Permit •
CITY OF TIGARD • MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: MEC2012 -00606
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/21/2012
Parcel: 1S 134CB 10201
Jurisdiction: Tigard
Site address: 12476 SW EDGEWATER CT
Project: Donivan Subdivision: MILL VIEW Lot: 2
Project Description: (1) furnace replacement
Contractor: ABLE HEATING & COOLING LLC Owner: DONIVAN, ETTA A
16285 SW 85TH AVE #105 12476 SW EDGEWATER CT
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 579 -2250 PHONE: 503 - 590 -3278
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/21/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/21/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/21/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
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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: .��r,WIXY Permittee Signature: a A ppt iC H / r0,
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.
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Mechanical Permit A licatio t3 Tigard EfVE Date/By: ll � t�t�
FOR FFU E t ONI,I
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Ci of Ti all- � � atdv >( 1 Z S< Permit N o. it)-' OO
13125 SW Hall Blvd., Tigard, OR 97223 NOV 21 2012 Plan Review
. Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Da Dale/By.
l I G A It i) Inspection Line: 503.639.4175 ,, OF TI GAR RaadyfBv emu. El See Page 2 for
CITY Internet: www.tigard-or.gov I ( Noti6edmtethod: 'f a Supplemental Information
BUILDING DIVISION
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: S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special tnfonrmrien use chherJdst
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 12476 SW EDGEWATER COURT (requires site plan showing placement) , 46.75
Furnace 100,000 BTU (ducts/vents) 1 46.75 46.75
City/ State/ZIP: TIGARD, OR 97223 Furnace 100,000+BM (duets/vents) 54.91
SuitefbldgJapt. no.: I Project name: DONIVAN Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic bet water system 2332
Residential boiler (radiator or
hydraulic) 23.32
Unit heaters (fuel -type, not electric).
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I no : Flue/vent for any of above 2332
Lot Other. 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
REPLACE EXISTING CAS FURNACE Gas f vent f for w 3339
Flue vent for water heater or ps
fireplace 2332
Log lighter (gas) 2332
Wood/pellet stove 3339
Wood fireplace /insert 2332
® PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
Other 2332
Name: ETTA DONIVAN Environmental exhaust and ventilation:
Address: 12476 SW EDGEWATER COURT Range hood /other kitchen
equipment 33.39
City /State/ZIP: TIGARD, OR 97223 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)590-3278 Fax: ( ) toilet compartments. utility rooms) 2332
❑ APPLICANT ❑ CONTACT PERSON Attie/crawlspace fans 2132
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 •
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Phone: ( ) I Fax: : ( ) Water heater ;
Fireplace 1
E -mail: Range
CONTRACTOR Barbecue
Business name: ABLE HEATING & COOLING LLC Clothes dryer (gas)
Otter.
Address: 16285 SWW 85 AVE. SUITE 105 MECHANICAL PERMIT FEES*
City / State/ZIP: 77GARD, OR. 97224 Subtotal 46.75
Minimum permit fee ($90.00) 90.00
Phone: (503) 579 -2250 I Fax: (503) 620 -3980 Plan review (25% of permit fcc)
CCB lie.: 184392 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80
This permit app5eatlan expires If a permit Is not obtained within 180
Authorized signature: ! days after it has been accepted as complete.
Print name: KELLY WIO21ge,
I Date: 11 -21 -2012 1 • Fee methodology set by Tri- County Building industry Service Board
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