Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00186
10" Date Issued: 04/27/2010
13125 SW Hall Blvd Tigard OR 97223 503
„ Parcel: 2S103CB08100
• Jurisdiction: Tigard
Site address: 12321 SW QUAIL CREEK LN
Subdivision: Lot: 0
Project: Gan
Project Description: Install A/C Must maintain 3' rear and side yard setback
Owner: FEES
GAN, SUGANDI & Description Date Amount
SARI, SHANTI P, 12321 SW QUAIL CREEK LN
TIGARD, OR 97223 Air Conditioning 04/27/2010 $46.75
12% State Surcharge - Mechanical 04/27/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 04/27/2010 $43.25
Contractor:
A -1 AIR HEATING & COOLING
2038 NW ALOCLEK DR #225
HILLSBORO, OR 97123
PHONE: 503 - 645 -5900
FAX: 503- 648 -9824
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 OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: diteif Permittee Signature: L-w 4fpLLeI O� (-- ,
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.
Apr 26 10 02:58p A -1 Air Heating & Cooling 503- 648 -9824 p.2
- f v -
q�� ! Cit of Tigard i 1 Date/B Permit No. (_ / 0 — dal
critjld 13125 SW Hall Bivd_, Tigard, OR 97223 RECEIVE" Received
Plan Review
1 e <r:; Y , Phone: 503.639.417! Fax: 503.598.1960 Date/By: Other Permit
;
iu Inspection Line: 503.639.4175 APR 2.6 2010 TIGAPD Date Ready/By: luris B1 See Page 2for
.. .. +:�.,.: Internet: www.tigard- or.gov Notifiedffatethod: Supplemental Information
CITY OF TIGARD.
TYPE OF W 9HilLDING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition/alteration/replacement Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT f SYSTEMS FEES*
1K 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder 0 Other: Description 1 Qty. Ea I Total
JOB SITE LNFORMATION AND LOCATION Heating/cooling
: Air conditioning
Job site address.. S Z ( S <-c-J QUf3 (L C ec t^ l C L /4, (requires site plan showing placement) I 46.75
City /State/ZIP: ( G, /i _ p 9 - ) z, 'Z - Furnace 100,000 BTU (duelsrvents) 46.75
Furnace 100,000+ BTU (ducts'vents) 54.91
Suite/bldg./apt. no.: Project name:
Heat pump 61.06
Cross street/directions to job site: Duct work . 23.32
Hydronic hot water system ' 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
i in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: : Flue/vent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK j Water heater 23.32
Gas fireplace 33.39
7`/LJ S -- / -- /-4 L L /A / C_ Flue vent for water heater or gas
fireplace 23.32 _
I Log ligghter (gas) 23.32
I Wood/pellet stove 33.39
Wood fireplace/insert 23.32
■ Chimney /liner /fluelvent 23.32
ra PROPERTY OWNER I , ❑ TENANT .
Other: 23.32
Name: 57-- ,,c ie.:7 c.,, Environmental exhaust and ventilation
Range hood/other kitchen
Address: s /9 M ) - equipment 33.39
City /State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (So3 ) ,_:56s--....... C Ss FS Fax: ( ) toilet compartments, utility rooms) 2332
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 2332
Other: 23.32 1
Business name:
Fuel piping
Contact name: $14.15 for first four; S4A3 for each additional
Address: Furnace, etc.
Gas heat pump
' City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) l Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
r Clothes dryer (gas)
Business name: A,_ 1 A 1 re__ t+ 0.._/-4 T) 70 c-- ; G 6 G 1 rU C--
Other:
Address: ! b '7 3 S r= 3 - 7 714 A. L) E , MECHANICAL PERMIT FEES'
CityiState /Z1P: /4 (�,., L, S /30 n a , — 2 i Z 3 Subtotal
) O Fax: � d3) ( L/ - g Z Minimum permit fee ($90.00) q 6 .. e. 0
Phone: (5'09 6 ys - S 9 y Plan review (25% of permit fee)
CCB tic.: , Z / � Z l ()lug( 1 1 State surcharge (12% of permit fee) i a, • �tS
TOTAL PERMIT FEE j a G, 'a
This permit application expires if a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
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Apr 26 10 02:58p A -1 Air Heating & Cooling 503 - 648 -9824 p.3
Air Conditioning Site Plan
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j7 < 1W Q Creek Lane
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