Permit n CITY OF TIGARD MECHANICAL PERMIT
" • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00570
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/01/2012
Parcel: 2S112CB14700
Jurisdiction: Tigard
Site address: 15007 SW KENTON DR
Project: Rollins Subdivision: ASHFORD OAKS NO.3 Lot: 156
Project Description: (1) gas fireplace replacement and (1) flue /vent
Contractor: TRI COUNTY TEMP CONTROL INC Owner: ROLLINS, JACK
13150 S CLACKAMAS RIVER DR 15007 SW KENTON DR
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE: 503 - 557 -2220 PHONE: 503 - 639 -1064
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/01/2012 $46.75
Type of Use: SF FlueNent For Any of Above 11/01/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/01/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/01/2012 $19.93
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: Permittee Signature: a u /1/1 fl ij _ ,E it gefr... 4 .2.4e r___
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. �AT�
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.
. . , ,
, . RECEIV —
Me Permit Application 1` ('1' 1` 1(I I S'-11NI.1 .
}� g , Permit No .: r r ., ,y,r�t�
`J , of Tigard g Date./13y. ill I
CI I � Y �I µ /�► /a/
. •.; 13125 SW Hall Blvd., Tigard, OR 97223 OCT 31 20 ' Ian Review .
Other Permit:
II Phone: 503.639.4171 Fax: 503.598.1960 ' D1ue/By:
'r I u it n inspection Line: 503.639.4175 � T , ,. ,te Ready/By: hod:
ions. ® See Page tel Information •
Internet: www.tigard- or.gov OFT tifi
BU1101NG DWI i:. - - .
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, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION -
RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
® I - and 2- family dwelling ❑Commercial /industri¢I ❑Accessory building . For special Information use checklist. •
0 ❑ Master builder ❑ Other: Description 1 Qty. I Ea. Total
• JOB W 7 SITE INFORMATION
6 � n I AND LO v CATION � Heating/cooling
I� Ks ) , _ Air conditioning
Job site address: �(�r ` (requires site plan showing placement) 46.75
• City /State/ZIP: Tigard qi Furnace 100,000 BTU (ducts/vents) , 46.75
`J Furnace 100,000+ BTU ( ducts/vents) 54.91
Suite/bldg. /apt. no.: 1 Project name: Heat pump 61.06
Cross street/directlons to job site: Duct work 23.32
. H1dronic 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 i 23.32 _
Subdivision: Lot no.: Other. 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
1 :)f ow gas furnace �' �t urns e) Flue vent for water heater or gas
t /l h✓ fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent
PROPERTY OWNER ❑TENT Other: 23.32
Name: 1J tJ lO Ut1/15 Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment - 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone:) ( ?-• I044 Fax: ( ) toilet compartments, utility rooms) 23.32 ,
® APPLICANT ❑ CONTACT PERSON Atlic/crawlspace 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 '
Furnace, etc.
Address: G heat pump
City /State/ZIP: WalVsuspended/unit
Water heater
Phone: ( ) FIIx: ' ( ) Fireplace
E -mail: Range
CONTRACTOR Barbecue ,
Clothes dryer (gas) ,
Business name: Tri County Temp Control Other:
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES*
City /State/ZIP: Oregon City, OR 97045 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 557.2220 Fax: (503) 557.0919 Plan review (25% of permit fee)
CCB lie.: 72623 State surcharge (12% of permit tee) .
• TOTAL PERMIT FEE j� $O
This permit application expires if a permit is not obtained within 180
-
Authorized signature: 1 days after It bas been accepted as complete. .
Print name: VI c mason Date: 1 0/1112. (/ 2 I • Fee methodology set by Tri - County Building Industry Service Board
I lBuilding \Pcrmits∎MEC- PertoltApp.doc 10/01/09. 440. 46171(11 /02 /COMIWEI)
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