Permit y CITY OF TIGARD MECHANICAL PERMIT •
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• a ' COMMUNITY DEVELOPMENT Permit #: MEC2012 -00545
T I G ; A D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/22/2012
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Parcel: 2S109BA05700
Jurisdiction: Tigard
Site address: 13750 SW MISTLETOE DR
Project: Gregory Subdivision: HILLSHIRE SUMMIT NO.2 Lot: 43
Project Description: (1) gas furnace installation
Contractor: ROTH HEATING & COOLING Owner: GREGORY, CANDACE
PO BOX 1265 13750 SW MISTLETOE DR
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 266 -1249 PHONE: 503 - 522 -8005
FAX: 503 - 266 -3478
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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 $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law, All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
• Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
• Issued By: tkt-a31- Permittee Signature: Oki AP P4 CA-To
,
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
OCT -19 -2012 FRI 02:15 PM � FAX NO. 5032663478 P. 0
Mechanical Permit Appli FOR OFFICE I SE ONLY
City of Tigard OCT 2 2 2012 Received Permit No.:
: r 1 1 3125 SW Hall Blvd., Tigard, OR 97223 P Review
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• Phone: 503.718.2439 Fax: 503.59 �t � OFTIGABD Data/By; OtherPenniC
T I G AR D Inspection Line: 503.639 � G S , A )aria: nte Ready/By: la Seo Page 2 fur
InternetInternet! www,tigard- or.gov Notilied/Method: at Supplemental Information
:. ... :: : .rfVPE : OF :WORK '. • ' .. •:�: ` : :.CO.MMERCIAL FEE :sellD.1)1X: USE',CHE.CKLI$T.:• •
' Mechanical permit tbcs* 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
' ' CATEGORY' OF • CONSTRUCTION' . ..
Value: $ • ' ' : RESIDENTIAL CQtaintEN11 / SY5rBl1fS Fi E9" : • ; •• .,
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special Information use checklist.
0 Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea. 1 Total
JOB SITE INFORMATION. AND „VOCATION " .. • ', Heating /minting:
Air conditioning
Job site address: 13750 SW Mistletoe Or (requires site plan showing placement) 46.75
City/State/ZIP: Tigard OR 97224 Furnace 100.000 BTU (duets/vents) I 46.75 46.75
Furnace 100.000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt, no.: Project name: G regory/36898 Heat pump 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;WOR* • ; ... ; ' . Water heater 23.32
installation of gas furnace Gas fireplace/insert 33,39
_ Flue vent for water heater or gas
fireplace , 23.32
Log lighter (gas) 23.32
Wood/pellet stove _ 33.39
Wood fireplace/insert 23,32
' •® PROPERTY; OWNER; : ! : i .: ' : . '1 •:: : ! ::,0; .I'ENAN'f �..
finer /flue/vent 23.
... umneyA'
Other: 23.32
Name: Candace Gregory Environmental exhaust and ventilation; _
Address: 13750 SW Mistletoe Dr Range hood/other kitchen
equipment 33,39
City /State/Z1P: Tigard OR 97224 Clothes dryer exhaust 33.39 ,
Single -duet exhaust (bathrooms,
Phone: (503)522 -8005 Fax: ( ) toilet compartments, utility rooms) 23.32
' . ' . .APPLICANT., . „ „ : ,Q CON'1'Ac ..PERSON , Attic /crawlapuce fans 23.32
Business name: Ruth Heating and Cooling Other; 23.32
--• Fuel piping:
Contact name: Angela McGraw $14.15 for first four; $4.03 for each additional
Address: 6990 S Anderson Rd Furnace, etc.
Gas heat pump
City /State/ZIP: Canby OR 97013 Wall/suspended/unit heater
Phone: (503) 266 -1249 Fax: : (503) 266 -3478 Water heater
— Fireplace
E -mail: angelam @ruth- heat.eoln Range
.: ' • ...: , : ,. .. COT TRACT.Oa . • . .
Barbecue _
Business name: Roth Heating and Cooling Clothes dryer (gas)
- Other,
Address: 6990 S Anderson Rd !..'' '
:: M�EC tlalu><cnl:rct�►71a�I�Ers
City/State /ZIP: Canby OR 97013 Subtotal 46.75
Phone: (503) 266 -1249 Fax: (503) 266-3478 Minimum permit foe (590.00) 00,00
Plan review (25% of permit fee)
COB lie.; 14008 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 140.80 •
Authorized signature: This permit applirartion expires if a permit a not obtained within 180
g A . . i. I , ! ' _ .. A A days after it has been accepted as tomplet
Print name: Angela "raw 1 Date: 10/19/12 • Feo methodology net by Tri-County Building Industry Service Board
1.11tnildIng erml aMEC- PermitApp,doe 07/07/12 440- 46177(I t/a 2 2ICOM/WPH)
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