Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2012 -00583
Date Issued: 11/08/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S103AB03000
Jurisdiction: Tigard
Site address: 12465 SW 114TH TER
Project: Distant Subdivision: WALNUT GROVE Lot: 18
Project Description: (1) furnace and (1) water heater installation
Contractor: SPECIALTY HEATING & COOLING INC Owner: DISTANT, DEBRA V
7500 SW TECH CENTER DR SUITE 130 12465 SW 114TH TERRACE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 620 -5643 PHONE: 503 - 524 -5248
FAX: 503 - 681 -0793 •
•
FEES
Specifics: Description Date' Amount
•
Furnaces < 100K BTU 11/08/2012 $46.75
Type of Use: SF Water Heater 11/08/2012 $23.32
Class of Work: ALT Type of Const: • 12% State Surcharge - Mechanical 11/08/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/08/2012 $19.93
Stories:
•
Fuel
Fuel Types:
Gas Pressure:
•
Total. $100.80
•
Required Items and Reports (Conditions)
•
•l
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: OK /41 u C H� / Dkt
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.
From: 11/07/2012 16:48 #091 P.002/002
Mechanical Permit A lic CEwED FOR OFFICE USE ONLY
City of Tigard N�� Q 7 2012 Date By: ��" PennitNo.: �/�./3
Date'By: I I - HEG �►a'o t/fp.:a
ss 13125 SW W Hall Blvd., Tigard, OR 97223
i = Plan Review
Phone: 503.718.2439 Fax: 503.5 1 11�f 11 fl.! Date; By: Other Permit:
Inspection Line: 5036394 l 75
T I G A R D .. I Date Ready, By: Suds: el See Page 2 for
Internet: www.tigard or.gov BUILDING DIVISION Notified/Method: ./.1(o Supplemental Information
n BUILDING DIVISION
OF ,WORK` COA'ANERCIAL FEE ±• SCHEIWI.E - .11SE.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.
'''; ;- .. ..:.. ; :': ;`;.'. . CATEGORY'_ OF, CONSTRUCTION'' r': 'r: ' :,.,:; ': '
- , ue: -
a Es -,
RESIDI�N'ragl: / FE _, _
/ LES 1- and 2-family dwelling g ❑Commercial /industrial El Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
_ ' ';;:JOB' SITE INFORMATION ; - LUGA'I' ION ",,`' . :::' _'. " : :'
, . ' ' '
Heating/cooling:
. ,. _ ... ... ` ' ' ' Air conditioning
Job site address: 2 4 v \ S (4 t.{ ' i ' - - (requires site plan showing placement) 46.75
City /State/ZIP: '` f C� Furnace 100,000 BTU (ducts'vents) / 46.75
T I , "77 L Z 3 Furnace 100,000+ BTU (ducts'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:
- : • DESCBIPTION.`OF' WORK .:- .:-> . Water heater r 23.32
Gas fireplace; insert 33.39
Flue vent for water heater or gas
fireplace 23.32
tt r ' ) � � Log lighter (gas) 23.32
N
V �" Wood /pellet stove 33.39
Wood fireplace /insert 23.32
Chirnneyiine :flue/vent 23.32
PROP.ERT.X ❑.TENANT, - Other _ 23.32
Name: ( -.a )l 01 e Environmental exhaust and ventilation:
Range hood/other kitchen
Address: equipment 33.39
City /StateiZIP: Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: ( ) S 4— S L Lis Fax: ( ) toilet compartments, utility rooms) 23.32
` Q' APPLICANT • __ ,- - , , D, CONfA CT PERSON,, Attic /crawlspace fans 23.32
—
Business name: Other 23.32
Fuel piping:
Contact name: 314.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wallsuspended:Unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail:
Range
. _. .. _ONTRACTQR . , - ,_. - .... . :_ _. Barbecue
Business name: Specialty Heating & Cooling, Inc Clothes dryer (gas)
Other
Address: 7500 SW Tech Center Dr #130 : MF471A1 , UCAL PER0IIT00 . . -
City /State /ZIP: Tigard, Or. 97223 Subtotal
Phone: (503) 620 -5643 Fax: (503) 598 -0718 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: 66578 CIL_ St ate surcharge (12% of permit fee)
\ n TOTAL PEmMs FEE /c0. Authorized signature: This permit application expires If a permit Is not obtained within n 18 18
0
days after it has been accepted as complete.
Print name: Andrea Dripps Date: ( 1 / - 7 J / L • Fee methodology set by Tri- County Building Industry Service Board
t: Buildng \Pcrmicsw- MEC "PermitApp.doc 03/07/12 440.46I2T(Ii'02COMWES)