Permit M k n CITY OF TIGARD
MECHANICAL PERMIT
: COMMUNITY DEVELOPMENT Permit #: MEC2010 -00238
as
Date Issued: 05/25/2010
:T .I GARIa 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S133DD16500
Jurisdiction: Tigard
Site address: 11994 SW 129TH PL
Subdivision: VILLAGE AT SUMMER LAKE NO. 5 Lot: 201
Project: Chin
Project Description: Replacing furnace, heat pump and water heater.
Owner: FEES
CHIN FAMILY TRUST Description Date Amount
BY LAWRENCE D /ELAINE F CHIN TRS, 11994
SW 129TH PL Furnaces < 100K BTU 05/25/2010 $46.75
Heat Pump 05/25/2010 $61.06
PHONE: Water Heater 05/25/2010 $23.32
12% State Surcharge - Mechanical 05/25/2010 $15.74
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 $146.87
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 1.8 .0.3327 4.
Issued By -% ` / Permittee Signature: ��
- �/ :
all 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.
Mechanical Permit Application' 't►. 7 - ,i, t rt;l<t)hhll r. I,SI' ONIs
City of Tigard Received
Illi 13125 SW Hall Blvd., Tigard, OR 97223 I`11AY 2 2 1'I DateiBy; 5 I Q I V
' Phone: 501639,4171 Fax: 503.598.1960 Plan Review Other Permit;
Inspection Line: 503.639.4175 Date/By:
I t i i A r. n P i t 's ': �t • Data Ready/By:
Internet: www.tigard- or.gov — 9ta
' o J: Sd See Penn l Information
TYPE OF WORK , . ',..., ..,.
COMM
OMMIrRCIAL FEE "', SCHEDULE - USE CHECIQ 1ST
❑ New construction dd i t i o n/a I t e r at I on/re p 1 a c e m e nt Mechanical permit fees* are based on the vntue of the work
performed. Indicate the value (rounded to the nearest dollar) of all
[l Demolition Up Other mechanical materials e.ui m...• labor ovcrh and .rofit.
•
CATEGORY OF CONSTRUCTION :' �, „ • Value: 5 ��!r/ �5 c,
1 -and 2-family dwelling :RESIDENTIAL EQUIPM ' / SYS 'MS FEES' ' t
Y g ❑ Commercial/industrial E A ccessory building
Multi -famil For special information use checki `�
y ❑Ma ster builder ❑O ther: Description Qry. L•a. Total
. • JOB. SITE INFORMATION .'AND V OCATION :;, :' . Heating/cooling
Job site address: /15941 S �'] Q ( C ct' Air conditioning
rc ui site pl showing al cement) 46.75
/
City /State /ZIP: \ de 1 e � Furnace 100 000 BTU ducts/vents) . 46.75 •
Furnace 100,000+ BTU (ducts/vents) 54.
Suite/bldg. /apt. no.: Project name: CA �
Heat pump 61.00 Ci
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),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: [ Lot no.: Flue/vent for any of above 23.32
Other; 23.12
Tax map /parcel no.: , Othtr fuel appliances
DESCRIPTION OF- WO r Water heater _ J 23.32 2-1.31
/� Oas fireplace 33.39
: /
_ L :e ,Ef Fe =5/14. ... • , 4 Flue vent for water heater or gas
fireplace 23.32
" • ` / ' Log lighter (Ras) 23.32
Wood /pellet stove 33.39
Wood fircjilace /insert 23,32
PROPERTY OWNER • •. .. I ' Chimney /liner /flue /vent 23.32
[ � • .TE'NANT .:;;'.' „ Other: 23.32
Name: 4 C.-1\ Il r hi f Environmental exhaust and ventilation
Address: el i A i Range hood /other kitchen
•. equipment 33.39
City /Stets /ZIP: ` • , Clothes dryer exhaust 33.39
Phone: . /�) r + on Fax: ( ) '�+�► Single -duct exhaust (bathrooms. '—
toilet compartments, utility rooms) 23.32
• • ( APPLICANT ' " '''!D-CONTAGT: PERSON.: . • Attic /crawlspace fans 23.32
Business name: -- Other: . 23.32 ,
Foci piping
Contact name: *Q 514.15 fur first four; 54.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /'LIP: Wall/suspended/unit heater
Phone: ( 3 7 / T-37 g e Fax:: ( ) water heater
E -mail: v Fireplace
Range
. CONTRA OR' 4. ' :;! a r... , : Barbooue
Business name: 13 e N c, 1 d- k 1 Clothes dryer (gas)
Other:
Address; V MECHANICAL PERMIT FEES*
City /State /ZIP Ater N'N p t' 4 _
`L / ca, Ca io _ Subtotal 1 31, I
Phone: ( ) a33 - � 77 I _ Fax: (• r) 6 3 .a— Minimum permit fee (590.00)
IO ` ) j / �^� Plats review (25% of permit fee)
r_. _CBlie.: r'J - State surchar 7y
ge (12 ° �6ofpermitfee)
/S•
' 1'UTAL PER MI'1 "
Authorized signatur ` I This perm ApplfcAtion expires if permit is n ot obtained w ithin 180
Print name: � r'� � ����� d Actor it has been accepted as complete.
-
Date: • Fee methodology set by Tri- County Building Industry Service Board
I'u3° ildirupPci mil a\hlEC.Pnmit i.doc 10/01/09 440 - 6111' (1 a2/COM/WEa)
T00 [A HIVVDNIIvaH 21 X83 SC :60 0T0Z /17Z /S0
L CY'11 Lic.:
Authorized signature:
Z00 L
Plumbing Lic. no.:
HIVVONIIV H — SNHS
Plain review (25 %u1 " permit Ice)
5111E surcharge (12% of perm l Ice)
i ()TAI. PE'RMI h
This permit apptic�t n exl1rir�fc if x rermlj, it nal b
o(talned wllhbr IMO days
aR�4 tt i189 UeCrl N�CCpIQU en complete
'Fee methodology set by Tri•('ouniy Duildiug Industry Service Board
SbCCTS9CO5 DU SC:60 OTOZ /fiZ /50