Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2012 -00486
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/24/2012
Parcel: 1S133CA08600
Jurisdiction: Tigard
Site address: 13646 SW ROSEMARY LN
Project: Cichy Subdivision: VILLAGE AT SUMMER CREEK Lot: 9
Project Description: Installation of a /c. Placement of a/c unit must maintain 5 side yard and approved rear yard setbacks.
Contractor: MUEHE QUALITY HEATING INC Owner: CICHY, CATHERINE
7301 SW KABLE LN #500 13646 SW ROSEMARY LN
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503 - 598 -0966 PHONE: 503 - 789 -2387
FAX: 503 - 598 -8498
FEES
Specifics: Description Date Amount
Air Conditioning 09/24/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 09/24/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 09/24/2012 $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
issuan -, • •rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti Notification Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
o direct questions to OU b all g .13.232.1987 or 1.800.332.2344.
, 111..
I - ued By: te4AtAit Permittee Signature: _.41
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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 Application FOR OFFICE USE ONLY -
City � 9 E Date/B r �,! �a JY�e,�oi�.,aa 44 ,
CI of Tigard Date/By: No.:
V 13125 SW Hall Blvd., Tigard, OR 972 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 :. J 2 4 2012 Date Ready/By: Suns: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
CITYOFTICIA,RD
TYPE ° EKING DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition/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*
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 13646 SW Rosemary Lane (requires site plan showing placement) 1 46.75 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: SW 135 and SW Scholls Ferry Road 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: Summer Creek • Lot no.: 9 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
Addition of air conditions to existing system Gas fireplace/insert ent or aer 33.39
n � Flue vent for w ater heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER ❑ TENANT Chimney/liner /flue /vent 23.32
Other: 23.32
Name: Catharine Cichy Environmental exhaust and ventilation:
Address: Same Range hood/other kitchen
equipment 33.39
City/State /ZIP: Same . Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)789 -2387 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ® CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: Muehe Quality Heating, Inc.
Fuel piping: .
Contact name: Kyle Birman $14.15 for first four; $4.03 for each additional
Address: 7301 SW Kahle Lane, Suite 500 Furnace, etc. .
Gas heat pump
City/State /ZIP: Portland, OR 97224 Wall/suspended/unit heater .
Phone: (503) 598 -0966 Fax: : (503) 598 -8498 Water heater ' .
Fireplace
E -mail: MQHKYLE @INTEGRA.NET Range
CONTRACTOR Barbecue
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Business name: Muehe Quality Heating, Inc. Clothes dryer (gas)
' Other:
Address: Same MECHANICAL PERMIT FEES*
' City/State/ZIP: Same Subtotal 46.75
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) 43.25
Plan review (25% of permit fee)
CCB lic.: 50096 Aft.
State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80
. 0 '
Authorized signature: This permit application expires if a permit is not obtained within 180,
days after it has been accepted as complete.
Print name: Kyle Birman D 9/24/12 • Fee methodology set by Tri -County Building Industry Service Board
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Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13646 SW ROSEMARY LN, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
2013-12-17 00:00:00
MEC2012-00486
PASS - No C of O
Meets setbacks
Violation Summary:
Inspector Contractor