Permit y v CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00626
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2012
Parcel: 2S 111 CC08800
Jurisdiction: Tigard
Site address: 10110 SW SUMMERFIELD DR
Project: Callahan Subdivision: SUMMERFIELD NO.2 Lot: 115
Project Description: (1) heat pump installation ductless mini -split
Contractor: TRI COUNTY TEMP CONTROL INC Owner: CALLAHAN, DANIEL
13150 S CLACKAMAS RIVER DR 10110 SW SUMMERFIELD DR
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE: 503 - 557 -2220 PHONE: 503 - 746 -6992
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Heat Pump 12/03/2012 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 12/03/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 12/03/2012 $28.94
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 b y calling 503.232.1987 or 1.800.332.2344.
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Issued By: ^ /y/ / I i/ J Permittee Signature: Ok P' PPLi CH/y�ON
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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.
DEC -3 -2012 • ,10:05A FROM: 70:5035981960 P.1
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Mechani Permit ADDlicat Lt)IrOI'l l( I. rS1 • c) NI.1
RECEIVED Received / .A
City of Tigard Date/By: /a-/ /13,_ W Permit No.:ge CiaOfex.- 004, 4.
13125 SW HaII Blvd., D
Tigard OR 97223
DEC 3 2012
d • Phone: 503.639.4171 Fax: 503.598.1960 Plan Review atelBy: Other Permit:
I t,t, A It 0 Inspection Line: 503.639.4175 CITY of TIGARD unto Ready/By' tutu SI See Page 2 for
In ternet: www.tigard- or.gov V OF TIGARD Notified/Method: 'T) Cp Supplemental Information
DUILDtNG DIVISION
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
❑ New construction ® Addition/alteration/replacement Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1 -and 2-family dwelling RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
® y g ❑ Commercial /industrial ❑ Accessory building
. For special igjormatlon use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
ow py�c� `/�p� Air conditioning
Job site address: I I I Q e Ytf �(,m1.� -� �n v V (requires site plan showing placement) 46.75
City /StateiZEP: T 4124 _ Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: I Project name: . '
Heat pump 61.06
Cross streeUdirections 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: _ l L ot no.: Flue /vent for any of above 23.32
Other: ' 23.32 .
•
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Flue vent for water heater or gas
In tI, dui mini -€flit fireplace 23.32 ,
1 0. 2t Wood/pellet stove 33.39
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: X1 Y) (1,t ohm Environmental exhaust and ventilation
i hood/other kitchen
Address: equipment 33.39
City /State/ZIP: . Clothes dryer exhaust 33.39
(6� 7410^-024C12,, toilet Single-duct-exhaust comp tments compartments, utility o
Phone: ) Fax: ( ) compartmsility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic erawlspace fans 23.32 •
Other: 23.32
Business name: Same as contractor Fuel piping;
Contact name: Diane Mason $14.1S for first four; $4.03 for each additional
Furnace, etc. ,
Address: Gas heat pump _
City /State/ZIP: Wall/suspended/unit heater •
Fax: Water healer ,
Phone: ( ) ( ) _. , 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 /Slate /ZIP: Oregon City, OR 97045 Subtutai
Minimum permit fee ($90.00)
Phone: (503) 557.2220 Fax: (503) 557,0919 Plan review (25% of permit fee) _ it
COI lie.: 72623 State surcharge (12% of permit fee) Io0.�d
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: X414 days after it has been accepted as complete.
• I Print name: ((n[, mason Date: 7 2,,, , • Foe methodology set by Tri - County Building Industry Service Board
I mn ;dino \Permin\MEC- PefmiIADDdoe 10/01/09 , 440.4617T (1U0]JCOM/WEB)
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DEC-372012 10:05A FROM: TO:5035981960
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