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Permit C ITY OF TIGARD MECHANICAL PERMIT ° COM MUNITY DEVELOPMENT PERMIT #: MEC2007 -00682 TIGARD} DATE ISSUED: 11/21/2007 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S104BD - 09900 SITE ADDRESS: 12645 SW 135TH AVE ZONING: R - SUBDIVISION: ALEXANDER PARTITION LOT: 001 JURISDICTION: TIG PROJECT: POTTS Project Description: Valuation = $11,000; install furnace and A/C, gas piping to WH, FP & range. Other units = exhaust, rar hood exhaust CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS: 1 STORIES: BOILERS /COMPRESSORS HOODS: 1 FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN: NAT 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: CLO DRYERS: FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS: 2 FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: > 10000 cfm: Owner: FEES DIANA POTTS Description Date Amount 12645 SW 135TH TIGARD, OR 97223 [MECH] Permit Fee 11/21/20C $84.20 [TAX] 8% State Surchar€ 11/21/20C $6.74 Phone: 503- 810 -6247 Total $90.94 Contractor: UNIQUE DESIGNS INC 9117 NE 100TH ST VANCOUVER, WA 98662 REQUIRED ITEMS AND REPORTS Contact #: PRI 360 - 260 -0476 FAX 360- 260 -2825 Reg #: LIC 141819 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 OU NC by calling 503.246.6699 or 1.800.332.2344. Issued By: C 1 Permittee Signature: , Call 503.639.4175 by 7:00 a.m. for inspections that bus in essvda . 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. ti 1 11/21/2007 09:32 FAX 3602602825 UNIQUE - DESIGNS a002 /004 • Mechanical Permit ApplicaT "' "� `f r c ``'" �fl „ >' r .., r '. Il) IL(JI 1I( 11tiF UN I l 3 R eceived J : City of Tigard Dara/B g • Permit N , a oo - ©:) 6, i U 13125 SW Hall Blvd., Tigard, OR 97223N0 V 2 1 2U0/ Plan Rene 1 li>' 1 � d . to Phone: 503.639.4171 Fax; 503.598.1960 Other Pcnnir: hT`' DatclBy. T;l c.,AR , D Inspection Line; 503.639. �O tl f ®� ��� � Date Ready /By; tuna ® Scc Pagc 2 for Internet: www.tigard.or.gov '' BU1LDINGDWIS(O ) Notified /Method. Supplementnllnfurmution ��,� {' {, „1 :':N •' �t Ll� I fd ' t d , V ,I e� I' I,' I �,,' ( r ..u, , �, , ors ,,II•� r,�" C� . ., ' a r' '! ,i,� ! II i .I ;,,,.;, ,., ,,,�i,. ,,,,,;` "�, I 'i' . ,!i' , .:m, I'', ,'I,,' , Oil1' ii�','I({ i'"',:''il'1{ I :'J r' 'l, i, :', �' p� l';,�I� vSE. E li l•,,,.,o,r�; :. :,ii '11 ,� 1,. , :.',� .., ,. •, 1, il { i l d li ,,, 11 ,a d; Il'I,f) � „ �',11�C',i �•' '��'' �, 'r,'T .. ,., , flew construction Addition /alteration /replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. 'I( 1' :, „r, 1 , n . ,m �,,,,' , 1gi; Va lue: ,i ., i, `i ''��►��oY� 1p ea � c' • 5� {;� l i; , . , , ■,' 1 l�1?U -- - 1 ; i ',1, :, i)�i,' ' , � ,' , . dtt , � , a , t 1 i• ,,. - ' „ • / Z 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ;r! i SI 1,,,... '''!'1, ,,,EQ i,',' j !!!i , , STEMS FEE$ '''', ; ,, , :i, For special rrlforrnatron use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. I Ea. I Total 'lifi, "' ,,,li! : ., :0B10 'd,Ti{11'IA - #0, AN !1 .9CATIO]VI ' ; �;,i '11 ;, g/ r,; ,� � � „t ,; �� • Heating/cooling cooltrt g Job site address: I S` ie L4 c S JJ 1-11 — t, Air conditioning or heat pump 1 ' 1 (requires site plan showing placement) 1 14.00 y'-t .0 O