Permit ,.q CITY OF TIGARD MECHANICAL PERMIT
1,
, :' a COMMUNITY DEVELOPMENT Permit #: MEC2010 -00400
T i A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/09/2010
Parcel: 2S111DB09800
Jurisdiction: Tigard
Site address: 15515 SW OAKTREE LN
Subdivision: Lot: 0
Project: Sacconaghi
Project Description: Replacing gas furnace and A/C unit.
Owner: FEES
SACCONAGHI, RODNEY W & Description Date Amount
SACCONAGHI, SANDRA F, 15515 SW
OAKTREE LN Air Conditioning 08/09/2010 $46.75
Furnaces < 100K BTU 08/09/2010 $46.75
PHONE: 503 - 620 -3520 12% State Surcharge - Mechanical 08/09/2010 $11.22
Contractor:
BEN'S HEATING & AIR CONDITIONING LLC
PO BOX 80607
PORTLAND, OR 97280
PHONE: 503 - 233 -1779
FAX: 503 - 651 -3345
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.
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Issued By: _AC J Permittee Signature: '` � `..g---
AO
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 ,,-. FoR (wricE It -.J' MI A'
City of Tigard • ., „, ‘2, ‘, .. \ ',' Received
. ..:_--• • 13125 SW Hall Nerd OR 97223
Blvd.:, , ,''" ' ''' • ,''' Dlitof s
71 Plan Review :11122111211
, • . Phone: 503.639,4171 Fax: 503198100 aD te/By:
Other Permit:
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F1(;,% KT) Inspection Line: 503.639.4175 .
c, 0 \13 Date Ready/By: Fa See Page l for
Internet: www.tigard-Orgov : W %.• . Notified/Method: PM Supplemental Information
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.„ 0...,. , ,
.. . . . . • ... TYPE oF *OaK,:i...; .commERciAvirEE!..:sc4EopLE USE'CRECKLIST
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Mechanical permit fees* are based on the value of the work
0 New construction IP Addition/alterntion/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition J Other: • mechanical materials, equipment, labor, overhead, and profit. ,
Other: ,, • ' • • CATEGORY. OP CONSTRaTION•. • ;:./;f:4',: :.,. : •• .• : • , Value: $ 76d0
.. .
1 - and 2-family dwelling 0 COmMereial/ihdustrial 0 Aceessory building
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Multi-family 0 Master builder El r Description :;.::.., REsamin ggi)/PMENT rSYSTEMS PEES"
. For special Wormation use checklist._
Qty, 1 Ea. I Total
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. • • . JOB SITE INFORMATION•:ANA : ttoCATIori ': Heating/cooling
Job site address: . e Li c :.-i- ee- . Air conditioning
(requires site Man showing placement) 1 46.75 1 16 rir
City/State/ZIP: ,
1 j , . 6 0 1 • : Punt= 100,000 BTU (ducts/vents) / 46.75 1 /&. 1 5
Furnace 100,000+ BTU (ductsA.ents) 54.91
Suite/bldg./apt, no.: Project name: ! .. 'S,_ , ,„ ;
kr r ON "1 Heat pump 61,06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
.•
• Residential boiler (radiator or
hydronic) 23.32
--.------- Unit heaters (fuel-type, not electric),
in-wall. in-duct, suspended, etc. 46.75
Flue/vent for any of above
Subdivision: Lot no.:
,
' Other: 23.32
Tax map/parcel no.: : Other fuel _appliances
• - • '' ' • • • DESCRIPTION ip , , , .:,:7;,',i -, '..•:.E7', -, :&i. ; ., ' s! i . Water heater 23,32
.. • n ' " ' 1 .. Gas fire •lace 33,39
Icepereitz 19 Al. rINArCe- se ) a l t ."' Flue vent for water heater or gas
fireplace 23.32
- . — — Lo.. 1 il ter Iasi_ 23.32
- .• .
• Wood/pellet stove 33.39
• .
Wood fire • lace/insert 23.32
1 Chimne /liner/flue/vent 23.32
•• til • PROPERTY OVVNER ' . I i ' . . •.:.' ..• '.: 13 TENANT:':):"?':;:: :';:.:' ':' ' .•
' , Other 23.32
Name: 12-0-*---Si ,..._ t C e ?)14)A4lai Environmental exhaust and ventilation
Range hood/other kitchen
Address: iss __ccu o Mtliee /Air e • ui . ment 33.39
City/State/ZIP: r ,_- .1.A ,LL3 :7 a a q Clothes dryer exhaust 33.39
Single.duct exhaust (bathrooms.
Phone: (03) 6,210.. ac,7 Fax: ( ) toilet com•artments utilit rooms 23.32
1'. APPLICANT . • • • • : I - ...n
:...,:•: PERSON )': Attic/crawlstace fans
- _ INE11111111111
. • - . .
Other: 23.32
Business name: '
_ : Alk _ Fuel piping
Contact name: e..- V C7'e7 $ 14,15 for first four; 54.03 for each additional
Furnace, etc,
Address:
- • • Gas heat • um • —
City/State/Zip: . WalUsuspended/unit heater
/ z.. g 0 ,Fax: :L ) Water heater
E-mail: Range
. .. • . ' ' •. i : . . ..... CONTRA OR ' '",:.'. . ' . ••::..:. 2. : :., ; .:-,....,.... . Barbecue
f il Clothes dryer (gas)
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Business name: .1Z e rv ,,,e, n epr INA 4-. ..6- / 6 Other ,
Address: '' 7 _ . .• • • MECHANICAL PERMIT FEES,
City/Siete/ZIP: p, ,--r- l ; 0 ge Cf Z,M, s u b tota l
'')one: Q-3) D.33 - I "7 1 Fax: (SV ) &SI - 3 3 iii--- Minimum permit fee (590.00)
Plan review (25% of permit fee)
t lic ' 6 ill .cci 7 State surcharge (12% of permit fee) 1 1 . 74,
1. - ' TOTAL PERMIT FEE iv y. 7
This permit application expires if a permit is not obtained within 180
Authorized signaturia I al • days after it has been accepted as complete.
yr WI rEl
Print name: Datc: v o
' Fee methodology Set by Tri-County Building Industry Service Board
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muadin 10101109 . 440-4617T (ltM/COM/WEB)
T 0 0 21 Cl yae 0 1 ( A-)1\J SI VON I ,LV ali- SNHEI 2VCCTS9COS XV 1717:ZO L00/CT/T0
01/13/2007 02:45 FAX 5036513345 BENS - HEATING &AIR Z002
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