Permit
q CITY OF T'IGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2010-00086
n 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/25/2010
Parcel: 1 S133DD17500
Jurisdiction: Tigard
Site address: 11898 SW 128TH AVE
Subdivision: VILLAGE AT SUMMER LAKE NO. 5 Lot: 211
Project: Lewis
Project Description: Install furnace
Owner: FEES
LEWIS, JAMES W & CINDY C Description Date Amount
11898 SW 128TH AVE Furnaces < 100K BTU 02/25/2010 $46.75
PORTLAND, OR 97223 12% State Surcharge - Mechanical 02/25/2010 $10.80
PHONE: 503-318-2451 Minimum Fee Adjustment - Mechanical 02/25/2010 $43.25
Contractor:
OREGON HEATING & AC
PO BOX 397
DUNDEE, OR 97115
PHONE: 503-691-9699
FAX: 503-691-8556
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
applicab I work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
iss nce, or if work is spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
ility Notification Center. hose rules ar set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules
r direct questions to OUNC call g 03.246.6699 or 1.800.332.2344.
Issued By: Permittee Signatu
Call 503.639.4175 by 7:00 a.m. for an inspection that business
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.
:tea
Mechanical Pelrinit Appli F D City of Tigard Received o2 oZ5 /D Permirxo.: ,e D
Date/8Y:
13125 SW Hail Blvd., Tigard, OR 97 it '6 ZM Plan Review plhet Permit:
Phone: 503.639.4171 Fax: 503.59x(r Daie/ey:
Inspection )Line: 503.639.4175 ~,y P;Il Dam Ready/By: I la See Page 2 for
Internet: www.tigard-ar.gov Y U,_ 1 Imo! Alotif thud: ~ Supplemental lnformattou
' D1 V
, a ~ SIG
Mechanical permit fees" are based on the value of the work
❑ New construction Addition/alterution/replacement performed, indicate the valuc (rounded to the nearest dollar) of all
911
E] Demolition ❑ Other: mechanical materials, c ut mcnt, labor, overhead and profit.
ON re,' Value S
IS"
and 2-family dwelling Commercial/industrial ❑ Ace sso 14 buildin 0 4,
4 ) F1 r g For special infonnadim use checklist.
❑ Multi-family ❑ Master builder ❑ Other: Description Qn. ! a. Total
rZ f t I+~~ i C( ,yam pl7n~ ~%P r,~,t,w+,f 7iM 1 :(~7ikA ~f. I[CAtin COOIIrI
` Air conditioning
Job site address: LJO l r uses site plan showia laoemeut3 46.75
Furnace 100200 BTU (dacts/vents) 46.75
City/State/zIP: Furnace 100,000+ BTU (ductslvents 54.91
Suite/bldg./apt. no.: Project name: Heat um 61.6
Duct Ulork 23.32
Cross sVCCUdirections to job site: 23.32
H dronic hot water cyst .ern
Residential boiler (radiator or
ic 23,32
h rdron
Unit heaters (fuel-type, not electric),
in-wall, in-due stir ceded etc, 46.75
PliuJvertt for an of above 23.32
Subdivision: Lot no.: Other: 23.32
Tax map/parcel no.: Other fad appliances
.771
t "Dy~ON, , `t', C Y~uF ( Water heater 2332
Gas fire, lace 33.39
flue vent for water heater or gas
fire lace 23.32
Lo ki ter as) 23.32
Wood/ ellet stove 33.39
Wood fire lace/insert 2332
Chimae /liner/flue/vent 23.32
v!Mr-' • ~ ,r + ~ i~ +r ~ ° ~ ~ ~ ~ ~ "r~ ) O)tltfr: 2352
NaznC. Environmental exhaust and ventilation
Range hood/otherkitchen
Address: cut dent 33.39
Clothes cr exhaust 33.39
City/State/ZIP Or-~ Single-duct exhaust (bathrooms:
Phone Fax ( ) toilet com artruents, urili , rooms) 2132
Attic/crawls ace fans 23.32
Ol~AI1[ FEI
Other: 23.32 11
Business name: Fael i in
$14.15 for first four- 54.03 for each additional
Contact name:
Fumacc, etc.
Addtrss: Gas heat
Cit}/State...: l Wall/sus euded/unithcatcr
Water heater
Phone: LOA Fax: Fire lace
Email: Ran e
barbecue
aS
. Pn. M Clothes dryer(g
Business dame: 1 Other
Address: O u 1 Jvn" x+,
y Subtotal
City/State/ZIP: 6 Minimum perr it fee ($90.00)
Phone: Fax: I~ Plan review (25% of permit fee)
CCB lie.: ` State surcharge (12% of permit fee) Q.
I I TOTAL PERMIT FEE 1
This permit application expires if a permit is not obtniued within r 0
Authorized signa JA A 104 days after it bas been accepted as complete,
Hate: x Fee methodology set by TriLbunty Building Industry Service Board
Print name:
410-461 IT (I 1102JCOUVEB)
Ze/ie 3~dd 9NIid3H N093Z10 9558-Z69-605 66:61; OTOZ/5Z/Z0