Permit •
CITY OF TIGARD MECHANICAL PERMIT
• ''1 a '` COMMUNITY DEVELOPMENT Permit #: MEC2012 -00612
T IGAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/28/2012
R
Parcel: 2S103DC00803
Jurisdiction: Tigard
Site address: 13530 SW 115TH AVE
Project: Mills Subdivision: VIRGINIA ACRES Lot: 1
Project Description: Replace existing gas furnace
Contractor: ABLE HEATING & COOLING LLC Owner: MILLS, ROBERT W & IRENE C
16285 SW 85TH AVE #105 13530 SW 115TH AVE
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 579 -2250 PHONE: 503 - 624 -2343
- FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Furnaces :< 100K BTU 11/28/2012 $46.75
Type of Use: SF 12 %State Surcharge = Mechanical 11/28/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/28/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 ication C: ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir ct questions to O C , . . 503.232.1987 or 1.800.332.2344.
Iss d By: , Permittee Signa � / `, g `
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.
Mechanical Permit A licati ECElVE l FOR OFFICE I ONLY
City of Tigard Received
Date/By: /i a 8 /A I Permit No.: Il ie,90ia- p/0i
' 13125 SW Hall Blvd., Tigard, OR 97223 NOV 2 8 2012 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960
TIGARD Inspection Line: 503.639.417 CITY TIGARD ��Y Other Permit:
Internet: wuw.tio CITY OF I I�AT11J Dale R`ady/By: Jung EI See Page 2 for
sand -0r.gov Notified/method: Supplemental information
BUILDING DIVISION _
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST 1
❑ New construction Mechanical permit fees* are based on the value of the work
® Addition /alterationireplacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
® I- and 2 dwelling RESIDENTIAL EQUIPMENT I SYSTEMS FEES'
g ❑ Commercial/industrial ❑ Accessory building Forspectal information use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description
Qty" I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 13530 SW 115 AVE. (requires site plan showing placement) 46.75
City/State/ZIP: TIGARD, OR. 97223 Furnace 100,000 Bill (ducts'vcros) 1 46.75 46.75
Furnace 100,000+ BTU (ducts/vents) 5 4.91
SuitelbldgJapt. no.: I Project name - MILLS Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 2332 ,
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 2332
Unit beaters (fuel -type, not electric),
in -wall. in-duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Other: 2332
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
REPLACE EXISTING GAS FURNACE Gas frreplacc/ir 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 2332
Wood /pellet stove 3339
Wood fireplace /insert 23.32
• ■i PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
■
Other. 23.32
Name: ROBERT AND IRENE MILLS
Environmental exhaust and ventilation:
Address: 13530 SW 1 158 AVE. Range hood/other kitchen
equipment I 33.39
City/State/ZIP: TIGARD, OR. 97223 Clothes dryer exhaust 33.39 ,
P} : ( )624 -2343 Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 2332
Business name:
Other: 23.32 ,
Contact name: Fuel piping:
S14.15 for first foam 5403 for each additional
Address: Furnace. etc. I
Gas heat pump
City / State/ZIP:
Wallisuapended/unit heater
Phone_ ( ) Fax: : ( ) Water heater
Erman: Fireplace
' Range
CONTRACTOR Barbecue '
Business rare: ABLE HEATING & COOLING LLC Clothes dryer (gas)
Address : 16285 SW 85 AVE. SUITE 105 Other:
MECHANICAL PERMIT FEES*
[ City / State/ZIP: TIGARD, OR 97224 Subtotal 46.75
Phone: (503) 579 - 2250 I Fax: (503) 620 Minimum permit fee ($90,00) 90.00
Plan review (25% of permit fee)
CCB lie.: 189392 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100"80
Authorized signature: This permitappLcetioa expires if a permit is not obtained within 180
i days after it has been accepted as complete.
Print name: KELLY TE Date: 11 - 28 - 12 • Fee methodology set by Tti- County Building Industry Service Board
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