Permit CITY OF TIGARD MECHANICAL PERMIT
r COMMUNITY DEVELOPMENT Permit #: MEC2010 -00430
T f GAP D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 2S103CA03400
Jurisdiction: Tigard
Site address: 11555 SW TERRACE TRAILS DR
Subdivision: Lot: 0
Project: Bergstrom
Project Description: Gas furnace replacement.
Owner: FEES
BERGSTROM, DENNIS T AND DAWNA L Description Date Amount
11555 SW TERRACE TRAILS DR Fumaces < 100K BTU 08/26/2010 $46.75
TIGARD, OR 97223
12% State Surcharge - Mechanical 08/26/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 08/26/2010 $43.25
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE: 503 - 692 -1565
FAX: 503 - 691 -1879
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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
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 • :s0.332 :4.
Is sued B Permittee Signature:
CaII 50 175 by 7:00 a.m. for an inspection th ness 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.
08/25/2010 14:28 5036911879 ARROW MECHANICAL PAGE 02/02
Mechanical Permit A lie . EXNE " FOR 01:1:1(.1 i ts , ()yi,Y
III City of Tigard Received P ermit No,;
^ 13125 SW Hall B1vd.. Tigard, OR 97223 L > l�l 7 - 1 r en E /() —cr 3{�,
' p Phone: 503.639.4171 Fait 503.59X.1 01.3 2 5 Platt Date/Ely; R other Ponca: .
r.i D Inspection Line: 503,639.4175 T D
• . ' . • • Internet: www,tigard•or.gov F tG a Dam Reedy/By; R >i RI bee fate nrr
Cx 0 piVis O Notified/Method. if , t tap supptoroa t inia msuon
,Y�y pL"S�}y i "fyKJy''a C Y1:75. . _ "� :S%T:• .. . �!..v � ,rp. ,�. y,,. _ /.!..- 1►i
,AFit r at' •+o•' 'W 1 ( - , !!4w �M1: . y �, Y y r,.:, • - f 1 r, / t2I r F H 1, o\. n. rf ( .r t,,,a: .�J ! o •.. / ',w,tfTv ,u: t'•,,r
w n (.x, n ! :.t.: • fl � ,C << , : a k/ it „ �: 1 ' � i •,1 .2 ni r a F5 4 3 :�
t
tiy'te;•. {+:ddAtztrIeVa yrafi�;kv>c ^c<,�.iAl.?; re.5.. u ? 4 .. a .: t ' Tenn ) ” aK, e4 4 l SiA (t; k 't: t "=Wy ` ;!1 f r , 4 ,1 ed c
�t .•1rtc.�Y, 1xS,ds A, .�, i t.�..t tt.J,..1'J !.11;� ,.�a�. ,!f d. ;�; t. A I
�,f t,d•;*„ .r/.•,,.. 1 ,.+i�17 tda,„(. t.:lr ., / aA l i'a ?.;Mss idt,ro.,l
0 Now construction 111. Addition /alter tli0/3/MplaCeulant Mechanical permit fees* arc batted on the value of the wank .
0 Damoiilitm Other performed, Indicate the value (rounded to the nearest dollar) of all
mechanical materials. equipment, naive, overhead; artd'tlmvfrt
e ostY •:•i +o 'g'.7F,q,.r f
U•if,;:( .m.:
. ;; l: :eiM1.", :v :..."% `94:. .y. (f. VI'„5,z, ri.V,I.l,1t7 i,". � 7i` :p e;
ti9 R
y� .c n ,, r l,s ';' �` '1 ^.;: 11 : a�iS r w` g .)..1 t p N1 )> Y. :; u.f1 Valu $
rte. ?•('��• aMh e 0.•Ei +S, li Wi�.l';l r � • t :1 ....! JA Y. GY..,'MI 1 �1( A.�.AG,h (;�.:(LL_I.Ly NI •c1,4..: U.i., ri..t � �Q' ,r:! ,i.r7 ,hv'7 $s 1 q.r : •
t -p r t %, L7 r . t VV. s, { .r ,,.. i .... o
t v ���yJ � s�+ r�rS t. a � F i r rp tt-!�
11' 1- and 2 - fmttiiy dwelling ❑ Conttnexciski/industrial 0 Accessory building ', _... s.t,AY ....,s,t:v , .'r :,, : : :w,.J, . n., a.ar:.,,, * ... A _r:r_,..1 «, of /4 >+�•- 6
0 Multi- family ❑ Master builder [l Other hbr rpacfal lrrformat(orr use cheoklI i
n �cn F3 +, fSti t°: t a' ;:p ,a 'mi +far �; , 'y -;, �7` G;; r . ✓+ � Description Qty, Eo. Total
i ° �"
a trs r v, II T mac„ �-+- . r
.,.., �' 4. Inn i 4 t t 3 a j c t ,.r si r t e x 'L`�'t +) ', i �,
#, ! ���wi'Jr�i4 ';,:'.0.'. t t.. l� ?�W� r� irr�t%t n �t4id�;.lrf Jt�4 a,.t'11 �W aE }N4 <f v'::i �. ��.n�t�;� L�.r,� i:7,� � Fr � art Ho • � coo 1 �LYN r � -
!ob sito address: 156 . , ,.biz. _ _ , . Air coudltibeng
�1 l - ins site .ran rho '. 'Income 4G 75
City/Statc/Z1P: i1, O o ''y . ( �3 lenses .1 . TO r.: i If! I�P'7�I /7 1 46,75 EST"
vi
• - axt 1' sr'It: f )•' 1ll _ IrmilliiiiIIII
Suite/bldg./apt no.: Project name: : ,7. r grg erv ,. ' _
Heat pump ■ 63.32 III
Cross street/directions to job site: )duel work 23.32
-- Nydroniebot.watar.systani 23.32.
