Permit CITY OF TIGARD -
MECHANICAL PERMIT
COMMUNITY'DEVE Permit #: MEC2010 -00091
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.63'9:4.1,71 Date Issued: 03/03/2010
• Parcel: 2S 111 CC 13500
Jurisdiction: Tigard
Site address: 10265 SW HIGHLAND DR
Subdivision: Lot: 0
Project: Blakeslee
Project Description: Replace a /c.
Owner: FEES
BLAKESLEE, RICHARD Description ' Date Amount
10265 SW HIGHLAND AVE
TIGARD, OR 97224 Air Conditioning 03/03/2010 $46.75
12% State Surcharge - Mechanical 03/03/2010 $10.80
PHONE: 503 - 639 -7275 Minimum Fee Adjustment - Mechanical 03/03/2010 $43.25
Contractor:
BEN'S HEATING & AIR CONDITIONING LLC
• PO BOX 80607
PORTLAND, OR 97280
PHONE: 503- 233 -1779
FAX: 503- 651 -3345
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in'the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work'will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules aresetforth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246 1.800.332.2344.
Issued By: 14104 •, 1 i Permittee Signature: (�
AP I 1 V Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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13125 SW :H a l l 131yd., Tigard, OR 97223
41 A p 0 .2 2010 Plan Review
t 9 i , Phone, '503,639:4171 Fax: 503.598.1 Dateiay; Other Permit; •
+° . ; i nspectton,Line 5031639 4175
ti A IL D; � Date Ready/By; 12f See Page 2!far
;.e Internet :.www tigard•or.go CITY OF I' Notil ed/Mctli Supplemental lnfprmutilm
j t ill P I@tl`tIVIC/'+rAt
ry o 7: .�. ' ` y a 1 r °, a , : -, :, CQMMERCIAL FEE" SC1iEDULE •- USE CIIECKUS'F
,
Q New construction KLAdditian /alteration /replactmeni Mechanical permit fees* are•bascd on the value of the work
performed. Indicate the value,(iuunded 1u the nem'esl dullar)''uf till
0 Demolition Other: - mechanical materials, equipment, labor. overhead, and profit.
• Yti'd:'it ( value:$
` ` , 1 1cATiir�t� Y,ID`�` �?>,��f � � ���'?�''�ft�l�,d���;��`r }m '
I and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL FAL 17QU1Pf41ENT / SYSTEMS FEES*
Pot special information use c/recklisl.
❑ Multi-family 0 Master builder ❑ Other: Description Qty. Ea. Total
i
.!'f• ,; :' • 'JO» SITE:IiiPOtt1► e!'t'10/4 i1N l "i K ,4ad. , ,'A:4` r 4V , . r
� � M � � ; Heating/coaling
Job ite address. /rJ A f ,. �) 1� ' Air conditioning or heat pump
` `� rl i - �p� -�. '' ii (rcqud6s site pion showing placement) I 14:00
City /State/ZIP: '" of l Furnace 100.0001370 ((I, cla /vin! %) 14.00
/ / as
1 , °' Humace 100,000+ BTU (ducts/vents) 17.90
Suite /bldg. /apt. no,: Projectname: Gas heat pump _ 14:00
Cross street/directions to job site: Duct [ 14:.
Hydronic hot water system 14,00
Residential boiler (radiator or
hydronic) • 14:00
Unit heaters (fhel• type, not electric).
in•wall -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue /vent for any of above 10;00
Other - -- 10:00
• Tax map /parcel no.: Otherfuel appliances , _ w
•
;. , . F (ry R dii �4�� , f ,�, �. ...�.,,...- ..M,.....�...
DESCRIP'T'ICb Ili WO t , , Water heater 10.00 •
„ ,,..
` ' Cos fireplace
10.00
r - . e. . ;, 1. / Flue vent for water heater or gas
/l / � fireplace t -0.00
e Log lighter (gas) — 10.00 ^—
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
.. +�... , Chimney /liner /flue /vent 10,00
' .
PROPERTY ' . " ❑' ∎ - -_ Other: 10.00
Name: i 1 vk keS e Environmental exhaust and ventilation
Address; / Si f k . r Range hood /other kitchen _ 6 C\ equipment I 10 00
City /Stale /ZiP: ! t d [ � -ia2d,14 Clothes' dryer. exhaust 10,00
1 Single-duct exhdust(bathroonts,
Phone: (.Z.1 b 3`�' - 1S Fax; ( ) toiletcompanments, wilily rooms) 680
❑ APPLICANT , CONTACT';.PERSON: Attic /crawlspace, fans 10.00
' Other: 10.00
—
Rosiness name: (3R {ip'4{rr t ,4-G LL C. Fuelnlning
Contact name: ' iv c f_ t __,R, A . - a 1L) $5.40 for first four; Si.Ofl for each additional
Addres: Furnace, eta
Oas heat pwnp
City /State /ZIP: Wall /suspended/unit heater i
Phone: (57)3) 3 1 - 3 qeo Fax:: (.rv3) 6 r / y. f/r Water hcatc ,
Fireplace ,
E -mail; Range
CoR4
'N GTOR
Barbecue
,�, t N P a-- 4p,_(-5,,,,j(9710,, Clothes dryer (Ras)
Business name,
r 2 Other: •
Address: 1 ° 6 Q Sy.V b 2 . MECHANICAL PERMIT FEES*
City /Stale /ZIP: 00cz+l 0 I 972 Subtotal -
Q
l le:(,S � ,3) X -179 Fax :(ro3 / —y3 tvlip „ur,ttcrnlirlc� ($72.j0>
Plan review 25% tit' ern,)( lee
- CCB lie.: , 1/3—q , nat State ureharge(l2/ of permit fee)
TOTAL PERMIT FEE !4U,V`)
i I „• ......a. ......a. Thit permit app hue expires It permit is not obtained within ISO
th
Auorized si g ure: = 1 �� days after it has been accepted as complete,
Print name: .. , a � as e: 1 ! • Foe methodology set by Tri- County Building Industry Service Board •
I. 1lluilding \Pcrreas1MEC•PerrnitApp.doc 04 /007 n � , �,1( '1�C�1, 440.1617T(11r02 /COM)WEBI
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03/02/2010 07:25 FAX 5036513345 BENS - HEATING &:AIR
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