Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit#: MEC2014-00236
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/19/2014
Parcel: 2S 103C B07100
Jurisdiction: Tigard
Site address: 12392 SW HOLLOW LN
Project: KINTIGH Subdivision: QUAIL HOLLOW-EAST Lot: 20
Project Description: A/C installation. Placement of the NC unit must comply with manufacturer's clearance requirements.
Contractor: BULL MOUNTAIN MECHANICAL Owner: KINTIGH,JACKIE
6520 ROSEWOOD ST 8949 SW BELLFLOWER ST
LAKE OSWEGO, OR 97035 TIGARD,OR 97224
PHONE: 503-612-6677 PHONE:
FAX: 503-692-3084
FEES
Specifics: Description Date Amount
Air Conditioning 05/19/2014 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 05/19/2014 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 05/19/2014 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ' Permittee Signature:
- —
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Appliczl__,,n ..V ..OR OFFICE USE ONLY
i 11,1 1 �l Received
City of Tigard �� Date/By: .7 I I"( r7 PermitNo.: `��_ _' _,,a tit• 13125 S W Hall Blvd.,Tigard,O,
Plan Review
' s Phone: 503.718.2439 Fax: 50' 't T'1 0 Date/By: Other Permit:
T I G A F [7 Inspection Line: 503.639.4175 Py 1 0,�, ���` Date Ready/By: BE ® See Page 2 for
Internet: www.tigard-or.gov Y` 1 V Notified/Method: Supplemental information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction t1.Addition/alteratiorilreplacement performed. Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
Multi-family Master builder ❑Other Description I Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
- ' 1 Air conditioning 1 46.75 40.413
Job site address: 19, 670,7 S Ro f(UGC L e Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: It . a P• 11/73 Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: l 1 ; AG Heat pump 61.06
Duct work 23.32
Cross street/directions to job site: Hydronic hot water system 23.32
' J J Residential boiler(radiator or
W I y1 C Neu O /c J IT'D((Olin 144e hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
i n.Izt(l a e fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove _ 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
PROPERTY OWNER ❑ TENANT Environmental exhaust and ventilation:
Name: -1,,,e Ke h.' l t Range hood/other kitchen
�J,}1 equipment 33.39
Address: (7,41 ' ` u) ((I0 e Clothes dryer exhaust 33.39
City/State/ZIP: T) a P'� , vttv ( 4 yy1 Single-duct exhaust(bathrooms,
(�a� �(���� I ( toilet compartments,utility rooms) 23.32
Phone: U ) Fax: ) Attic/crawlspace fans 23.32
1-APPLICANT ❑ CONTACT PERSON Other: 23.32
j�� • u Fuel piping:
'�
Business name: At I I M O&4 HI(r Ilmillyr. $14.15 for first four;$4.03 for each additional
Contact name: ` t 4.- C OF/ �(,(, p. A Furnace,etc.
Address: /s�_ _ forte/4000A ,Dt Gas heat pump
7v�� �C Wall/suspended/unit heater
City/State/ZIP: I/aYe P/[0, D Ol loj G'i Water heater
Phone:(9-Cj) O I G' 04 q jlJ{ Fax::(�fj/) fiery m Fireplace
n'^,' T ! �� Range
E-mail: (yl f (V ►M 11 W1 ot. (f't well. ('6�+'1
+��" Barbecue
/���� CONTRACTOR Clothes dryer(gas)
Cam°" Iri (tikt ) Other:
Business name: MECHANICAL PERMIT FEES*
Address: Subtotal
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( )
State surcharge(12%of permit fee)
CCB lie.: (9 I N TOTAL PERMIT FE' Q•(?1)
, VP This permit apps afte n expires if a permit is not r rained within 1:
days afte a accepted as corn,lete.
Authorized signature: I , • Fee methodology set ri/A, )l In •ce Board
Print name: Date: 'WI 4 Ilagii IA : Pill
1:Building\Permit s MFC_PermitApp_040I 13.doc 440-46171(11'02'COM•WEB)