Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00504
T i G AFLD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/03/2012
Parcel: 25111 BA06400
Jurisdiction: Tigard
Site address: 9574 SW MCDONALD ST
' Project: Silvey Subdivision: ARLIE'S PLANTATION Lot: 4
Project Description: (1) furnace replacement
Contractor: TRI COUNTY TEMP CONTROL INC Owner: SILVEY, TOM
13150 S CLACKAMAS RIVER DR 9574 SW MCDONALD ST
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE 503 - 557 -2220 PHONE' 503 - 880 -8244
FAX 503 - 557 -0919
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/03/2012 $46 75
Type of Use: SF 12% State Surcharge - Mechanical 10/03/2012 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/03/2012 $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: . 7 A w Permittee Signature: O d A PP U e TioLL
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 App (k 1 _ 11112 01 11( 1.1 S t 0, I
City of Tigard Date/By- O 3 l X C �O► , - d 67,*
OCT 032012 Permit
13125 SW Hall Blvd., Tigard, OR 97223 Nan Review
' . Phone: 503.639.4171 Fox: 503.598.1960 , � Date/By: Other Permit
t it n Inspection Line: 503.639.4175
CFI; j•- I i?3f lfi1J Date Rcady/By toms ® See Page 2 for
Internet: www.tigard- or.gov 71 IP ,. 1 9 r i r Notified/Method. ?, 9 8applemental information
TYPE OF WORK 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 labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
® I- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building
- For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE ` I p p NFOR A MATIONN AND LOCATION Heating/coefing
Job site address: 0574 YY I coo ltd e'- Air conditioning
���� (requires site plan showing placement) 46.75
City/ State/ZLP: �.Q Furnace 100,000 BTU (ducts/vents) , 46.75
� `JJ Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential holler (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: 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
— �„^' ^ n n� jh Log fireplace igh
}�" J "� J � (I — ` (,L(J � [ 1 L Log 23.32
ter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 2332
PROPERTY OWNER
I ❑ TENANT Chimney /liner /flue/vent 23.32
Other: 23 32
Name: m 0 i (V Environmental exhaust and ventilation
J�/t Rmtge hood/other kitchen
Address: equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single-duet exhaust (bathrooms,
Phone: ( ) .+$2,44 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspacc fans 23,32
Other: _ 23.32
Business name: Same as contractor Fuel piping
Contact name: Diane Mason $14.15 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 Rarhecue
Business name: Tri County Temp Control Clothes dryer (gas)
Other:
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES°
City/ State/ZIP: Oregon City, 014 97045 Subtotal
Phone: (503) 557.2220 fax: (503) 557.0919 Minimum permit fee ($90.0
Plan review (25% of permit fee)
)
CCL3 lie.: 72623 State surcharge (12% of permit fee) „/1
1, QJ � r�' jrAL PERMIT FEE I 1dJ. �
+."c” L �, J Thi p application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: 1) MOM I Date: II* 112 • Pee methodology set by Tn- County Building Industry Service Board
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