Permit CITY OF TIGARD '�. MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit#: MEC2020-00585
TIC A R I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/8/2020
Parcel: 2S114BB20300
Jurisdiction: Tigard
Site address: 16497 SW 103RD AVE
Project: Olson Subdivision: RIVERVIEW ESTATES NO.2 Lot: 47
Project Description: Replacing air conditioner. 1/19/21: REPRINTED permit to include furnace.
Contractor: BUCKHANNONS HVAC LLC Owner: OLSON, MARY M
7455 SW APPLEGATE DR 4414 SW 41ST AVE
BEAVERTON, OR 97007 PORTLAND, OR 97221
PHONE: 503-747-6585 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 09/08/2020 $46.75
Type of Use: SF Furnaces< 100K BTU 01/28/2021 $46.75
Class of Work: OTR Type of Const: 12%State Surcharge-Mechanical 01/28/2021 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
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: Holly Vc, t,De,jq)e ..e Permittee Signature: O yiAppLizat-Can
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.'f'
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 ApplicatibECEIVED iiimEmiliamigim
Received
City of Tigard �� 2021 DatelBy: Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.71g.2439 Fax: 503.59g.196U Date By: POther ermit Permit_
Inspection Line: 503.639.4175 CITY OF TIGARD Defy Read rB . Juror:
Y r la see Pagel for
Internet: ww•w.hgard-ur.g BUILDING DIVISION Nntificd ttthnd: Soppiemeotal Information
iF":4 rn w .e.A w • J! _ "•
Y �%. . . -^ rJ ' a- z°'bt, MechanicalIndicate '� 'wd�llT'9i::r
� permit fees*arc based on the value of the work
EI New construction ❑Addition/alteration.h r !aJ pe the value(rounded to the nearest dollar)of all
❑Demolition 0 Other:
a mechanical materials.equipment labor,overhead,and profit.
�t r 1 Value i
` fr.xr igOSS oil > :''''..1 . ', ... - " ' yt��n4a.�a.,s�/ any *.
.e.. .. .uf .C: •t J �' t�F.e '��.�mR'+' af�+f*!1 .. ���., '+IS(',�
1-and 2-family dwelling ❑Commercial/industrialin❑Accessory building For special information use eheck(i Y
0 Multi-family ❑Master builder 0 Other: Description Qty. Ea. Total
y Heating/cooling:
` - A _1 Y. Air conditioning I 46.75
Job site address: I CD q _I -1 `N 1 A 3 a A V L Furnace 100.000 BTU teuctch•cnto i 46.75 ,
City'StateiZIP: •'T,sty../c!, d>iz. 01 ZZU Furnace100,000- :s BTU i 54.91
t f Ilea%pump 61.06
Suite/hldg.lapt.no.: 1 Project name: 0 \St.,r-.1 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. i 46.75
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: Lot no.: •
Other fuel appliances:
Tax map/parcel no,: Water heater 123.32
° ' S) Y; ,.-.1;:''" „ ,:-' ` Gasfireplaceiinsert 1 33.39
2 s flupvnt for water hCater orgas
( `� At
�M 6 C U1..w� a OS
�as fireplace 23.32
Log lighter(gas) . 23.32
fu,Otl Q.d'� �a`(hC^�' ,<2Plr'.eei*�eeF- Woudipellct store 33.39
Wood fireplace/insert 23.32
Chimney,tines Ilu event 23.32
,y ,, Other: 23.32
° - _ Environmental exhaust and ventilation:
Name: W ki h t_ 0\g4Y, Range hood/other kitchen I -�
I equipment 33,39
Address: Clothes dryer exhaust 33.39
Ciry"State/ZfP: Single-duct exhaust(bathrooms,
toilet compartments,utility roams) 23.32
Phone:Sp ) 3v' (1-""•Z e� Fax.I 1 AtGc'orawlspace fans 23.32
f y ' �, t*''t Other: 23.32
�s�71 Fuel piping:
Business name: \ ALbeiur+rhq�,a h s S f( 1 f A C (-LC 514.15 for first four;54.03 for each additional
Contact name: xv`Y "j C_-It.4.-S. el.
d.„I
,. Furnace.cu. i
Address: tins heat pump i
-7 c
1 ��� +- ���� ).1%. t Wail/suspended/unit heater I
City'1State/ZIP:�P.A..J.,,(4.,a,rt Oa_ of 1 d o --) Water heater
Phone:(C11{1 '11 --' Li g-0 .1., Fax::( ) Fireplace ___
Range
F mad: is, /.Ni) . f 1 9.x1 tn. 1� 1 •. > m Barbecue
f '. .> t t: Rf ,.•._ X:.T i'ii...ii-.i.'iir Clothes dryer(gas)
Business name: Other:
1.�VlLICArnt.r1 n dye s,$ KO l�}c...... LL� 4:'` 7 ,
Address: --IL{
g-S S(, t L (ti c. �`i Subtotal
CitylStateiZlP:r ( 4�> f, , 41 GO "7 Minimum 125%t fee(590A0)
Lt V Plan review(25%of permit fee)
Phone:( , -t 1 6 c�.S I Fax:( 1 Slate surcharge(12%of permit fee)
CC13 lie.: '1 2Q 5 'Z j TOTAL PERMIT FEE
G t Thls permh application expires If a permit is sot obtained within IRO
methoddogs after II has been accepted as complete.
Authorized signatu • Fcc methodology set by Tri-Coumy Building Industry Service Board.
Print name: �l+r1 r1,l+er.✓rL�LLfilc+ht4el"KM Date:)71 d IJ 7.d
y `i
I..n.l .l'rrms MEC PennuApp n14113.doe 140.1617T f1IeS- Ou Willi