Permit (33) n CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2016-00240
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2016
Parcel: 2S111DB04800
Jurisdiction: Tigard
Site address: 15202 SW ALDERBROOK PL
Project: Taylor Subdivision: SUMMERFIELD NO.7 Lot: 412
Project Description: Replace gas furnace with like kind
Contractor: A ACTION APPLIANCE& HEATING INC Owner: TAYLOR, C JAMES&CLARICE L
18245 SW TV HWY 15202 SW ALDERBROOK PL
ALOHA, OR 97006 TIGARD, OR 97224
PHONE: 503-649-3524 PHONE: 503-598-8410
FAX: 503-649-6095
FEES
Specifics: Description Date Amount
Furnaces< 100K BTU 04/12/2016 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 04/12/2016 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 04/12/2016 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notific nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct stions to O.NC b calling 503.232.1987 or 1.800.332.2344.
Issue By: 11 I / Permittee S gnature:
Call 503.639.4175 by 7:00 a.m.for the next available inspect' date.
This permit card shall be kept in a conspicuous place on the job site unt completion of the project.
Approved plans are required on the job site at the time of each inspection.
MAR-31-2016 09:51 From: 5036496095 To:5035981960 Pa9e:1'2
Mechanical Permit Applies j 1,! CEIVEP FOR OFFICEUSE ONLY
City oTigard Daleivea ' �L�l(p—!X,�'
_ Date/➢y:. kf �l I(o / Permit o.:
13125 SW Hall Blvd.,Tigard,OR 97223
1 i hone: 503.639,4171 lax: 503598,1 P q
Plan Review
Qrtapcedon Line: 503.639.4175 Pr'- 3 I 7 n 1 A Date/By: other onnit
TIGARD i
lntertteL www.tigard-or.gov
Date Ready/By: le^s ]a1 See Page 2 for
q '� ;s) "'t td v Notitied/Mcthod: • f Supplemental Information
I _ ' .l d 01 ?i(yr��s�/Il I
1I TYPE x3'91 I 1fl\JI,i1()N COMMERCIAL FEE* SO1EDULE- USE CHECKLIST
❑New con5tuction _ dditionfalteration/rcplaeenlent Mechanical permit fees*aro used on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: - mechanical materials,etluipmcrtt,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Vatic:$
and 2-flamily dwelling ❑ConunerciaUndustrial 0 Accessory building RESIDENTIAL EQUI'MENT/SYSTEMS FEES*
❑Multi-Fall,ily 0 Master builder 1:1 Other:
For special ir(fo/7natlorr use checklist.
Description I I Qty. 1=a. Total
I JOB SITE INFORMATION AND LOCATION Heating/cooling ( _ -
Job site addr4s: Air conditioning E
a J� L�=� (requires site plan showing placement) 46.75 4��_
ty/State/ZT¢: \ -
CiFurnace 100,000 BTU(ducts/venrs) I 46.75 n
Suite/bldg./apt.no.: Project name: Furnace 100,000+13TU(ducts%veins) 54.91
Heat_pump
Cross street/directions to job site: Ductwork E 23.32
j_lydronic hot water system I 23.32
Residential boiler(radiator or
- hydronic) 23.32
••— Unit heaters(fuel-type,not electric),
1 - _ in-wall,in-duct,suspended,eti:. 46.75
Subdivision: I I Lot no.: Flue/vent furan of yabove I 23.32
Other:
Tax trap/parcel no.: _ Other fuel appliances 23.32 _
inn. I DESCRIPTION OF WORK Water heater I — 23.32
r Gas fireplace I 33.39
�e J 0—e C) 1 , ami, t 4 Flue vent for water heater or gbs
I fireplace 1 23.32
•
+Log lighter(gas) 23.32
I
Wood/pellet stove I 33,39
Wood fireplace/insert I 23.32
" Chimney/liner/lite/vent 23.32
)4'!RO-PERTY OWNER 0 TENANT
Other: I 23.32
Name: 4 * Environmental exhaust.and ventil:,tion _
Address: 1 Range hood/other kitchen
t ^ ^ equipment- 33.39
City/State/Z1P:I Clothes dryer exhaust 33.39
I'hon )— Single-duct exhaust(bathrooms
- ib ), ���' -�+� Fax:( toilet compartments=utility rots) .. 2332 —..
ID APPLICANT ID CONTACT PERSON Attic/crawLspaco fans ` 23.32
OtheBusiness name;
A-ACTION HAAT( Fuel I 23.32
C - Fucl suing
Contact name: I - • . V HWY $14,13 for first four;$4.03 for each additional
Address: I t ! 4• '- -ii • I I: - Furnace,etc, , 1 \6
Gas heat pump
City/State/ZIP:I
1 Wall/suspended/unit heater
Phone:( )I Fax::( ) Water heater
E-mail: ireplace
-mai[: I
• Range
I CONTRACTOR - Barbecue -
Business ttamc;I Clothes dryer(gas)
A-ACTION HEATING&NC---- Other: I
Address: I 18745 SIN.TV.HWY MECHANICAL'PERMIT FEES*
City/Statc/ZIP:1 ALOHA,OREGON 97006 I Subtotal
f-- ' Minimum Crrnit fee($90.00
Phone TLV�� r �) l4 R- _ P. )
_ Plan review(2:5%of permit fee)
CCI3 lic.: '')'j ' 31, D\ State surcharge(1:.%ofpermit fee)
TOTAL PERMIT FEE
Authorized signk.ure � This permit application expires ilk permit Is not obtained within ISO
days after It hat Ileenlaccepted as completes
Print name: i a c Date: 11E111 1, * Fee methodology set by Tri-County Building Industry Service Board
anaitainglPe...0n,1•FPennitApt,,da; 10/01/09 44n-5617T(Ii,mrt AiW x%