Permit CITY OF TIGARD MECHANICAL PERMIT
I • COMMUNITY DEVELOPMENT Permit #: MEC2010 -00484
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/05/2010
Parcel: 1S133DD11900
Jurisdiction: Tigard
Site address: 11864 SW 126TH PL
Subdivision: VILLAGE AT SUMMER LAKE NO. 4 Lot: 156
Project: Clarke
Project Description: Furnace installation.
Owner: FEES
CLARKE, EDITH JEAN Description Date Amount
11864 SW 126TH PL Furnaces < 100K BTU 10/05/2010 $46.75
PORTLAND, OR 97223 12% State Surcharge - Mechanical 10/05/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/05/2010 $43.25
Contractor:
SPECIALTY HEATING & COOLING INC
7500 SW TECH CENTER DR #130
TIGARD, OR 97223
PHONE: 503 - 620 -5643
FAX: 503 - 681 -0793
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
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.
ger
Issued Permittee Signature:
/
Cal 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.
SEP /30 /2010 /THU 08:35 AM NtckIVED FAX No. P. 002
Mechanical Permit Applicati P 3 0 '- r ri' FOR OFFICE USE ONLY
Ili City of Tigard � � Y OF TIGARD Plan Re view o ►0 j
Plan Re Permit No.: Y PC-MO lei _ , ,r
r, 13125 SW Nall Blvd., Tigar 0 Received
Phone: 503.639.4171 Pax: 503. RING DIVISION Daze/BY: Other Pet:
TIGARD
Inspection Line: 503.639 Daze Ready/By: 0 See Page 2 for
Internet: www.tigard-or.gov Notifed/Medtad: MI SupplementalInformadon
.:.. .; -;,: • _,_.,.. ;: r' l .'(� :C. ,.:D 'GHEOKL: T3T 'i
„ .".�, .. ........ r : >2 _.. ORK'. = � � P�1~7' �...�r� -_:.:
Mechanical permit fees` are based on the value of the work
❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, equipment labor. overhead, and profit.
0',.li�'�`.liR - i P;r Ji � - °r... ii7 ". •ay..>.... : :l':' .;��::_ ; V
9; ..... .. - alUe:
1- and 2- family dwelling ❑ Commercial /industrial [] Accessory building '' ` ' ' `; l
Multi- family ❑ Master builder For special information use checklist.
❑ Other: Description 1 Qty. Ea. I. Total
- i i y D C 1 t r' i' % Heating/cooling .
Job site address: n Q ( 4( C (,J r p Z,G'.C Air conditioning
1 1 t �t (requires site plan showing placement) 46.75
City /State/ZIP: Furnace 100,000 BTU (ducts/vents) ( 46.75 L. 47,15
• Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 1 Project name: C 6✓ue__ • Heat pump 61.06
Cross strcct/direotions 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
Subdivision: 1 Lot no.: Flue/vent for any of above 23.32 _
I Other: 23.32
Tax map/parcel no.: Other fuel appliances
rn' , :a? ,yq:Vi twd� ,44' :i,,)' `li ioi1 ! { $w ,° Water heater 23.32
s ,, L._.. r„q ,:.,: ^;., . r'• , . '!.;,..r.
Gas fireplace 33.39
Flue vent for water heater or gas
fireplace 23.32
Liil-N-..-€.4--k-P , Log lighter (gas) 23.32
/r -tr•-9-A-'-u---4- •
Wood /pelletstove 33.39
Wood fireplace/insert 23.32
1 i y : , _, . , . ,.. Chimney /liner /fluelvent 23.32
;4: . l ,ih aaijr�y 1. ,ti hY .r, :�r u;' a1T������t.� ,. i : ; iC.4'
�f a_� '�.5�tiElc' i :..O.V►'[llr/aC::.. ! tiff' :I. - , :,iii . /MY:1!'i i : ":7.'L �?71',c,:
,�.�. ` i Other: 23.32
Name: Clarke, Edith R10364 Environmental exhaust and ventilation
Range hood/other kitchen
Address; 11864 SW 126`" Place equipment 33.39
City /State /ZIP: Tigard, or. 97223 Clothes dryer exhaust 33.39
(503)524 - 9502 Single -duct exhaust (bathrooms,
Phone: ( ) toilet compartments, utility rooms) 23.32
- ,, ^, - ,.:�. '1:4.,,3;: _ 4;:, :r: w p efans 23.32
•��' F _,r �ra .. _ . �:•: ... 'IQ.'CQN�'AGT, p>ETFS N;_�:.; , "::�,; A ttic /era is ac ,
Other: I 23.32
Business name:
Fuel piping
Contact name: 514.15 for first four; S4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail: Range ,
CO)Vt PTO
Business name: specialty heating & Cooling, Inc. Clothes dryer (gas)
Other:
: , 'n.C1EIA?VYCAL' „E tly_(1T4>
Address: 7500 SW Tech Center Drive #130 . +i :'. 1,...1:''..':.
. . .. .
. . .
City /State /ZIP: Tigard, Or, 97223 Subtotal
Minimum permit fcc (590.00) !
Phone: (503) 620-5643 Fax: (503) 681.0793 )
Plan review (25% of permit fee)
CCB lic.: 66578 State surcharge (12% of permit fee) ' to_ TO
-
TOTAL PERMIT FEE too, `fib
Authorized si nature Thls permit application expires If a permit is not obtained within 180
g ��1�. \� �j days after it has been accepted as complete.
Print name: Andrea Dripps Date: t ( 0 • Fee methodology Set by Tri Building Industry Service Board
1: 1H ull dinglPermiuVvEC- Perrnit Ape. doe 10/01/09 440 -4d17T (11 /02/COM/WEB)