Permit CITY OF TIGARD MECHANICAL PERMIT
s , COMMUNITY DEVELOPMENT Permit #: MEC2012 -00547
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012
Parcel: 1 S133DD03300
Jurisdiction: Tigard
Site address: 12611 SW BRIDGEVIEW CT
Project: Cook Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 72
Project Description: (1) furnace replacement
Contractor: SPECIALTY HEATING & COOLING INC Owner: COOK, JOHN
7500 SW TECH CENTER DR SUITE 130 12611 SW BRIDGEVIEW CT
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 620 -5643 PHONE: 503 - 579 -3122
FAX: 503 - 681 -0793
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/22/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/22/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/22/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.198 or 1.800.332.2344.
Issued By: lal
b i t 4 7 Permittee Signature: O01,1 4 PP 1 ��
Y Call 50 by 7:00 a.m. for the next available inspection date. �
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
From: 10/22/2012 09:06 #024 P.002/002
Mechanical Permit ApplicaRECEIVED FOR OFFICE USE ONLY
CI of Ti and Received P ermit N
III h' g Date. By: to 0 P A- sr t ''ie.100, eir)C
a 13125 SW Hall Blvd -, Tigard, OR 97223 O CT 2 2 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permi
Inspection ection Line: 503.639.4175 Date'Re
T I GA
RD p CITY J �1C I I ]Qn Date Read}; By: tub. Supplemental See Page 2 for
Internet: www.tigard V1 1 �1r rwwu+ Notified:Method: 11 Supplemental Information
BUILDING DIVISION t l Co Y
- COMMERCIAL " -,E W:,•$CIIEDULE?', USE'CIEECKLIST -:i : ,
— 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.
CA T E G OR Y;.: C • -' • - JCTION , 7 { >'.'; -. ;; - ; >:_: Value:
.:. RESIbENTIAL1QUIPMEN0 SYSTEMS, F_CES° :` ' .. =
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special Information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea. 1 Total
JbB'S)GTE,.IN FORMATION? AND;LOCATION' ' l.1 `•'-. c " =k : i `` %;'" Heating/cooling:
Arrcondlhonmg
Job site address: I Lk f , c W j2 r• U� t' d e e.") C f (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducu'vents) 1 46.75
City /State /ZIP:
Ll. � ` 7 2_1's Furnace 100,000+ BTU (doers vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing placement) 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: Lot no.: Flue/vent for any of above 23.32
Other 23.32
Tax map /parcel no.: Other fuel appliances:
< <
DESCRIPTION OF, )1'VbRK' : - ,..-: , Water heater 23.32
Gas fireplace'insert 33.39
Flue vent for water heater or gas
1 fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner /flue/vent 23.32
OPERTY OWNER_ ' :: t ❑ -T ENANT.a ` '-:'::•'::..:::`,.%'. Other. 23.32
Name: JOIN 6. D t Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City/State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) ) ) `7..- 3 ( Z Fax: ( ) toilet compartments, utility rooms) 23.32 _
-- .. ...a; APPLICANT r • ..• ;D CONTACT PERSON." ' :' .` • : Attic/crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping:
Contact name: $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; ; , , : ='''...-:: : :' •' Barbecue
Business name: Specialty Heating & Cooling, Inc Clothes dryer (gas)
Other
Address: 7500 SW Tech Center Dr #130 ":;MECHANICALPERMIITFEES *, _ „
City /State/ZIP: Tigard, Or. 97223 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 620 -5643 Fax: (503) 598 -0718
Plan review (25% of permit fee)
CCB lie.: 66578 State surcharge (12% of permit fee)
7 TOTAL PERMIT FEE WO -e0
T his permit application expires If a permit is not obtained within I80
Authorized signature: - — days after It has been accepted as complete.
Print name: Andrea Dripps Date: l 1 2_i t i t v Fee methodology set by Tri- County Building industry Service Board
I., Building 1PermitsMEC- PermitApp.doc 03, 440 -4617T (11 OVCOM. -WEB)