Permit (2) Mechanical Permit Application , FOR OFFICE USE ONLY
City of Tigard C Date/By: y//;r/ 161-- Permit No.: �'�-- -c!a S{1
III *I 13125 SW Hall Blvd.,Tigard,OR 97223 �07+
■' c LL CGPtan Reviewq
Phone: 503.718.2439 Fax: 503.598.1960 S E Date/gy: 1 - .Z Z f Other Permit:
Ti G RD Inspection Line: 503.639.4175 ``-r� 1 ® to ReadyBy: Imis: ® see Page 2 for
Internet: www.tigard-or.gov �i11 1 OF `'��n� ed/Method: Supplemental Information
Mechanical permit fees*are based on the value of the work
❑New construction Egi Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Va❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist
gi.Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
Heating/cooling:
�. Air conditioning 46.75
Job site address: %%359, SW Q.,ree.nburq Qe‘ Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: i`qq Grek 00, a—)2 Z4 Furnace 100,000+BTU(ducts/vents) 54.91
"1 1 Heat pump 61.06
Suite/bldg./apt.no.:C�D Project name: QU11..�
C au rt- 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: I Lot no.: Other 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
s' '' Gas fire lace/insert 33.39
R p
'w Flue vent for water heater or gas
�1:AS C.L..\ `\ (AVM? 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
1 a . as a ( i
,� _� �� ��-- � -_ �• .R <. w. •w Environmental exhaust and ventilation:
Name: 1 Range hood/other kitchen
Q11G�1, Cr� �Glrl1�'S equipment 33.39
Address: 11 S5"b `'ireeA bue,.. ad , E Clothes dryer exhaust 33.39
City/State/ZIP: 1 `QotG o tt C `r zit, Single-duct exhaust(bathrooms,
1 toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
1 t 1a , Other 23.32
Fuel piping:
Business name: 11‘1��
n 4 Sons N /9 . 7-4 C $14.15 for first four;S4.03 for each additional
Contact name: J Furnace,etc.
Address: y,g� C Q G►L Aide. %Q� Gas heat pump
Wall/suspended/unit heater
City/State/ZIP:C kojvc.1 02, q"7 0 is Water heater
Phone:50 ) Z3.5 ,5 S4 1 Fax: :( ) Fireplace
Range
E-mail:cavto,Aadr.. fObbe"0.,A4 sons.C(M Barbecue
r',' i Clothes dryer(gas)
Business name:A_ A -V Sons ‘•k,e0. Aci Idle Other:r Other
Address: 15900 Sh P►A2Z4 AVM- lit i0(1 Subtotal
City/State/ZIP:C'ac1(co 5 Q I_ crio I s Minimum permit fee($90.0 )
Plan review(25%of permit fee)
Phone:Sab)1:6.3.5�y�l yl Fax:( ) State surcharge(12%of permit fee)
CCB lic.: I D(a 4 TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: * Fee methodology set by Tri-County Building Industry Service Board
Print name: N . %A1 ae-- Date:8-I(o�ZL
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