Permit V CITY OF TIGARD MECHANICAL PERMIT
s .. COMMUNITY DEVELOPMENT Permit #: MEC2013 00014
T I CARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 01/09/2013
Parcel: 2S102CC00314
Jurisdiction: Tigard
Site address: 13530 SW CRESMER DR ,
Project: Pitelko Subdivision: CRESMER HILLS Lot: 13
Project Description: (1) A/C amd (1) furnace replacement
Contractor: TRI COUNTY TEMP CONTROL INC Owner: PITTELKO, TINA M
13150 S CLACKAMAS RIVER DR 13530 SW CRESMER DR
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE 503 - 557 -2220 PHONE 503 - 620 -3864
FAX 503 - 557 -0919
FEES
Specifics: Description Date Amount
Air Conditioning 01/09/2013 $46.75
Type of Use: SF Furnaces < 100K BTU 01/09/2013 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 01/09/2013 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types
Gas Pressure
Total $104 72
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.
9 I Issued By: �,j I / 4-' - Permittee Signature: e�1 CA7 (D � —
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.
RECEIVED
Mechanical Permit Application ttttt l 1 1( I 1a1 ()NI 1
1111 City of Tigard JAN 0 9 2013 p ! q 1 3 Permit Nod of 3 --(WO ( q • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
n Phone: 503.639.4171 Fax: 503.598.190� Date/By: Other Permit:
1 f t.i A 1i 1 , Inspection Line: 503 639.4175 B(ii r,uM/*�+_>t1:T{Tl'� ' ' Date steady /By t la See Page 2 for
Internet: www.tigard- or,gov y Ifi+lsL�u Notified/Method. ' I 6 I Supplemental Iaformation
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USECIIECKLIST
❑ 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
. For special lgforrnallon use checklist.
❑ Multi- family 0 builder ❑Other:
Description 1 Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
_
Job site address: l� C �'"• Air conditioning t
� %I j (requires site plan showing placement) ` 46.75
City /State/ZIP: f 1 Q I eM� Furnace 100,000 BTU (ducts/vents) 1 46.75
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldgJapt. no.: Project name: Heatpump 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
-. - 'i` Flue /vent for any of above 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
q° Flue fig ht for water heater or gas
PC-PIOT flitn dk fireplace 23.32
Log og lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/Iiner /fue/vent
Other: 23.32
PROPERTY OWNER I ❑TENANT 23.32
Name: 1 na, Pit ko Environmental exhaust and ventilation
a�
, Range hood/other kitchen
Address: Bl 1Iv equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Phone: 'e
Single-duct comp rtm en t s (usury rooms) s,
F es: ( ) toilet compartments, utility ro 23.32
® APPLICANT ❑ CONTACT PERSON Attidcrawlspace 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
Address: Furnace, etc.
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
E-mail: Fireplace
Range
CONTRACTOR Barbecue
- Clothes dryer (gas)
Business name: Tri County Temp Control
Other:
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES*
City/ StaterZIP: 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 Slate surcharge (12% of permit fee)
e � ! T OTAL PERMIT FEE w�IS Authorized signature: Th is pe rmit application expires if o permit Is not obtained within 1 0
days after it has been accepted as complete.
Print name: D (arc mason I Date: I tit 0 1 • Fee methodology set by Tri-County Building Industry Service Board
l lauitdlne PennasMMEC.PmoitApp doe 10/01/09 440 -4617T (11 /02/COM/WEa)
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ru SITE PLAN
Address: 0050 OW Omen( Jurisdiction:
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