Permit
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CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit#: MEC2009-00548
Date Issued: 10/20/2009
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 104BA03500
Jurisdiction: Tigard
Site address: 12045 SW WESTBURY TER
Subdivision: Lot: 0
Project: Essich
Project Description: Install furnace.
Owner: FEES
ELLA ESSICH Description Date Amount
8700 SW CREEKSIDE PL #A Furnaces < 100K BTU 10/20/2009 $46.75
BEAVERTON, OR 97008 12% State Surcharge - Mechanical 10/20/2009 $10.80
PHONE: 971-570-4098 Minimum Fee Adjustment - Mechanical 10/20/2009 $43.25
Contractor:
ROSE CITY REFRIGERATION HTG & AIR
PO BOX 19207
PORTLAND, OR 97280
PHONE: 503-636-5371
FAX: 503-655-4669
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 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 952-001-0100. You may obtain a copy of the rules
or direct questions to OUNNC by calling 503.246.6699 or 1.800.332.2344.
Permittee Signature:
Issued By: J,.
Lty A 'u
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.
Oct. 16 09 05:46p Rose City Heating and Air 503-655-4669 p.2
Mechanical Permit Aaplication
RECEIVES
City of Tigard Pt:mitN.:
]Jet^BY c~o~r• ooS4
° 13125 SW Hall Blvd-Tigard. OR 97223 OCT 16 2009
Plan hevicw
Phone: 503.639.4171 Fax: 503-598.1960 Uatc.`Pv C)thcrP rmit.
Inspection Line: 503.639.4175 llatc ReadyBy: turi+' H7 Sre Pal c 2 for
intsnek k%w%v.tigard-or.gov CITY OFTIGARD NotiliecL"actMd: l Supplemental Information
BUILDING DIVISI
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USL: CHECKLIST
Atechartical perniA l'ces* ate based on the value of the work.
❑ New construction ®Addition+alteratiott(rcltlaccment performed. hidimiethe value (rounded to the nmrest dollar) 01 7,111
❑ D011101ilion ❑ Other: luechaniml materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUC-HON Value: $ -
RESIDENTIAL EQUIPMENT / SYSTFM8 h'EES*
® i - mid 2-!amity dwcllutg ❑ Coni ncrciallutduslrial ❑ accessory building
Fir specro( in_Jormation use clteeklrsr.
❑ Multi-family ❑ Masux builder ❑ Od1CT: -
- [h criPtion (qty, Ga. Total
.JOB SITE, INFORMATION AND LOCATION flcatin lcoolinl; _
Job silo address: 12045 Ski' 1Vestbury 1'crracc tir ounditioninb
(ccyui:ea sit., plan showing placcmrrl) 46.75
CttNlS.ate;7.IV-. Tigard, OR 97223 Furnace 100,000 f37IJ(ductanents) 1 46.75 46.75
Furnace I00,000-1- BTU (ductsvents; 54.91
SuitcibVdg.htpt. nu.: 11rnjecl name: Essich
IIeat pump GLO6
Cross.ctrcccJirectinns tujeb site: Duct work 23.32
Ilydronic hot water system 23.32
Residential boiler Iradiator or
ln•dronic _ 23,32
Unit healers (fiml-type, nut electric).
J in-mall- in-duct, suspended, rtc. 46.75
Flue/vent foram, of above 2332
5nbdivisioa: J Led no.: Other: 23.32 -
Tax map'parccl no.: Other fuel aprlianccs
DESCRIPTION OF WORK -Water heater 23.32
lnsta1180 o furnace Gas fire lace 33.39
Flue vent ]'or water healer or gas
fireplace 23.32
- - T,o lighter( m) - - 23.32
Wood; ellet stove 3:1.31)
Wood fireplace/inserl 23.32_
Chimney/l i tier/ fi u event 2332
PROPE14TY OWNER ❑ TENANT Other. _ 23.3?
FNZ-1- Ella Essieh Environmental exhaust and ventilation
Address: 8700 SW Creek side Place i#a Range hood/other kite rcn
c ui meat 33,39
Ciiv;Stnte,'71P: Beaverton, OR 97008 Clothes dryer e.lhaust 33.39
- Single-duct exhaust (bathrooms,
Phone: (971)570-3098 toilet compartments. utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON AttiNesawlspace Cans 2332
ether: 23.32
Business mine Rose City Hearing & air
Eel i ;n~
Contact name: Jef Pangbnrn 514.15 for first four; S4.03 for each additional
Address Furnace- etc.
- Gas heat pump
Cil) ~Stale'ZIN: 'Ala II.-sus ended/unit heater
Phrotc: (503) 636-5371 Fas:: ( ) Water heater
Fireplace
E-mail:
Kan e
- CONTI2A('TOk Clollicue
C'lot}tes dryer ;as i
Business name: Rose City Heating & Air
Other.
Address: PO Box 19207 MECHANICAL PERMIT FEES*
Ciri:-Statc,M Portland Subtotal t6.75
Phonc: (503) 636-5371 Fax: (503) 655-4669 Minimum permit fee ($90,00) 90.
Plan review (25% of permit lac)
CC13 he,: 161325 State surcharge (129, of permit f") 10.3
TOTAL PERMIT FEE 100.80
This permit applicatiun expires il'a permit is not obtained within 1811
!\u lboni, d signature: days after it has bten accepted as complete.
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