Permit . CITY OF TIGARD MECHANICAL PERMIT
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°a . COMMUNITY DEVELOPMENT Permit #: MEC2010 -00394
T t GA R o 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2010
Parcel: 2S110BD03600
Jurisdiction: Tigard
Site address: 11753 SW ASPEN RIDGE DR
Subdivision: ASPEN RIDGE Lot: 1
Project: Buchholz
Project Description: Replacing gas furnace and A/C.
Owner: FEES
BUCHHOLZ, KARL P REV LIV TRUST & Description Date Amount
PARENT, PHYLLIS A REV LIV TRUST, 11753
SW ASPEN RIDGE Air Conditioning 08/05/2010 $46.75
Furnaces < 100K BTU 08/05/2010 $46.75
PHONE: 12% State Surcharge - Mechanical 08/05/2010 $11.22
Contractor:
EASTSIDE HEATING & AIR CONDITIONING
7200 SW JOHNSON CREEK BLVD
PORTLAND, OR 97206
PHONE: 503 - 774 -3281
FAX: 503- 774 -3057
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $104.72
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 1.800.332.2344.
\
Issued By ;�, _ Permittee Signature: / - / 9
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dill
Call 503.6 • . 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.
'; , From: 08/04/2010 07:31. #362 P.002 /003
Mechanical Permit Application FO O}• k IC L US OBI 1 -
City of Tigard .t , ,. Reeeivea
t i t DateB •: Permit No
• 131 o SW Hall Tigard, OR 972 / 5 ., 0 y — q
_ t�0 � Plan Review
Phone: 503.639.4171 Fax: 503.598.1 D � Date/By: Other Permit:
T"1 G A p D . Inspection Line: 503.639.4175 163 �rV Date Ready /By. 21 See Page 2 for
Internet: www.tigard Or.gav -clt •s r . O Notif:ed/Method. Supplemental Information
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TYPE OF WORK cA - COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction �Addition/aiteratio l c a e ment 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.
CATEGORY OF CONSTRUCTION Value: $
O and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: Air conditioning or heat pump
1 `� 5 3 Svl As�e vti "�, lP . 1) C ^ . (re ires site .tan showin_ iacement) • r t 4,15
City /State /ZIP: "j'-' �,C t CNN C1 1 2.-2...L\ Furnace 100,000 BTU (ducts vents) -44769- t '�• DO 4(0 r
`l Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: 8 /ActAiv 1 Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
t a) 14.00
Unit h
Unit heaters {fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00 �
Flue/vent for any of above '` Yf.
Subdivision: Lot no.: �1/
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
e P\Q� . \ - )\0-...C t .Q . 0--5 C V `C\CN,C Q . Oov.8. , S -- \--csr Flue vent for water heater or gas
fireplace 10.00
O. \ "'C t OY \UY12'<- Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
,PROPERTY OWNER ❑ TENANT
Other • 10.00 _
Name: \\O- ` •)U A'2-- Environmental exhaust and ventilation
Range hood/other kitchen
Address: t 1'"153 Sk1 (\ ‘ s per�' 4t` P- • equipment 10.00
City /State /ZIP:'" N z_s,c...._A..\ G'V, C —I-2:12_1A Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms. ' Phone: (503) 192 1 ` -- n Fax: ( ) toilet compartments, utility rooms) 6.80
0 APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: Eel . .s � tc e >t- R■� ' Jv ∎ o , r . ` k h
Other: 10.00 .
L � � � Fuel piping
Contact name: j0�,.., a \wood 55.40 for first four: 51.00 for each additional
Address: - 1 2-00 ' "SChrSCn Cee.x' Y� \‘iCS, - Gas heat pump
p u
Gas heat
City /State/ZIP: po ` OV 9 Z OC Wall/suspended/unit heater
r Water heater
Phone:( so a)'1 ( 'ax:: ( - 3Z.6\ 503) 11" - '30 1
/� Fireplace
�:-.
E- mail: ; r1C0 Zc�S• yl `- Neo- >c `v-.,c C-C - t Range
CONTRACTOR Barbecue
` ` t 1 Clothes dryer (gas)
Business name: Eo.S' t-�Q¢�A r t�� � cGV OvNtK%c`
Other: _ i
Address: - 1100 SE ,0\-,,n j0i e rZ..2..\I-N ?j\\La • MECHANICAL PERMIT FEES*
City/State/ZIP: 7e x - CO ZO ( Subtotal
Minimum permit fee (572.50)�r�"3, 5
.
Phone: (til'�)'77 "3��,\ Fax:(spa)'�'�y ""� Plan review f25 %of permit tee) •••••
CCB lie.: 'S'L S i5 State surcharge (12% of permit fee) _: I 1 �7
�' t! -
TOTAL PERMIT FEE � � �1.\ �'7).
Authorized signature i,..v a This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
U.;.,r ',AM... V o.,. . ` I eN Z T.s i n „-. $ _ y _ 1 O 1 Fee methodology set by Tri-Countv Building Industry Service Board
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