Permit CITY OF TIGARD MECHANICAL PERMIT
111 11 ° COMMUNITY DEVELOPMENT Permit #: MEC2013 -00076
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/05/2013
Parcel: 2S103BD03000
Jurisdiction: Tigard
Site address: 12780 SW 121ST AVE
Project: Yerby Subdivision: CARMEN PARK Lot: 1
Project Description: ,(1) gas furnace installation, (1) chimney liner and (1) gas line to furnace
Contractor: RA SCHWARZ HEATING & COOLING INC Owner: YERBY, MARK AND LUCY
15078 SE BRIGHTWOOD AVE 12780 SW 121ST AVE
PORTLAND, OR 97015 TIGARD, OR 97223
PHONE: 503 -668 -3399 PHONE: 503 - 803 -5738
FAX: 503 - 344 -4900
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 02/05/2013 $46.75
Type of Use: SF Chimney /Liner /FlueNent 02/05/2013 $23.32
Class of Work: ALT Type of Const: Fuel Piping 02/05/2013 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 02/05/2013 $10.80
Stories: Minimum Fee Adjustment - Mechanical 02/05/2013 $5.78
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 by calling 503.232.1987 or 1.800.332.2344.
1
Issued By: Permittee Signature: O i i PGICA 1 1 Dad
CaII 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.
02/9/2013 09:12 p T0: +1 (503) 5981960. FROM:5033999900 Page: 2
Mechanical Permit Ap , 1 o D ; I o O F IC LS 1 (J;.1 A
: .! .. " .,.: ' ' �� Received ' :
City of Tigard 17ate/n : S / 3 Si
permit No. /��1 - DOD? (o
Y d
13125 SW Hall Blvd., Tigard OR 1 0 Z013 Plan Review
n'. Phone: 503.718.2439 Fax: 503.59 Date/By: Other Permit:
L +i (Li n ii. Inspection Line: 503.639.4175 Date Ready/By: lurk. HI See Page 2 for
.2'-'. Internet: www.tigard- or.gov GIN OF TIGARD Notified/Method: / _ Supplemental Information
DING DIVISION _ �o
OF WORK COMMERCIAL FEE' SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
El New construction dition/alteration/ replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
' Value: $
TEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT /SYSTEMS FEES
d 2- family dwell in Commerciallindustrial ❑ Accessory building Forspedal [r(jonnation use checklist
u ti- family ❑ Master builder ❑ Other: Description I Qty. ! Ea. 1 Total
JOB S1TE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 12, go so (Z ( , „ (ems site plan showing placement) 46.75
�
� Pomace 100,000 BTU (ducts/vents) 1 46.75 (� "]S
CiCity/State/ZIP: L Qa/� t 223 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: �` I Project name: Heat pump
(requites 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 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/insert 33.39
OF 1 4.� �� _ . „ G.I '. Flue vent for water heater or gas 23.32
/ l/\.&( ad 'IYV Ct f /l Me, A C45 I tifte
Log L lax
1 Log lighter (gas) 23.32
ri■Q- ti 1-l' kOtCQ . Wood/pellet stove 33.39
Wood fireplace/insert 23.32
PROPERTY OWNER I ❑ TENANT Chirnney/liner /fluetvent
Other. 1 23.32 73 3 Z--
^ � � �� 23.32
Name: ^ Environmental exhaust and ventilation:
Address: 2;7 c1UD SO IZ { 01 ' j'v` Range hood /other kitchen
equipment 33.39
City /State/ZIP: Clothes dryer exhaust 33.39
4'3) �3_L73 a ( 9 /)(
Single-duct compartments, utility Phone: 7' Fax: , ), ! toilet corn enis, utility rooms) 23.32
= PPLICANT ID CONTACT / PERSON Attic crawlspace fans 23.32
Business name:
.4q � ��.1/"L PQIU L I t &v(i '. Fuel : t 23.32
piping:
Contact name: - " j / ! jai. 514.15 for first tour, 54.03 for each additional
'n. Furnace, etc. 1 1
Address: { VD-7 �SE zeta,. C Gas heat pump
City /State/ZIP: 1wlcK/at2 1 (»' 1 P 7 Wall/suspended/unit heater
Phone: (5'p3 ) 9.1.4 9-f)13 I Fax:: (S() _ L O o Water heater
/_ Fireplace
E-mail: rI (st.) a/Z ht�c k9 i C.CV 1 Range
CONTRACTOR � C4�ItV� �
Other:
ate
` c _ u1 1 Clothes dryer (gas)
Business name: Y &,,,,,,,,,,,I.,4,. �p Address: I r l �/ 1. 2 S f' W lel At/ `' s MECHANICAL PERMIT FEES*
City /State/ZIP: R I c 2 L . C k L e � 61 1 Xg 7 Subtotal , 7...2.._ t Minimum permit fee ($90.00) 0,0C)
Phone: (5o3) (OVA 3 3q I Q Fax: ) 34-11-4.1-q OD Plan review (25% of permit fee) -ttf-
CCB lie.: / 4 2,3 5 3 t I 1 01144' State surcharge (12% of pemtit fee)
l TOTAL PERMIT FEE
This permit application expires if a permit is not obtain e d' o �m 180
Authorized signature: V
1 days after it has been accepted as complete.
Print ntun ik (/2 Date: 2",/ 4. 13 ' Fee methodology set by Tri- County Building Industry Service Board .
IABuila M
ioglPeanits \EC- PermitApp.doe 03/07/12 446-017T(11/02/COM/WEB) 1vv /0/') . -
02/4/2013 04:12 p TO: +1 (503) 5981960 FROM:5033444900 Page: 1
- Fax Transmission
To: City of Tigard From: R. A. Schwarz Heating and Cooling, Inc
Fax: +1 (503) 5981960 Date: 2/4/2013
RE: Mechanical Permit and credit card form. Pages: 3
Comments:
Please see attached mechanical permit and credit card form for 12780 SW 121st Ave, Tigard, Or 97223.
Thank you,
Deborah Schwarz
R.A. Schwarz Heating and Cooling, Inc
503 - 668 -3399
fax 503 - 344 -4900
email: rick@schwarzheating.com
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12780 SW 121ST AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
02/21/2013 00:00
MEC2013-00076
FAIL
No access 9:15 am
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12780 SW 121ST AVE, TIGARD, OR, 97223
Residential - Mechanical
610 Gas Line
02/21/2013 00:00
MEC2013-00076
FAIL
No access 9:15 am
Violation Summary:
Inspector Contractor