Permit a CITY OF TIGARD MECHANICAL PERMIT
IN
Is ' COMMUNITY DEVELOPMENT Permit #: MEC2010 00395 i.
T I G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2010
Parcel: 2S103BB00800
Jurisdiction: Tigard
Site address: 12525 SW 124TH AVE
Subdivision: BROOKWAY Lot: 8
Project: Durham
Project Description: NC and furnace installation.
Owner: FEES
DURHAM, STEVEN W & SHELLEY L Description Date Amount
12525 SW 124TH AVE
TIGARD, OR 97223 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:
OREGON HEATING & AC
PO BOX 241
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 $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 1.81 • -
A
Issued By / — �. Permittee Signature: ,
/TI��
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.
Mechanical Permit Application y FOR OFFICE USE °Nil(
la . City of Tigard I R \ ,, k rt,0\ pat. 3'LrirAIRMi- Permit No..
.
13125 SW Hall Blvd., Tigard, OF. 97223
Phone: 503.639,4171 Fax: 503.598.1960 ',\3 e., , ; E9Z3111111.1.111111. Other Permit=
^. ";',. 11.
nspecion Line: 503..
TIGARD I t6394175 N % Vete Ready/By: RI See Page 2 for
Internet www.tigard-orgov 1 ...\ - ‘% 7 , ,Q ,.. N.Y■ Notified/method: FM Supplemental Intormation
.1"i1PE OF WW . ' . :1° 1 ' ? 674 Ocil/DTA L...0sE
0 New construction rigZdd Won/alteration/replacement Mechanical iermit fees* aM based pn the value of the woriC
performed, Indicate the value (rounded to the nearest dollar) of all
0 Demolition El Other: mechanical materials, equipment. labor, o-verhead, and profit.
, :::.:.. CA ; fF,Gbity,i3ii tl*,i :: ::....::,.. .: : , .., .__ Value: S ,
:''...;*11)*I14:i400111*0 /SYS FEES*, . • .:
K.I.- and 2-family dwelling D Commercial/industrial 0 Accessory building
F ,special 110nm:bon use checklist. ----
D Multi-family 0 Master buildilP 0 Other: Description Qty. - Ea. 1 Total
40 0 1104 7. 411 Vitl4F •:' 1 ' 1 110 ''::: :' ..' ::'..' Heatin7/caollot _
Air conditioning
-•
Job site adchr-ss: gSD S /AD . 4.....1.2Alkatin (requires site plate showing placement) 1 46.75 4 1(, • 77
City/State/ZIP: - 1 7 1 rt j rcl,... a aa, Furnace 100,000 BTU (ducts/vents) I 46.75 kb
, 7C
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt.no.. Project naroe: ,,-I
Ar Heat pump 61.06
Cross street/directions to job site: Duct work - _ ..
livdronic hot water system 23.32
Residential boiler (radiator or
hydronic)
23.32
Unit heaters (Mel-type, not electric),
in-val. in-duct, suspended, etc. 46.75
. . Flue/vent for any 23.32
Subdivision: . ` Lot no.:
Other: 23.32 ...j
Tax map/parcel no.; Other fuel appliances
23 32
,.• ,?,." ..E.,..r.,::c,:::, ...':i ,;'..::!,.?4l
Gas fireplace 33.39
..,iminiTiwgaid..„4" water heater or gas
fireplace 23.32
Log lighter (pas) 23.32
„ .
Wood/pellet stove 33,39
Wood fireplace/insert . 23.32
Ai rt./flue/vent 23.32
11 • '::.:::.":. chimn -11--- 23.32
Narrie:
ynrillalk Environmental exhaust and ventilation
A A . 1,1 -
' T Range hood/other kitchen
Address:
fr .... 1, P., • equipment 33.39
City/State/a?: i A * CilaaZ Clothes d er exhaust .
Single-duct exhaust (bathrooms, 33 39
Phone: 50) 1 (3 le Lae, Fax: ( ) ' toilet compartments, utility rooms) 23.32
ESIMEIMMN11111111 . 0 tp**0'iuxi0oN :;::.: Attic/crawis • act fans 23,32
Other: 23.32
Business n ame: gAMWM„,, TAMSFAZNIIIMIN Fuel .i •
Contact name: ini • NIS • 14.15 for first four; S4.03 for each additional
Address: , 0 , 6 X /9-4 Furnace, etc.
Gas heat puns
City/State/ZIP: 01Art CAIL • -bik Wall/suspended/tmit heater
Phone: t l a e z i # c Fax: : pt pit 4:: IQ Water heater ,..
Fireplace
; '.. .:; ' . : .'' :„ . : :. : . .. : 1
Clothes dryer (gas) .
Business name: do r wt it . uh ' o . CA- i /
Address: . b t • ■ th. 0 S.- -- . : : ::'::.; . ,1 FOS, ..:. .7
City/State/a?: 1111 ..LAL 1 tl: Subtotal
Mininutat permit q3-!-Irtb
Phone: 4563 (rXti Cif tjA q Fax &a tA 1 eISS(.0 ______ Plan review (25% of permit fee)
CC13 lic.: -1 ' 0 --- State surcharge (12% of permit fee)
TOTAL PERMIT FE ,
Tbis permit' application expires it a permit is not obtained within ISO
Authorized signature: INT , days after it has btu) accepted as complete-
Print name; 1 OMIMINMEr ' D . Fee methodology set by Tri-Couury Budding Industry service Board
EO/TO 39Vd TaSA 9NIIV3H NOD3N0 9S98 -T69 -E0g IT:ZT OTOZ/b0/80
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