Permit CITY OF TIGARD MECHANICAL PERMIT
111
_ COMMUNITY DEVELOPMENT Permit#: MEC2021-00478
T f CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/12/2021
Parcel: 28103CC13200
Jurisdiction: Tigard
Site address: 12076 SW WHISTLER'S LOOP
Project: Rockenstein Subdivision: WHISTLER'S WALK NO.2 Lot: 79
Project Description: Replace furnace and NC.
Contractor: EFFICIENCY HEATING&COOLING LLC Owner:
4040 SE INTERNATIONAL WAY E105
MILWAUKIE,OR 97222
PHONE: 503-698-5588 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 07/07/2021 $46.75
Type of Use: SF Furnaces< 100K BTU 07/07/2021 $46.75
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 07/07/2021 $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. Specially 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
Issued By: Hollyvain,De,wege Permittee Signature: 0n,App .
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 ApplicatOIECEINIED I.OR OFFICE t SF ONLY
City of Tigard 1 L 0 2 2021 o y: 7�2-f -f /�.' ':' Permit Na /r b 2c a 1-C it 7 J
III-I • 13125 SW Hall Blvd.,Tigard,OR. 97223 JU Plan Review ' '
Pbone. 503.718.2439 Fax: 503.59R.1960 T`` F-r,Gpial) Datelkly: Other Permit
Inspection Line: 503.639.4175 C ` 1 N Date ReadyiBY , ®5ee Page 2 for
7 t.At.0 L. .,1 �)V)�SD Supplemental fnformauoa
Internet: Line:6gafd-or.gov t(i '1 U T<otifie<VMethod� j". ',�,� f.:. f: PP.
j
� 1=/ �•z 1r
'*_� '' 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 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:E
_' ..C.ATE+G:,,RFY L`rii t 7'm ., r -& :«1 IALiro, MIN''r f
.(-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
F a) F , Heating/coottng:
,rs_{...JUB S1' �; "'19 ''?�1 TLQ `f T ),t":-, = ,� '. Air conditioning I 46.75 ?14:iC
Job site address: 1 30,...7(.0 <ii 0)-1(3+40.5 0„p)op Furnace 100,000 BTU(duds/vents) I 46.75 v "
City/State/ZIP: gi�(:tt C)Q �3- -' Flunabc 100,000+BTU(duets/vees) 51.91
„ / Heat pump
Suite/bldg./apt.no.: Project name:Qf1C 1-LS4-t✓1(', ,(pnryl. .l4t,, Ductwork 23.32
Cross street/directions to job site: / Hydronic hot water system 2332
Residential boiler(radiator or
hydeenic) 23.32
Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc. 46.75
fluelvent for any of above 23.32
Other: 23.32
Subdivision: Lot no.: Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
Ores fircplacClinsert 33.39
"- - scitiOt*V � - Flue vent for water heater or gas
(���'`t.,j J... IO.Ce d-`-7^ s-i-0 Q ? /TZ.- , 23.32 fireplace
C} � � t - 1 Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Otter. 23.32
:;=`3s1 :Plw--,u1R'3t`>, -. '.;, 0':' NA `. Environmental exhaust and ventilation:
Name: CA L'CL ci Qt t;yt a..t -t'l Range hood/other kitchen
f., equipment _ 33.39
Address: i c'q-gyp 3(4) Wn is''.¢t3 �Jry-.e� �) Clothes dryer exhaust 33.39
City/State/ZIP: 1 o'„' Y T s Single-duct exhaust,utility
i(bathrooms,
{;, f,(rV'(' toilet compartments,utilityrooms) 23.32
Phone:((01`X) q q .-Pi'I"411 Fax:( ) Attic/crawlspace fans 23.32
Other; 23.32
Q'APItfiIGANT ,,., �.tl�9At f
.- •_ '� . , / Rue[piping:
Business name:c '1C t4,rltt'([ (' 'd7�l Cl 1-, („(}CY 1 ,D S14.15 for first four;S4.03 for mien additional
Contact name: alpy'y A(�j(Yn„ J E,141.5 Furnace,etc.
�jGas heat PAP
Address:�'`a' re �f"er 1Y2.i q?�Q,Er ZU� �^� Wall/suspended/unit heater
.N1 City/State/ZIP: 1i )a� �. 0(a..- Q "t3 )--3'- Water heater
Phone:( 1 ) �ci }— Fax::( ) Fireplace
y Range
E-mail: 'SSW!' ('es j a 2,hau._�"'CG90 t .CL'l irk Barbecue
ti ." ALTO& t s a i 3 ' y Clothes dryer(gas)
rR ' r� / 'ry� f Other:
Business name:r:�->fiC1 + (•1(+CJ.Y"((c-' O. o t.I13 : ." ` ruartteat y$s.ittro ' ", .,l` .; '..
Address: t) i SubtotalS .00 �' .Y+'�
City/State/ZIP: Minimum permit fee(594.00)
Plan review(25%of permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
CCB lie.: t 9 0 3 TOTAL PERMIT FEE f/)�/ 7}
�} Tb4 permit application after
ha be If a permit accepted
b complete. tNn IaD
fJ days It has been ateepsd u complete.
Authorized signature: 6
y j� J_ ) ' Fee methodology set by Tri.County Building Industry Service Board.
Print name: 3 C 1 r,/'/") 44( , Date: -rt,,!/1/ j ..r
i ((
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