Permit CITY OF TIGARD MECHANICAL PERMIT
q
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00540
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/18/2012
Parcel: 1 S134CC04600
Jurisdiction: Tigard
Site address: 12421 SW WINTER LAKE DR
Project: Couch Subdivision: CAPSTONE Lot: 13 _
Project Description: (1) furnace replacement
•
Contractor: TRI COUNTY TEMP CONTROL INC Owner: COUCH, LESLIE
13150 S CLACKAMAS RIVER DR 12421 SW WINTER LAKE DR
• OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -2220 PHONE: 503 - 524 -0100
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
• Furnaces <'100K BTU - 10/18/2012 $46.75
Type of Use: SF 12% State Surcharge - . Mechanical 10/18/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/18/2012 $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: i , 4/' Permittee Signature: 0Al A APtrca t l
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 Applic E tVED, I.OR 01 11( I t'St. UNI.)
City of Tigard Received
DateB : 0 (g !lr M PenmtNo./,{ _, ,.....4 4 0 / ., r�5 ao
' 13125 SW Hall Blvd., Tigard, OR 9722®C 1 T 1 7 2012
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/ny. Other Permit:
I I c n It D Inspection Line: 503.639.4175 egg o F T Data Rcady/By: ® See Page 2 for
Internet: www.tigard- or.gov 1 11 , 1 ��� _ —r_„ Notified/Method - Supplemental Information lall
BUILDING TYPE OF WORK tYJ1�, COMMERCIAL FEE* SCHEDULE - USE-CHECKLIST
Mechanical permit fees' are based on the value of the work
New construction
❑ ®Add ition/alteration /replacement performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: $
® l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
- For sped& informwrun use checklist.
❑ Multi - family ❑Muster builder
0 Other: Description I Qty. I Fa. I Total
JOII SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 12421 OW winter C.LI/t1" D'. Air conditioning
(requires site plan showing placement) 46.75
City / State/ZIP: Ttgard C1122.3 Furnace 100,000 B'l'U ( ducts/vents) 1 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suile/bldgJapt. no.: I Project name: f teat pump 61.06
Cross street/directions to job site: 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
Flue /vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Tax map /parcel nu.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
QJ��/, Flue vent for water heater or gas
P { /jai f tt� �.� /1/O fireplace 23.32
t W Log lighterigas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
W PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent
�� Other: 23.32
(� t
Name: Environmental exhaust and ventilation
yyt� Range hood/other kitchen
Address: CJt �,' r f equipment 33.39
City /State /"LIP: Clothes dryer exhaust 33.39
�/� Fax: Single -duct exhaust (bathrooms,
Phone: (Eta)024- OUP! ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Atticicrawlspacc fans 23.32
Business name: Same as contractor
Other: 23.32
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: ( ) I Fax:: ( ) Water heater
E-mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: Tri County Temp Control Clothes dryer (gas)
Other:
Address: 13150 S Clackamas River Drive
MECHANICAL PERMIT FEES'
City /State/ZIP: Oregon City, OR 97045 Subtotal
Phone: (503) 557.2220 I Fax: (503) 557.0919 Minimum permit fee ($90.00)
- Plan review (25 %of permit fee)
�CCB lie.: 72623 State surcharge (12% of permit fee) 11//��//�� QQ �r
�!/ /fit / � / /�/� TOTAL PERMIT FEE b V l/ r 0 �/
Authorized signature: .I� ^�.a' i L (J / / This permit application expires if a permit is not obtained within ISO
days after It has been accepted as complete
Print name: VI one, mason Date: 10111112 I • Fee methodology sot by Tri -County Building Industry Servhx Board
Ilauilding \ennitt\MEC-PermilApp .don 10 /01/09 440 - 46171' ( I I/03/COM/wna)
I'd 096T86S20S :01 :W0dA d90 :TO 2202 -LT -100