Permit CITY OF TIGARD MECHANICAL PERMIT
• a COMMUNITY DEVELOPMENT Permit #: MEC2013 -00409
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/18/2013
Parcel: 2S112BD09700
Jurisdiction: Tigard
Site address: 14657 SW 78TH AVE
Project: Golledge Subdivision: BRITTANY MEADOWS Lot: 33
Project Description: Install A/C. Placement of A/C or heat pump units must comply with the manufacturer's clearance requirements.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: GOLLEDGE, CYNTHIA P
13150 S CLACKAMAS RIVER DR BOGAN, REGINALD R
OREGON CITY, OR 97045 14657 SW 78TH AVE
TIGARD, OR 97224
PHONE: 503 - 557 -2220
PHONE: 503 - 312 -2418
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Air Conditioning 07/18/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/18/2013 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 07/18/2013 $43.25
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 by calling 503.232.1987 or 1.800.332.2344.
OF
g p�.J f . / ' / 9 L Cdr70�
Issued By: j Permattee Signature: /
•
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.
JUL -17 -2013 11:56A FROM: E i,
70:5035981960 P.1
Mechanical Permit Applicati V +Olt OF 1 I'SI.. ON1.) . •
Received
City of Tigard ,f UL 1 7 20 Date/By: - 7 /7 :'� Permit N VYa°2oi3 DOJO
1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
-t 1G A it i) Inspection Line: 503.639.4175 CITY OF TIGARD Date/By.
Date Ready/By: EIS ®See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ® Addition /alteration /replacement Mechanical permit fees* arc 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
Multi M builder For special information use checklist.
El y ❑ 0 Other:
Description I Qty. I Es. I Total
JOB SITE INFORMATION AND LOCATION Heatinp/eooling
lob site address: vik 51 4 v T Furnace r conditioning '
I Q i site plan showing placement) 46.75
i Fu
City /State /ZIP: ra I3T
100,000 BT U ( ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 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: Lot 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
1 vi jam (1 air fireplace 23 32
1 ` � J �, ( ,� ( �(,�l ► [(i[ N Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace/insert 23.32
PROPERTY OWNER 12 TENANT Chimney/liner/flue/vent 23 32
)��,,��JJ ,, Other: 23.32
Name: th !a. Coo[ 4t- (j Environmental exhaust and ventilation
Address: game, "�� Range hood /other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
AIZ l �� Single -duet exhaust (bathrooms,
Phon ) Z. Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic /crawlspacc 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
Fireplace -
E -mail: Range
CONTRACTOR Barbecue
Business name: Trd County Temp Control
' Clothes dryer (gas)
Other.
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES*
City /State/ZIP: Oregon City, OR 97045 Subtotal
/ Phone: (503) 557.2220 Fax: (503) 557.0919 Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lie.: 72623 State surcharge (12% of permit fee) /oo
TOTAL PERMIT FEE i
ka<0
This permit application expires it a permit is not obtained within 180
Authorized signature: �� days after it has been accepted as complete.
h I
Print name: Q. l , Kean Date: 1/22/1,6 • Fee methodology set by Tri- County Building Industry Service Board
I\ 9uirding \PermiuVNCC- PcrmitApp.doc 10/01/09 440- 4517T /02/COM/WED)