Permit CITY OF TIGARD
`�'�� MECHANICAL PERMIT
' �� 4
`` 1 1: v.; COMMUNITY DEVELOPMENT Permit #: MEC2010 00263
3A4 � .,AP:' , Date Issued: 06/10/2010
(GAab 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 112CD07400
Jurisdiction: Tigard
Site address: 15854 SW 76TH AVE
Subdivision: PP1995 -100 Lot: 2
Project: Davis
Project Description: Furnace installation.
Owner: FEES
DAVIS, ANN H & CHRISTOPHER A Description Date Amount
15854 SW 76TH AVE Furnaces < 100K BTU 06/10/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 06/10/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 06/10/2010 $43.25
Contractor:
HEAT RELIEF CO
13122 NE DAVID CIR # 800
PORTLAND, OR 97230
PHONE: 503 - 261 -9915
FAX: 503- 261 -9814
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 :11.- . • 4.
Issued By: 1 - , • — _■•••=4!- Permittee Signature: . ? 4(e_
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i
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.
06/08/2010 TUE 16:.12 FAX 50326 0001/002
Mechanical Permit A • 1 ' liea ;Just s tt ', -FOR OFFICE E USE - ONLY �
4 City of Tigard Q X E R ecei ved
Date/By: ` _ jir Permit No.: __ iv P� �ili tll lip_ V .�
s r 13125 SW Hall Blvd., Tigard, OR 9 t r •,w
P hone: 503.639.4171 Fax: 503.59:. 960 . Plan Review
3'. v I� f Da te/By: Other ?emit: T 1 GARp Inspection Line: 503.639.4175 ` � b Date Ready Juris: 0 See Page 2 for
. _ a Internet: www.tigatd or.gov No tified/Method -r i °coV, ` \ f �� Supplemental Information
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ID New construction ® Addition/a eratio . ,.. acemeq = Mech anical p emtit fees* are based on the value of the work
�i performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: wE mechanical materials, equipment, labor, overhead, and profit.
�- m, - r es ' Ti - �-- Value: $
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y, 3y � °4�11M•� 'f•.R'KT J.^!.`Y`Y' 1 533* 6 ,t�� .. :w
:� 1- and 2- family dwelling ❑ Commercial/industnhY ❑Accessory building R : ' 9 n-..,-,-1 s ?� .' ;, ES* "
Multi- family 0 Master builder 0 Other For special information use checklist.
z d
,_ w Description I Qty. I Ea. Total
- -^a,..h J ' e rt f - i(, sT �ir;11I ' 0. `.IM ,�w�
�� =M������������ Heating/cooling
Job site address: /S7
vUt/ 9" ' ,c7 0 ` / �D j1- Air conditioning or heat pump
S (requires site plan showing Placement) 14.00
City/ State/ZIP: -7-7.-e-0 fn g7.a,72r / Furnace 100,000 BTU (ducts/vents) 1 14.00 tj(i .`75
Suite/bldg. /apt. no.: Project name: `� Fumace 100,000+ BTU (ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
_ Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: I Lot no.: Flue/vent for any of above 10.00
Other. 10.00
Tax map /parcel no.: Other fuel appliances
, rz, 7 , Of` y � K . c7,70 ": `' - t M,
. e..w tri . .. . ' °�!" : A�Sf P1' J E x: �h 7 s. ,..,�,,: �T �4,� Water heater 10.00
u '
Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
,i.� Z i_ / 11. • Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
7; ° - R -'at` � lza -d� « '(���. t °-. Chimney/liner/flue/vent 10.00
, � n Other. 10.00
Name: ; AAV�-C v Environmental exhaust and ventilatlon
Address: Range hood/other kitchen
equipment 10.00
City/ State/ZIP: Clothes dryer exhaust 10.00
) Fax: Single -duct exhaust (bathrooms,
Phone:
( ( ) toilet compartments, utility rooms) 6.80 ,
`�r5..5R;ET a t ,,�, 1 �va:<<s,+ -w• •�4 t4sq[rF` "�"Ii7 �,x�," .��et7"vn " , :t i,�'1 7
, n .as :, . t hf ;o�41c1. �e r2 Jk, ,�]yt , ,i»< <�� Attic /Crawlspace 10.00
Business name: HEAT RELIEF Other: 10.00
Fuel piping
Contact name: MARK DEFRANCISCO $5.40 for first four; $1.00 for each additional
Address: 13122 NE DAVID CIR DR # 800 Furnace, etc.
Gas heat pump
City/State/ZIP: PORTLAND, OR 97230 Wall/suspended/unit heater
Phone: (503) 261 -9915 I Fax: : (503) 261 -9814 Water heater
Fireplace
E -mail: Range
aXrr3-e*5s aunt:" S,F e).te =' �h�",p�a qtr ` Barbecue
Business name: HEAT RELIEF Clothes dryer (gas)
Other:
Address: 13122 NE DAVID CIR DR # 800 ''' i, Z � W 6r v 4'. i,� ,
City/State/ZIP: PORTLAND, OR. 97230 Subtotal - , ,
503 261 -9915 Fax: (503) 261-9814 Minimum pemut fee ($72.50 091......Q: 0 ,cy,1
Phone:
(503) ( ) Plan review (25% of permit f::
I I _
CCB lic.: 122424 /'�-1 / 1 1 State surcharge (12% of permit fee) ,
l// TOTAL PERMIT FEE N cH 0j . ra J This permit application expires if a permit Is not obtai t n 180
Authorized signature: I0 _ > days after it bas been accepted as complete.
Print name: MARK DEFRANCISCO Date: * Fee methodology set by Tri-County Building Industry Service Board
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