Permit (2) Mechanical Permit Application �` i C
9t G eceived
City of Tigard Date/By: / ``,I. Permit No.: cx..>? ►y
114 " 13125 SW Hall Blvd.,Tigard,OR 97223 ry�} K.•�� -' ����
II Phone: 503.718.2439 Fax: 503.598.1960 CEP b' ` 02.0 Plan Review
J q y Q��� Outer Permit:
Inspection Line: 503.639.4175 Date/BY: ll
T l G A R D P T IGAR D Date Ready/By: Jurn: See Page 2 for
Internet: www.tigard-or.gov CITY OF otified/Method: Supplemental Information
BUILDING DIVI oil'
I
, _ .._ . . _: e k.,. .,,. ,.„ ,���/, Mechanical permit fees*are based on the value of the work
❑New construction (l Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
e V0V
.............«.,... 3.�.�. .,:� ..,Y,..v .w.._
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
Multi-family ❑Master builder 0 Other: Description I Qty. I Ea. I Total
- satin cooling:
Air conditioning 46.75
Job site address:1 vs,-1 SW CN« nbur ► Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: r 0. Q 224 Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.:0 4.E Project name: ., • r 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
z Gas fireplace/insert 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter(gas) 23.32
Woad/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
Other: 23.32
_ -,-; � �7a �. -.•�. - �-- Environmental exhaust and ventilation:
Name: ek •, G� A, , c Range hood/other kitchen
�' equipment 33.39
Address: 11 5 _ . .1 . ri ad : C Clothes dryer exhaust 33.39
City/State/ZIl': (L AI 2211 toiillele-duct exhaust(bathrooms,
t compartments,utility rooms) , 23.32
Phone:( ) Fax:( ) Attic/crawispace fans 23.32
3 ) s Other 23.32
Business name: l } Fuel piping:
• . • • - .0.--, w Z-I $14.15 for first four;$4.03 for each additional
Contact name: • t` Furnace,etc.
Gas heat Pump
Address: i I ;a , :it %04
Wall/suspended/unit heater
City/State/ZIP:C . A ,, s 0• q'7 0(5 Water heater
Phone:50 ) z.b.5 ,59,4, Fax::( ) Fireplace
Range
E-mail:0.h CANA" robbtna,A4 Sons.COfrt Barbecue
tiq ' ate` Clothes dryer(gas)
Business name: f • S �1 A. , • Other
Address: 15 i OU S6s 9 i A . t � Subtotal
City/State/ZIP:CA• �i. a-70 1 5 Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:5Cl3)Z..3b.5 i Fax:( ) State surcharge(12%of permit fee)
CCB lic.: •• (a 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: %Mier Date:S y I00I..0
\I:Building\Permits\MEC PermitApp_040113.doc U440-4617T(11/02/COM/WEB)