Permit N;W?"'" OF TIGARD
MECHANICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit #: MEC2010 -00258
(G km) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/09/2010
°T
Parcel: 2S1 11 CA02000
Jurisdiction: Tigard
Site address: 15505 SW SUMMERFIELD LN
Subdivision: Lot: 0
Project: Coquillette
Project Description: Replacing A/C unit.
Owner: FEES
COQUILLETTE, GLORIA M Description Date Amount
15505 SW SUMMERFIELD LN
TIGARD, OR 97224 Air Conditioning 06/09/2010 $46.75
12% State Surcharge - Mechanical 06/09/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 06/09/2010 $43.25
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 $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 1.801.32.2 44.
Issued By: i � Permittee Signature:
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.
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Mechanical Permit Anp icat i , ; ‘,IC. „!' 1(4,111'1.4.1 .. t�`, ...r sa `, rK c..
,t om ,�, _ '
1 fin; Daco Perm No.:
�� City of Tigard R l� , 1=G�11) —c,
13125 SW Hall Blvd., Tigard, OR 97223 p Plan R oview d /
p:' 6,U N 0 08 Other Permit;
" � � ( $ t �s, Phone, 503.b39.4171 Fa 503.59fl.19 L � � � Dare/By:
ti i i i j i”, Inspection Line: 503.639.4175 Date Ready/By: Junin. m Soe Page 2 for
Oht.zottroo,iti Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: ' M Supplemental Information
BUILDING DIVISION `_.
t •TYPE OF 1VORI ' , COMMERCIAL 'FEE* SCHEDULE — USECHECKLIST
. �
Mechanical permit fees" arc based on the value of the work
❑ New construction Cii Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other; mechanical materials, equipment labor, overhead, and profit,
value: 5 3 600
. CATEGORY, OF. CONa�'ll�Uf TION:, ;n ;',i,. , ::. 1 RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
g 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special li/ormartnn use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description Qty, 1 Ea, I Total
JOB SITE INFORMATION AND LOCATION : t _;j' Heating/cooling
c Air conditioning /
Job site address: /�,� (4/ >G 4 u e A _ (requires site plan showing placement) t 46.75 1(6 (1)
City /State /ZIP: -.y -.1,, 4 ,, o,/ Furnace 100,000 BTU (dttcta/ventn) 46.75
!f Furnace 100,000+ I3TU (duets/vents) 54.91
Suite/bldg. /apt. no.: Project name: r I je 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),
in -wall, in -duct. suspended, etc. 46.75
Flue/vent for anuf above 23.32
Subdivision: Lot no.: Other 2332
Tax mop /parcel no.: Other fuel appliances
Water heater J 23,32
DESCRIPTION OF= WpRI{ ' : :.‘„•1,,,....,; Gas fireplace 33.39 •
♦ to . t
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) •,_ 23.32
• Wood/pellet stave , 33.39
_ Wood fireplace /insert 23,32
Chimney /liner /flue /vent 23.32
PROPERTY OWNER . ❑ TENANT.; '. ; : Other: 23.32 .....
Name: ! 0 r - Y 0 ;, — - Environmental exhaust and ventilation
Range hood/other kitchen
Address: 0' � , ,, _ r • , equipment - 33.39
City /State /ZIP: Ti' OR Clothes dryer exhaust 33.39
- - Single -duct exhaust (bathrooms,
Phone: ( ) .. .- - ,4 Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT . d comer. PERSON, ,.';'.•
Atti /crawtspace fans 23.32
Other: 23.32 ,
Business name: Fuel .1 in?
. 514.15 for first four 54.03 for each additional
Contact name: ��"'_' e. d t r Furnace. etc.
Address: i , Gas heat pu
. --
� I
City /State /L1P: wall/sus.ended/unit heater
? WPle heater III
Phone: ( 3 � T. * � 0 � Fire•lace
E-mail: Range
' CONTRA OR ' ,- . :;'," Barbecue
Clothes dryer (Ras)
Business name: e IV ! w ,t" G. Other
Address: • o g • Ev r N . . MECHANICAL PERMIT FEES*
City /State /ZIP; •Or I' 5. I t1 'O ~ a, _ Subtotal LI1 S
7
/ Minimum permit fee ($90.00) cid
Phone: (-9.3) a 3 - ) "7'7 ' Fax: (l ) bS/ - 3 Plan review (25% of permit fee)
_CB iic,: # -5-13 7 I f / * i State surcharge (12% of permit fee) i f) ,,`;(0 `�
Irllle TOTAL PERMIT FEE _ 1
This permit application expires If a permit to not obtained within 180
Authorized signaler
j ! 1 p days after It has been accepted as complete.
u' � � P" Da te: "No • • Fen methodology set by Tri•County Building lnduatry Service Board
Pant name:
I ■auccimawennitatEc.eermitAe doc 10/01/09 440.4.17T( 1 /071COM/WEB)
T00 CJ HIV'8DN - SN3g MC XYd ZC t 80 0T0Z/L0/90
06/07/2010 08:32 FAX 5036513345 BENS - HEATING &AIR L 002
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