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel type, not electric). . T
in-wag, in -duct, suspended, etc. 46.79
Subdivision: Lot Flue/vent for any of above _ 23.32
______ Otter; 23.32
Tax tnap/parcal no.: Other iBe1'a , _
i' J'z$ " ' '4 " ?.. v�y:`�g r,, ,.y,..;ct:r , :r,T ,, :r.r. ;r w..rr.w.::R..}a r:1 7 ' :mtriy 1.7, - - .Fi rtly' J : NI.,....,..., t r W ota haRcr
: ot.a ,r,..i'esT l, - .,';P i : Af'4 , r.., .c.Tr. �tti!v i.v: -.ter _,. „ WNin e ,%.rod.'i, , � AT.to,S4, ,, , r ,1; :., 5. i . �� ,, ,
Gas fire .lace
' , „,„ ,,, P1uo vont for wator heater or qae
firaplaoo . 23:32
Lo:1i: , er 2332
Wood /p ,atovo. 3339
Wood fireplace/insert 23.32
,-,•• ; , s . s , .•,,) • ; r~.- - ; w• } f � ?t;. Clime. /liner/flue/vont 2332
q . S, ,, 6�,7.,tr° ",j ls, iw�r {4�ti�C it +�r ) �- l�ltr�1
e,y ,xaaa �� ► l .t «. ' .,t ' ..,.,..Ir 4 s4.t ?.d *a Other: 23.32
Name.: __ Pf l g �j p,•pl __� Environmental exhaust and ventilation
Address: 1 ,.s. 4.,/ , , : `. 1�.. A Range hood/other kitchen 33.39
City/State/ZIP: , , Clothes , 1 '= exhaust - 3339 �.
1 ' 0 �� Single -duet exhaust (bathrooms,
Phone: (5o3) 6 20 -0340 Fax: ( ) toilet eompartmcnts, utility room) 23.32
yp1 ��,'�. 7 '�' • tr, , v 'ri 11t� ku •'' ':1,L":11 ` @T 5.1 V: 4 �;trf}. enS t,t:Jxa �;r 3.k i t'.' ,� • 'torawls a fans 23,32
F. ra.A a+ :aa: & Jul � :•?' A d .r : 4 • : d al � 1, ' A'' . ! t uj 4 ',1 1 t 1..t,,yr,'. r' A „ Attle .
�: w.a e07x1F11u.a4u n.aYI
9cr,Ri.,.� �,- ,rJa.iA 3.,y �u ,:u. .%.>..a,.•. rvcYpa. :! «u. Other 23.32
Business name: , , + , : _ `• w f Fuel I • W:
Contact. name: 7 Fp /ti+ I� too" $ t4: 45 for flrat�htr ,34:031firraeltnddWotthak
Pomace etc,
Address: lc, 3N7 E.►L jltA1a � Oesheat •im . �
City /Stntc/ZZIP: / t , n 1A7-1,4 o4 9 iDia wall /nus9lcadcdhwit heater � ��
Phone: (Sb3) 6 z. r /5 , Foe : r .3 , 0 �. • q Water beater
Fireplace
E- mail :. e •
. ,.. ,�: �{+rryl �iJ.a ( ' '�r; •,r,I�' ^ �� 7 , ;:'r�`:�i [[x:71 i ��'ri'; ts � T. :3,i:” R : ;71.,'� Vii'F /( i .�" t "' iI ,Y4 T,W4 e
t }, d,7"t ,3 }�- 1t Lr „ ,ot i.. NI r "' ?'l'f.'l� T 4 ( a , .4010.' 9i � � 1 . h1 tn . ( .,: ,.i Borbccu
�t 1: tga7 i k..`ait ... ., .,tR•fr,cr.ht::xv.. •t. .. .7.. . ,.. e .. : t_,,.., , r.., t:, -- �—
Ct othoa • - _ s
Business name: Qp emit- �G� Other: 1 -�T� i %;'M: � 'rl'' ,,:...., E•3'.'„:.„, ; ..„EINE
R,. 7 �. -.: rM 4 ; ,. N ,v g ✓ ,r
r7 A 1 ' i f s a It t r,r � i Tr. " . 11 ) I f > I t' '^ ,,, :.i .,,
Addixas: `L 7 r ....0 .,,.,t.,.,,:; ct « ,.,_...: ...-t,1,�.- t..a.t -..!,k .e� ..
City /Stnto/ZIP: - pAIA- 'T7 roe 47062 Subtota
f raw, (6P5)64//-/g7/ Minimum permit 'fee ($90.00) Q d
Phone: (6-123) Q2 ` `� I Plan review (2$% of permit fcc _ 4.
ca tic.: a q Stmt surcbargo 12% of permit fee) .: 4
TOTAL PERMIT FEE 11o• ;
Thb par It application capita it n permit to not obtained within tan
Authorized signature. . -
days agar it has boon nceeptod.m compktc,
r ^^I „t,r,+ A• 1_ slit n„ 1,., t, " Fee mothodolomt set b ildm
y Tai - County Bue Industry Sarvico Board •