Permit CITY OF TIGARD MECHANICAL PERMIT
'' 11 ` COMMUNITY DEVELOPMENT Permit #: MEC2009-00654
.T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/08/2009
Parcel: 2S 1038813200
Jurisdiction: Tigard
Site address: 12270 SW ANN CT
Subdivision: LAKE TERRACE NO. 2 Lot: 25
Project: Chandler
Project Description: Replace furnace and a /c.
Owner: FEES
CHANDLER, CHERRYL Description Date Amount
12270 SW ANN CT
TIGARD, OR 97223 Air Conditioning 12/08/2009 $46.75
Furnaces < 100K BTU 12/08/2009 $46.75
PHONE: 503 - 590 -5922 12% State Surcharge - Mechanical 12/08/2009 $11.22
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE: 503 - 692 -1565
FAX: 503- 691 -1879
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $104.72
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. p n
Issued By: 1 n Q `- 4 Permittee Signature: � t X
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.
' . 12/08/2009 - 10: 34 5036911879 --- MECHANICAL PAGE 02
- - .
Mechanical Permit Application Ili) ECt
ln; City of Tigard
" 1 3 1 2 5 SW I loll Blvd.. Tigatd, OR 97223
j. 2 1 Phone: 503.639.4171 I' tIN: 03.59 f. 1
15 960 DEC Q P I" Rpr;civ,...(1
„ a an ,. aluiliy
M •I;in Rc.virw
Dolcilly: .. A Pcnnit No • rh
Olhcr Pcrinit
.: Inspection 1-inc: 5113.639 4175 --- ---____ —
1 Irk I Sec Pne. 2 Iiir
ntunci: www.tigarti BOLDIN ov CITY np TIG , RD: Po: 1,
••• • .„,,, , sityNt ot . Supplesnentnllenrmation
UIV /M 1 1l
- ' ...:'''• ' - 7: • . ''''' - ,'....:-Fr.'.. 0,40RIC ' . ' ' '''' . . . ..,...dei*Miktiiit** f!t:00
• • , . • "
. .•'...... ' " . .
M nloCrrni;fees* arc bar.cd on thev7;eof Me work
12 New construction RI Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of
Ei Demolition 13 Other: mechanicalmaterials, cquipmcitt,..lahrnoyethead. and profit
...., . .. _ ______
. . .... - . • •:,,,,.% , ' e0tecOir • ., v aiue!
PAI.*i0 _...
1g) l- and 2-farnily dwelling 0 Commercial/industrial 0 Accessory bin Id ini2,
For special inprmanon IlSe CheCkliSt _
E Multi-family 0 Master builder 0 Other; DeseriptiOn Qty.1 E71, .1 1 till
____ _., .,........ ----
:14 WVitt,F.IIM10.4n#16 tktiOr ; i' :: ' ' 10r.,.....
-...1
Air conditioning
lob site addreSS: 1 2.7_ 70 Nes1 4/4 14 CTI .. (require,: site plan sbowini; placcinc70) , ifi.75 ... ______.,
- - ........_ _..... _
City/SIFIlc/Z1P: 7 I 4 0 ei-n-1,3 Furnace 100,000 BTU (doei../,k) I 46.75
--- Furnace 100,000+ BT1.1(dactsivery9 54.91
Suite/bldg./apt, no ; Pro.1991 namc: C. ii NAO lesrg. •ft-.4...,, Hatt putty 61.06
_. ...... --- ......
- --
crop.: street/directions to jot) sile Duct work 23.32
llydronic hot water system 23.32
Residential hoiler (radiator
h)'dronic) 23 32
--.. -.. _.____ . . ______ Unit heaters (fitel-type, not elcettie).
in-wall. in-duct, suspended, etc. .Ir,.75
__.... -- Flue/vent for any of above 23.32
Subdivision: I.In no.:
.., .. --________ i O
_. , ther! 53 32
Tax map/parcel no.; _ Other fuel appliances
- . .....
• • ' - • . " • - - • •
.. • ..• t3tE.SOftiftlf0■1' oiF..,WORk . .. :, . Water beater 2.;..■2
—.----, Gas fireplace 33.39
LiT Lcr Am o tf,,g_g.b.c,z litie vent for water heater or gas
fireplace — 23.32
' •-
,..._ ..--_ .. ---- Log 14;1219E8as) 23.32
Wood/pellet stove l■ 19
- ....
.„ Wood fireplacelinscrt 23.32
..•. . . . Chimney/liner/flue/vent 23.32
. • ' .R - . . • L: L.. • . El' TENANT
. .___
Other. 11 1)
L .-- ...,.........
Natne , LA. A iel ..-
I C,44- AIAD16.72„ Environmental exhaust And ventitA inn
.
-„...----1../.. Range hood/other kitchen
Address: ...11. 70 i A,... c.:7 equipment 3
City/St teal l' - 174
1 ALZP 0 le q72-7-3 Clothes dryer exhaust
Single-duet exhaust (bathrooms, 33.39
Phone: (cO3 .16 i 0 - 51 z_.z. Fax: ( ) toilet compartments. utility ruums) 2.i .32
,: Li.:e.OsrAtt iimsorq;. ...... . ..
. 7..""..... " - . . " . . . ' " -7 Attic/crawlspace fans
• -- Other:
T3usiness !Mine: Aka b., el... I c . 4 4 Fuel piping
.... _
—... ... ... ____,....--
contact name F S14.15 for first lour; 54.03 fur each additional
:_ .. k.... t _ e l oc./ — -
—.......,, Furnace, ctc.
Address: 10330 6' '--r KA ..
---- — -- . Gas heat um
pp
-.. ------ .... __. ___
•
City/Statc/ZIP: 1 IA 0 4 1 og et 0 61 . Wall/suspended/unit heater
•
Phone: ()3 )6erz---/ 4 Fax: : (923 )6q I _ Water heater
Fireplace
--'
17.-muil: Range
• •
41, .:;W.:OPt:.:',„7,,I,...V. Barbecue #. 'i,i -.• •"::::,..L. Clot der
'• ;.
hes ry
13usi name: ARAD \ ,-_ . ./tEtila re..A/ --...._ - ---- Other .., ..., ,.,..,.,,.
Address: 10330 / b.-4 TbAl 9: 4 Cd .."w'z'o'vq0ORWAtitapttrittatiAkIA,,,,....,:„.
..........
skibloco I _.._.. 9
cit - 19 4 ei706z ._ ----- Mini mum permit fee ($90.00) .."--.
Phone: Q' ) On -- (-‘, L1 (6 1, JO 7q PIM" rCViCw (25% of Penni( (cc) •--
,..,,
.. -- -
CCB tic,: 6-tei 3 ___ State surcharge (12% of permit fee) IL 7,,
-- , -- - • -"" TOTAL PERMIT FEE l loci .12
e r . Thi; permit applientinn expires if n permit iA not obtained within 181
Authorized signature. • . days after it 1125 been :Iccepted ,i, complete.
F rrinl name: Pai . L i Date /117 1 * ree methodology set ily 'Fri-County El‘iilliing Indult/5 Service Boni
t:\ ri,iiidi-,0 Pr.rmiTANIEC•PermitAop nor. 10/61/00 10-40 17r (I I/0714 '(,)M,WHII)
12/08/2009 10:34 5036911879 ARROW MECHANICAL PAGE 03
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