Permit CITY OF TIGARD MECHANICAL PERMIT
.11,1 COMMUNITY DEVELOPMENT Permit #: MEC2010 -00491
T t GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2010
Parcel: 2S114BB20500
Jurisdiction: Tigard
Site address: 16431 SW 103RD AVE
Subdivision: RIVERVIEW ESTATES NO. 2 Lot: 49
Project: Anderson
Project Description: NC replacement.
Owner: FEES
ANDERSON, STEVE R & Description Date Amount
MARY ANN, 16431 SW 103RD AVE
TIGARD, OR 97224 Air Conditioning 10/07/2010 $46.75
12% State Surcharge - Mechanical 10/07/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/07/2010 $43.25
Contractor:
TRI COUNTY TEMP CONTROL INC
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 557 -2220
FAX: 503 - 557 -0919
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.
Issued By: Permittee Signature: N IP
CaII 50 • 175 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.
OCT -6 -2010 10:46P FROM: ® TO:5035981960 P.1
Mechanical Permit Anvil M ' ,
i o , ■ ,,■ 1 •I ,, , , ,
1 \ Received
City of Tigard 6 r
Date/11 : 1 D ® 6)/ l
13125 SW Hall 3.639.411 Tigard.
F 03.59 18 960 � C,Pp` " Other Pcnait
lrupe�On Line: 503.639.4175 QG \Cj \11
Internet: www.tigard- or.gov S� \ � \ ^S Notified/ Method: ' r (y sop meat Iuufornauo.
TYPE OF WOlUr COMMERCIAL FEE* SCHEDULE -- USE CHECKLIST
❑ New construction ® Addition /a1teration/replaccmcnt Mechanical permit tbes• are based on the value of the work
❑ Demolition ❑ Other: mechanical Indicate the value (rounded to the nearest dollar) of all
medtanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: S
I -and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
® Y g ❑ Conunercitr ndustrial ❑ Accessory building
❑ Multi - tinily ❑ Master builder ❑ Other • For specrd tgfortuar/ao use caecttlat
Description 1 Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Ikagmyeoe4on
Job site address: 140401 ow pm' i \v,- Air conditioning 1 46.75
(requires site plan showing placmneet)
Cily/State/ZIP: 7 e ���^��^^^ ���aaa 1 ? 24 Furnace 100,000 BTU (ducts/beets) 46.75
Q - ✓$v N Furnace 100,0001- BTU (ducts/volts) 54.91
Suite/bids /apt. no.: Project name: t i 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),
maters!!, in-duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: I Lot no,:
Other. 23.32
Tax map/penal no.: Other htel appliances
DESCRIPTION OF WORK Water heater 23.32
Rep\a c. c€ir cord rtio Gas fireplace 33.39
Flue vent for water heater or gm
fireplace 23.32 ,
Log linhter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32 ,
PROPERTY OWNER I ❑ TENANT Chimrney/litter /Aun/vt m 23.32
� � - -J� r� „p1/7AD Etna: 23.32
Name: � J lul llV� ;�./ � Environmental exhaust and vendladon
Address: ' 1 Range hood/otlter kitchen
equipment - 33.39
City /Stair./ZIP: Clothes dryer exhaust 33.39
)(AD-UM F t tong compartments, rtme s, willty c
Phe: Phone: ax: ( ) tilet cotm►ut utility rooms) 23.32
® APPLICANT 0 CONTACT PERSON Atticicrawlspace lira 2332 ,
Business name: Same as contractor Fuel 23 32
Fuel piping
Contact name: Mane Mason $14.I3 for Ant bur; $4.03 for each eddldonat
Address Furnace, etc.
Oe heat pump
City/State/ZIP: Wall/suspended/unit heater ,
Phone: ( ) ' I Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name: TN County Temp Control Clothes dryer (ges)
Other:
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES*
City/StateIZIP: Oregon City, OR 97045 Subtotal
of permi fee
Phone: (503) 567.2220 I Fax: (503) 557.0919 rmitti 0)
Plan review (25% of ptsrmit�
CCB lie.: 72623 State surcharge (12% of pcnnil fee) innon
TOTAL PERMIT E ± `
Authorized signature: //�/ 7�b permit application
dayys alter It � � . aepoed u oo ISO
I Print name: D Ian. moon I Date: lot Lobo 1 • Fee methodology set by Tri County Building tadusay Serviea Board
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CUSTOMER INFORMATION
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ADDRESS ,
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OZ PLE•ASB REFAX APPLICATION 1\'1T11 SITE PLAN.
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