Permit v- CITY �� MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 -00349
.cTI219 13125 SW Hall Blvd Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/14/2007
""�'= �� PARCEL: 2S103AD -04400
SITE ADDRESS: 12960 SW 107TH CT ZONING: R -4.5
SUBDIVISION: PATHFINDER LOT: 034 JURISDICTION: TIG
PROJECT: MIYASATO
Project Description: Replace furnance, add AC unit.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
MIYASATO, LANCE S Description Date Amount
12960 SW 107TH CT
TIGARD, OR 97224 [MECH] Permit Fee 6/14/2007 $72.50
[TAX] 8% State Surcha 6/14/2007 $5.80
Total $78.30
Phone: 503- 624 -8135
Contractor:
COST PLUS HEATING + AIR
7132 N FESSENDEN ST
PORTLAND, OR 97203 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 286 -2009
FAX 503 -286 -6552
Reg #: LIC 47978
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
‘'■
Issued By: �� ��� :j am " / ` Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for inspections that usiness 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.
• Mec, h�a 'cal Perm' 1
1,1 C it y Of Tlga j i L - l I� �� _ i � 1 (Y ` "ev& / ,. a - ii / ` Permit No.1 co/ ° co 5 ' j./ 1.
0 13125 S W Hall Blvd., $ Og 9'/223 �`
Plan Review
' . Phone: 503.639.4171 Fax: 503.598 9 0 D B Otter Pemtit:
T i G A r, D Inspection Line: 503.639.417AUM k 4 MU U Date Ready/By: IiiEl ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method Supplemental Information
T ``� - >< Mechan pe
i it fees are based on the va of the work
❑ New construction kit otalterationJ replacement `
performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical mataials,,equipment, labor, overhead, and profit.
EGORY OY'•CON'1'R ? Value: $
' RP 4 144 1 001'l El�tlE`,l SY k -; •,
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special.informatton use checklist.
❑ Multi - family ❑ Master builder i ❑ Other: Description I Qty. I Ea. I Total
'. Pl Aw' 014 4ND-t 0 „ ,(41-' ..' ? , , n, :: , Heating/cooling
Air conditioning or heat pump /
Job site address: / 2,...q(00 5 Lau / 07 cr (requires site plan showing placement) 14.00
City/ State/ZIP: A r (- 0 ,e. q 7 z-z-3 - Furnace 100,000 BTU ( ducts/vents) / 14.00 J t( t)?
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: I Project name: 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
Unitheaters :(fuel -type, not electric),
in -wall, in -duet, suspended, etc. 10.00
Flue/vent for any of above 1 10.00 / 0
Subdivision: I Lot no.: tea: 10.00
Tax map/parcel no.: Other fuel appliances
L ` is x.+ Water heater 10:00
4 rs t ... ' JFR' [ W�lltit 10.00
Gas fireplace
q - lp C -FAA-Cc to , 1 Flue vent for water heater or gas
A -4 �t fireplace 10.00
/ t' d L Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
} h 4 11' Q J jj I.E a r ', '': Other: 10.00
Environmental exhaust and ventilation
Name: it t-.t? r 4 Range hood/other kitchen
Address: / ZLee0 Si-t - I07 C� equi meat 10.00
City / State/ZIP: ,Ayer OW 4' 72.2,3 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone . 5 - Z, ) ( 2.' — g / 3.) Fax ( ) toilet compartments, utility rooms) 6.80
" , \ a , Attic/crawlspace fans 10.00
ry Q • :r AI!1!JA ' ? ;`+ Other: 10.00
Business name: Fuel piping
Contact name: S , a a-io► -.) $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Water heats
Phone: ($ `7g I " I Fax: ( ) Fireplace
E -mail: Range
` ry i lerR ► 4 s .. . ._ � r 4 '�' E „ . ` - M , *..,, f�"a Barbecue
T, ^ k B . .T . . to i � (gas)
Clothes a
Business name: et 1 ui Omer
3 Address: 7( •rr ,ems i " °a:4`- �, ^.4,All��0 'I,.��"�
City /State/ZIP: A ir f/a # 1 t'?X_ q 72 Subtotal `'
/ Minimum permit fee ($72.50) ' IL”
Phone: (� ) z S'4, ZOG J Fax: (-�'', ) ° (0 --6c,... Plan review (25% of permit fee)
CCB lic.: l!' n7 8 "Rep-, /vD'' State surcharge (8% of permit fee)
TOTAL PERMIT FEE 1 /3 '
Authorized signature Q This permit application expires if a permit is not obtained within 180
0,, p� - days after it has been accepted as complete.
, qr t e -iSt") Date: 4 • -f Y-0 7 J • Fee methodology set by Tri- County Building Industry Service Board
Print name: 5./e e
1:\ Building\Pamiro \MEC- PennitApp.doc 04/06/06 440- 4617T(11 /07/COM/WEB)
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