City/State /ZIP: 1 '` ( ' P j Furnace 100,000 BTU (ductivents) 1 14.00 (, Li. DD -(J - ) li ' (i Furnace 100,000+ BTU (ducts /vents) 17.90 Suite /bldg. /apt. no.: • f Project name: _ Gas heat pump 14,00 Cross streeUdireetion$ to job site: Duct work 1 14.00 4,00 Bydronic hot water system 14.00 . - _ Residcnrial.boiler (radiator or hydronic) 14.00 . . Unit heaters (fuel -type, not electric), in- wall, in -duct, suspended, etc. 10.00 Flue/vent for any of above 1 10.00 10 pp Subdivision: I Lot no.: - - Other: 10.00 Tax map /parcel no.: Other fuel appliances II a, *9,,,'' d y ! , f 1' f ; 9 i {{� p���'`' ((�� l,.' ' 1 ! ' I• W ater heater 1��i;'I, '�li'I dill �il'l l � � {ill F „II�Ii!„' a 1�.I),iut�'Rj„ ��,,. ,`, ,', � ,,�;a`”; ', • •;i ' , , -'. 111ii''�' v i9�il hi � i' 10,00 i l _ Gas fireplace 10 -00 ..� `- ("& i CtS vtia-e� l (J�.l Y Flue vent for water heater or gas c _` �� uv � A' , A 1 n „ - ` • 1 fireplace 10.00 iO 1/� j GII U (� ' �,� { 1 Lug lighter (pas) 10.00 Wood/pellet stove 10.00 Wood fireplace /insert 10.00 „ „ l „ 1 Chiron /liner /fluc/vcnt 10.00 llil "1'�� :,'Ilily;i �?Il Q II „• 1, (III!��li•ijl;� „!� {.I.��iiilll' ;l �f�!'if�Eil!li au ski ,_.:— : llii; {ii' ” i' il;Il,•,( Other: \ 10,00 Name; W Environmental exhaust and ventilation Address: 1 a ( SLA.� I , B; � Range hood /other kitchen l equipment 1 10.00 1 11i City /State /ZIP: 1 � �pQ � Clothes dryer exhaust 1 10.00 10. DO Single -duct exhaust (bathrootns. s Phone: ( 1 - {ph i Fax: ( ) r toilet compartments, utility rooms) ` 6.80 (7, I/1 ill „i ,ll �';ii� i 'l; �I�r { ][ „ ''r „'I''l,i i��; f '' • C'f1NT;4tt, r ,PE, ! ;' Attic /crawlspat:c fans 10,00 I PI �I � i !r ,u 1IiC� 'U :,�� ' :� "..', • !� .I.ii5,1t t', Other; _ 1 0.00 Business name: 1J�� I, - e 1 Fuel &inQ Contact name: ' ) S / i,!„1,lc S5.40 for first four; 41.00 fur each additional Address: �IJ�/ t Q J �' D, (]..,ti � 7 Furnace, etc. 1 tf -0 , X70`, 9 1 1 I `= (L/ u - Gas heat pump v l� Ci[ylState /ZIP: Wall/suspended/unit pended/ unit heater Phone: (, 1)f (e F'ax:: ((Q3) ,g(p0 - S Water heater C n_ ti), F Fireplace e E - mail: 1{1 cQ -VLi t de l ! ) Y Range ,t /) �t ,, � e. 1 , Ifl� ,. U lil(�, �' ' :!illlill'llb'.,.:;4!',' ,.,mlilitl l'' t ,, 1 'Ij�rr , „ ,,,i ' , i',li ;;Ii1■g; Barbecue Business name: Wai (4,t t p 1(y s �/ j,e- ` Clothes dryer (gas) U"Q IC ` (J� Other: Address: ( Q�D 1.�W L rye I , l,i��)!i� 1,lti ''' ' ,"4 � ��.14 1U ,� �t F �;il ,I!I, : : dill' I(•�' P: t V` `i r (� 1 ' , ' �' b � il, �ll i ` I ) ; Cit /StatcZT �JI/`.eil�''L1.jlel(� � �, •I • Subtotal 0-4. QC) Minimum permit fee ($72.50) Phone: (3(p0 (pc) Hi to Fax: ( O ( - a �j ., Plan review (25% of permit fee) CCB tic.: \ 14 1 go CI, State surcharge (8% of permit fee) (D1 ) TOTAL PERMIT FEE ' Authorized si la,ature: - , This permit application expires if a permit Is not obtained within 180 _ days after it has been accepted a. complete. Print name. I V. LOA 5 Date: _ Q • Pee methodology set by Trr- County Building Industry Service 9oari II / I;Uiuildmg1Permns \MEC•Perntlt • pace 04/06/04 , n40.4,6177 (11 /02/CUM /wF5) C70 r 9 1 , -11/21/2007 09:33 FAX 3602602825 UNIQUE - DESIGNS Cj 003/004 0-e1; 60 i CJ`s (C3 1 ,c, L.0CAT1on/ d r4:: `?„ 4 1 V �O G f(^j` A V / '