5f).501 -
Phone; ( ) Fare (t 3 ) 01 Plan revie (25 %ofpemit toe)
0213 tic.: • • • State surcharge (12% of perm &a) .
I TOTAL PERMIT FEE 1 , q&
yin permit application esphes Ira pe;lett IS not ubtithillId within 180
Authorized signs idi � a daps otter tt hes been accaptcd as complete.
i
Dom • Fee methodology ea by Iii- Cudaty Building leeway Service Board
Print name; / , , 0 I a • l ' 1 , ..
1 1Bui1diaglpmaimlMBC ParuitApp 09!09/10 . • •• 71' al/02/COM/WEa)
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A -TEMP HEATING &. COOLING, INC.
SITE PLAN
Prepared by: h J / l _ Date: "7 0
Customer Name: del) ri " t ' �: (:1
Address: /27? ,/ //el/ ( /7 E . _ f'p A ( I G 97e22'
Customer Phone(C ')'r t/- «2 Alt Phone: _
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Property Boundary Line s
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F A -TEMP •
HEATING & 1 6000 S.E. Evelyn Street COOLING, INC. www,kemph ating.c m
A (503) 650 -5014 Clackamas, Oregon 97015 FAX (503) 557 -2990
X TO:
C FROM:
M DATE:
PHONE: _ _ _ TIME:
T FAX: # OF PAGES:
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❑ URGENT
A , -FOR REVIEW
❑ PLEASE REPLY
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