Permit CITY OF TIGARD MECHANICAL PERMIT
111 '' COMMUNITY DEVELOPMENT Permit#: MEC2015-00646
T EGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/23/2015
Parcel: 25 110AB00900
Jurisdiction: Tigard
Site address: 14255 SW 112TH AVE
Project: Lee Subdivision: COLE'S ACRES Lot: 6
Project Description: Replace furnace,venting of bath fan,clothes dryer&range hood.
Contractor: ASSURED AIR COMFORT INC Owner: LEE, MICHAEL J
20170 S MAY RD 14255 SW 112TH AVE
OREGON CITY,OR 97045 TIGARD, OR 97224
PHONE: 503-880-8434 PHONE:
FAX: 503-723-7153
FEES
Specifics: Description Date Amount
Furnaces< 100K BTU 09/23/2015 $46.75
Type of Use: SF Range Hood/Other Kitchen 09/23/2015 $33.39
Class of Work: ALT Type of Const: Clothes Dryer Exhaust 09/23/2015 $33.39
Occupancy Grp: Single Duct Exhaust(Bathrooms,Toilet, 09/23/2015 $23.32
Stories: Utility Rooms)
12%State Surcharge-Mechanical 09/23/2015 $16.42
Fuel
Fuel Types:
Gas Pressure:
Total $153.27
Required Items and Reports(Conditions)
This permit is regulations pe t s issued subject to the regu ations 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
Utili 'o i ica i. -nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
• direct questions to O► C b -fling 503.232.1987 or 1.800.332.2344.
ssued 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 A lic 1 1,11 t11 I It I �l (,' I ,
City of Tigard EjVEI� Received 9} - �J�n . ,,��0 -
7 Permit No.: W] C_
III
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 Other Permit:
Inspection Line: 503.639.4175 S °P 2 3 2015 Date/By:
1 I ci t1 R I) Date Ready/By: Juris. 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
all(OFr l l( ARl)
TYPED'��O V dir1S101! COMMERCIAL FEE* SCHEDULE—USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction ®Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL mums:.ZN1T/SYSTEMS FEES*
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special Information use checklist.
❑Multi-family ❑Master builder ❑Other: Description 1 Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: 14255 SW 112th Furnace 100,000 BTU(ducts/vents) J 46.75
City/State/ZIP:Tigard Furnace 100,000+BTU(ducts/vents) 54.91
Suite/bldg./apt.no.: Project name: Heat pump 61.06
Duct work , 23.32
Cross street/directions to job site: 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
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
Replace furnace&venting of bath fans,dryer&range hood fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent . 23.32
❑ PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: H 1C_ f L L 5, Range hood/other kitchen
Address: ,equipment 1 33.39
Clothes dryer exhaust / 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) / 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
❑ APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: Fuel piping:
S14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc. ,
Address: Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace
E-mail: Range
Barbecue
CONTRACTOR Clothes dryer(gas)
Business name:Assured Air comfort Inc s Other:
I MECHANICAL PERMIT FEES*
Address:20170 S May Rd 136.85
Subtotal
City/State/ZIP:Oregon City,Or 97045 Minimum permit fee($90.00)
Phone:(503)880-8434 Fax:(503-)723-7153 Plan review(25%of permit fee) ----
State surcharge(12%of permit fee) /60•q 2
CCB lic.: 106403 S�?//r TOTAL PERMIT FEE i C5.;t7
This permit application expires if a permit is not obtained within 180
e days after it has been accepted as complete.
Authorized signature • Fee methodolo gy set by ty Buildia Industry Service Board
Print name:Phil J Davis I Date:9/22/15
I:LBuilding\Pennits\ EC_PemtitApp_040113.doc 4404617T(I1/02/COM/WEB)
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