Permit CITY OF TIGARD MECHANICAL PERMIT
.: COMMUNITY DEVELOPMENT Permit #: MEC2009 -00649
(G A kb 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 12/08/2009
Parcel: 2S103BB13000
Jurisdiction: Tigard
Site address: 12210 SW ANN CT
Subdivision: LAKE TERRACE NO. 2 Lot 23
Project: Jackson
Project Description: Replace gas furnace and install heat pump in previous a/c location.
Owner: FEES
JACKSON, DAVID Description Date Amount
12210 SW ANN CT Furnaces < 100K BTU 12/08/2009 $93.50
PORTLAND, OR 97223 Heat Pump 12/08/2009 $61.06
PHONE: 12% State Surcharge - Mechanical 12/08/2009 $18.55
Contractor:
VAN AIR & CONTROLS LLC
13327 S GLENN DR
MULINO, OR 97042
PHONE: 503 - 632 -5991
FAX: 503- 632 -8672
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $173.11
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.
4
Issued By: 4 °`.� APP
r s Y/ V n n Permittee Signature: y i tli;J T^
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.
Dec_ 06 .09 10:34a Greg Van Damme 503 - 632 -8672 p.3
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Mechanical Permit Applica>tio® r ' _ 4 l cE Uo�_ ...1'.' _ .: ,
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r71/1 Cl of Tigard L , � y " Received
City g 1..� Permit No.: /Y'+_ M ( ko
• 13125 SW Hall Bivd. Tigard OR 97223 tL Y % , r 1 J DateB ���"� w
II IIII
1: . Phone: 503.639.4171 Fax: 503.598.1960 till Plan Review Other Permit
_ DateBy:
I G'A R D Inspection Line: 503.639.4175 U i 7 C Date Ready/By: i
swate4 Internet: www.tigard- or.gov - �� iB o S Seemane2I -
rotified:7vledrod: Supplemenpol Information
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TYPE OF WORK: tt COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
:'. "' ` :n: i "'� "a`'" -C.' "11%: \. Mechanical permit fees* are based on the value of the work
❑ New construction `� /~ Addit /alteration /replacement
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 /SYSTEMS FEES'
( 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. I Ea. I "Fatal
JOB SITE INFORMATION AND LOCATION Heating/cooling
Irl D s rW t Arik 1 Air conditionin g
Job site address: c, u C'`�
(requires site plan showing ptacententl 46.75
City / State/ZIP C c' j ZZ 3 Furnace 100,000 BTU (duets'vents) 46.75 ] Se)
Suite/bldg. /apt. no.: r),„
roject name: � ��
Furnace 100,000+ BTU (ducts /vents) 54.91
�' "�� � C](11 -`-3(1/4.1
Heat pump i 61.06 O(G.
Cross street/directions to job site: Duct work 23,32
Flydronic hot water system 23.32
Residential boiler (radiator or
hydroniet 23.32
Unit treaters (fuel -type. not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.: Flueivent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
f (_ _� " � Y s ` G firee gas
33.39
N ava) e.... e � LYY 0,„4.1 (� � (�, l � � j.�_ Flu e vent plac for
3 fireplace 23.32
1 �n l � ► J AJ V �Y1C ' ktC P --• (n,.) \ r A) is t Log lighter it as) water heater or 23.32
a _ • . ce. e`tc� �h l h Wood/pellet stove 33.39
p " , ivy Lr � Wood fireplace/insert 23.32
C
�. A �11 Z 1 �C /4( �� � KYG Chimnev,'liner /flue/vent 23.32
Ill PROPERTY OWNER 1 ID
R ( Other: 23.32
Name: \n,/) 4 � , 1 �- Environmental exhaust and ventilation
Address: d 4 ,� Ranee hoodiother kitchen 5 l �-+ r , + N e F,, equipment 33.39
City /State /Z1P:' 1 Clothes dryer exhaust 33.39 -=y ` Single -duct exhaust (bathrooms.
Phone: (�j (l C, . 4 A ! -Q Fax: ( ) toilet compartments, utility rooms) 23.32
N - C PLICANT v 1 CONTACT PERSON Attic/crawlspace fans 23.32
Business name: ]< t� w rD$►el ` 23.32
t �� : t�.�i Fuel Fuel piping
Contact name = VIM �. ` ■ $14.15 for first four; 54.03 for each additional
Furnace,
Address: iiC�'�� f� r Gas heat e um
1 P p
City / State/ZIP: Kull t a ; r Cl) p 9 70 a_ Wall/suspendedtunit_heater
Phone: �� )240-4,3
t 1 l J C3�� 2ID / 7 a Water heater
4i �} Lc Fax:_ (�} 1 �
E -mail: , , I , ( Fireplace
�^"i mo ' �� vh ti 4 ]L w r Range
J CONTRA TO R Barbecue
Business narne: V N i i , p Gi- . e, J J C Clothes dryer (gas)
/ ((�, V' p U l- Other: V
�i „3�7 ,ct G i . MECHANICAL PERMIT FEES*
City /State/ZIP: tAu L ( () G, 9 7 �`i g Subtotal 1&4 Si?
Phone: (l z„ L, 6 i I Fax: ( . 3 ) _26,-41
Plan ta i rimum permit fee ($90.0
review (25% of permit fee)
t ✓cCB lic.: 1 £ ? L q State surcharge (t2 °6 of permit fee) 1 155
TOTAL PERMIT FEIj 1 i f
Authorized signature: ' 0)Asinite1A.C2---- This permit application expirre I1 a pennit is not obtained wit to Imo Uyn/L days after it has been accepted as complete.
Print name VA A,y\ 6/1e Date: 1 I - ;09 • Fee methodology s_t by Tn- County Building Industry Service Board
1 :1Building\Pennits\MEC -Per nttA spdoc 10 /01/09 �y'�\ 440 -01 (1 IIOYCOM/WEB)
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De; 06 `9 10:34a Greg Van Damme 503 - 632 -8672 p.4
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TUALATIN KENT - SKANE s
187 5S.W.TET•. 79 5 c TH1:•thSt. 730:.FSSTAV NU
T3)69IN, 0; 970:- K:NT, W• ••, 2 .P• •N WA 99202
• 5) 656 -7878 (589) 536 -1-
FAX (503) 692 -9868 FAX (425) 656 -0121 FAX (509) 536 -4009