Permit •
a CITY OF TIGARD MECHANICAL PERMIT
' — ' 8 COMMUNITY DEVELOPMENT Permit #: MEC2012-00526
T.I. GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/15/2012
Parcel: 2S103BB05800
Jurisdiction: Tigard
Site address: 12520 SW 124TH AVE
Project: Winkler Subdivision: BROOKWAY Lot: 58
Project Description: (1) gas furnace removal and replacement
Contractor: A ACTION APPLIANCE & HEATING INC Owner: WINKLER, L DUANE /MARIE B
18245 SW TV HWY 12520 SW 124TH AVE
ALOHA, OR 97006 TIGARD, OR 97223
PHONE: 503 - 649 -3524 PHONE: 971- 228 -8160
FAX: 503 - 649 -6095
•
- • FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/15/2012 $46.75
Type of Use: SF '12% State Surcharge - Mechanical 10/15/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/15/2012 $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: t kaL I / Permittee Signature: DM APPUM TI DL
•
.. 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.
i. Approved plans are required on the job site at the time of each inspection.
10/11/2012 16:37 FAX ZOO
Mechanical Permit Annli iii IVED FOR OFFICE USE ONLY
City of Tigard Received £0/ IS"' Z Permit No.: YEC.o1.Of - ■ 605 W
• 13125 SW Hall Blvd., Tigard, OR 9p 1 1 2012 Plan Review
: Phone: 503.639.4171 Fax: 503.59 1 Date/By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 �.�+� �y �iy!! �j�� Date R /B turfs: 10 See Page 2 for
Internet: www.tigard or.gov C i l 1 Vl 1tunny Notified/Method: 4 c Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CUECKL.
❑ New construction Ft dition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition • Other. mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT`-`/ SYSTE FEES*
Alb . • • 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
Multi For special information use checklist.
❑ y ❑ Master builder ❑ Other: • Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: Air conditioning
�a5ao s� Ia�� (requires site plan showing placement) 46.75
City/State/ZIP: Ot >sk (Q q - 23 Furnace 100,000 BTU (ducts/vents) I 46.75 , ,
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 boiler (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
V Q
h � A Gas fireplace 3339
�v r ej�-- Flue vent for water heater or gas
Q � � 0-1— fireplace
23.32
Log li ghter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
ROPERTY OWNER l ❑ TENANT Chimney/liner /fue/vent 23.32
Other 23.32
Name: our ) I A ) n Y Environmental exhaust and ventilation
Address: `� Range hood/other kitchen
(),A �_ rYt equipment 33.39
City /State/ZIP: Clothes dryer exhaust 3339
w '- q i.
Single-duct exhaust (bathrooms,
Phone. ) • toilet � Fax: ( ) toilet compartmrtmentss , utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawispace fans 23.32
Other. 23.32
Business name: F piping
Contact name: A'ACTION HEATING & A/C $14.15 for first four, $4.03 for each additional
18245 S.W. T.V. HWY 1 I -1.1A7
Furnace; etc.
Address: ALOHA, ORFGON 97006 Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name:
A- ACTION HEATING & A/C Clothes dryer (gas)
Other.
Address: 18245 S.W. T.V. HWY MECHANICAL PERM1'g`:FEES'
City/ State/ZIP: 35.±-\ ALUHA, UNEGUN 97006 Subtotal
Phone:A � - Fax: 503) j0 4 q y - p el - Minimum pemlit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: "21 � 3 Lo 9 State surcharge (12% of permit fee) ((��
Nib TOTAL PERMIT FEE 1 LJ�J� /
Authorized si a i . • �`— / I . a° This permit application expires if a permit is not obtained within 180
� days after It has been accepted as complete.
I Print name: „.Ja vk . Date: 1 O i)) A `2I ' Fee methodology set by Tri -County Building Industry Service Board
l:l Buildina\Pmnits\MEC- PrnnitAoo.doc 10/01/09 4404617r(11102/COM/WEB)