Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 00501
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/14/2010
Parcel: 2S109DD10300
Jurisdiction: Tigard
Site address: 12709 SW REMBRANDT LN
Subdivision: BELLA VISTA Lot: 33
Project: Bullock
Project Description: Heat pump installation.
Owner: FEES
BULLOCK, MOSES S Description Date Amount
12709 SW REMBRANDT LN
TIGARD, OR 97224 Heat Pump 10/14/2010 $61.06
12% State Surcharge - Mechanical 10/14/2010 $10.80
PHONE: 503 - 639 -2372 Minimum Fee Adjustment - Mechanical 10/14/2010 $28.94
Contractor:
OREGON HEATING & AIR CONDITIONING
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 $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:
•
�sn
CaII 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 Applicatil*c)c,:o , . ,. FOR OFFICE USE ONLY
--
1111 City of Tigard ,' N c) ; 1 " \ Received 10 iffilr PtIluitisi° - . . 0
Date/By _ 4 ift. - Cas010 40
.. .. 13125 SW Hall Blvd., Tigard, OR 97223 c: \ -
' . Phone: 503,639,4171 Fax: 503.598.1960 k3 \'' .... 42,11 • : . Review
Other Permit:
TI GARD Inspection Line: 503.639.4175 (4
\" t. ' e/BY.
..f■1 _ t - ..1.1 • ' naady/lay: ....._
Ma: IZ See Page 2 for
Internet: www.tigard t - k ‘ % r_ u Notified/Method: 7XL9 $upplemental lutormatioa
‘.) ' ,.■
. .. ;: tirE . OF WO* . - : . ' . " ' . :: .. • ..: '..:.: ... ): : 00 4 :4 1 litcta!4* * .0 114 : 1 4 , E . . : ' , tiStC*04 1 §T
Mechanical permit fees° arc ased on c vidue oftlic t
0 New construction
gAdditiOrilalteration/replacement
performed. Indicate dte value b tho
(rounded t the nearest dollar) of all
0 Demolition 0 Other. mechanical materials, equipment, labor, overhead, and profit.
Value: $
,; :. ::.,••_: , •:: : :::: , ,...: , ;.4itC* 6 1i. K•Ok OL*.OlitUei. ZO0 ••••••. :. 2 . * :;i•. ...•:.::: :•• ....: ...• ,. :.: ... ,. .. • • .. :.:. ,-• :••• •
:*: • f..0Y0#1140 FEES
gli and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist
0 Multi-family 01 Master builder 0 Other ,. Description 1 Qty 1 BE. 1 Total
fiS
*: •• •• ,. : ': 1 :::'• ;.:: ''',".;'*:.::::.*-;:'.;: '" AliB. 0.TFP 00i4 '4i t . ':, . . ' : ,1' . '. : :;.*:::: :', .:: Beating/cooling
lob site address: taica st .,, . -,,,,,,,,, LAA a Air conditioning
(requires aite plan showing ploccicacnt) 46.75
City/Stater2EP: -- 1 - 1 . 0,.../trrL . 0 01/ aa.3 Furnace 100,000 BTU (ductslvents) 46.75
Pomace 100.000+ BTU (ducts/vents) 54.91
Sitb1dg./apt.no.: Project name: 150 Ilh&L lieat pump 1 61.06 674L.a
Cross street/directions to job site: Ductwork 23.32
' Hydronic hot water system 23.32
•
Residential boiler (radiator or
hydronic) 23.32
•
Unit heaters (fuel-type, not electric),
in in suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: • Lot no.:
Other 23.32
Tax map/paroel no.; Other fuel appliances 1
. : - "'' '',. *W.to Water heater
Escpappia 23.32
. 2r 4I L S4 CULL-- lAeC latnia Gus fireplace
, Flue vent for water heater or gas
i fireplace 23.32
-
Log lighter (gas) , 23.32
Wood/pact Move 33.39
Wood fireplacermsert 23.32
2332
: . •,.':•.•::::-.::•.i:::t.::: V. •• tOttx.0**.2 , . •• - ••-':::. :: ,• .-; '.. .,, • ,•-••:•:••; .:,, 1, : .. 23.32 •
Name: .1 I A I , 411, ■ lib Environmental exhaust and ventilation
Range hood/other kitchen
Address: 1R-7 en ,.,./.,% , , II ir ill Z.A/ . .... cquiument 33.39
City/State/ZEP: -- in .7 , : • t Clothes dryer exhaust
- 33.39
Single-duct exhaust (bathrooms,
Phone: (.2. Le : 4, - 1 Fax ( ) toilet compartments, utility rooms) 23.12
, -
i..F; r, :. 20i1.16tiq 4 i. J.;:::: . :,: ..• :..'..1:1: Attickrmis fans 23.32
.
Other: 1 23.32
Business name: L . IT Fuel piping
Contact name: C WI 114.15 for first four; 54.03 for each additional
Address: r P( C) , )( a4 1 Rana ce, etc.
Gas heat . um .
City/StatefZIP: !I k j ur CUL CA1 ii‘ Wall/suspended/unit hrarer
Phone: e ( I . ct ci J Fax:; 50 LaCt gES CD Water heater
Fireplace
E-mail: Range
,.'•-• • • - '
,: .,..:.:',',,.'• ::.....:. :,, • :'... : •:- ,•••••::',;.• : ....:'•••;:amriAtr :' :: ".r ; .7 : .:::' ,• ... . .. • :.:, ,• :..:•* .• ..:.: Brubecue
Business name: r c4.) es dryer (as)
/c..)
• Address: C ‘I t y ag ( Cioth
Other
ir••:; ...-:.... -. .I . BI.4.1Srlc,A1C;018BW. : 1i 1 PS i ..•:,:•-••••..*: *..• ' :••• .; :*!:
. . . . . , .
City/State/ZIP: W ( 4.1, 1 l-. _ Subtotal
Phc tCa 1 ct Legg Fax: 5C8 O.Ct ( SSSL Pl
o Minimum permit fee (S90.00) Cf 0 ,
an review (25% of permit fee)
CCB lic.: 1 1 i a-IP ei 7/ 5'1- State surcharge (12% of permit fee) ID 4 el
TOTAL PERMIT FEE al I 6
• -
1
Authorized signa 1 - : el t „0,_/ L
. This penult application expires if a permit is not obtained within 1
days after it has heels accepted as complete
.
Print mune: V I : 1 19r9Irririll Iate: 0 . .. -1 . Fee methodology set by Tri Building Industy Service Board
60/TO 30Vd ONI1299H NO9360 9998 -T69 -EOS LO:ST OTOZ/ET/OI
GBath
En
Office
Job #:
Performed by Craig Roggers for
Moses & Emily Bullock
12709 SW Rembrandt In
Tigard, OR 97223
Phone: 503 - 639 -2372
Hall /Stairs
Dine
10' +
Butler
E0 /E0 39dd 9NI2ti3H NO93NO
First Floor
- 10' +
Kitch /Nook
Living
10w0 81
SW Rembrandt Lane
Jurisdiction - City of Tigard
Scale: 1/8" =1'0"
Pagel
Right Suite® Universal
7.1.25 RSU12736
2010 - Oct -11 12:18:07
...t HVAC1Bultock Moses & Emily.ruP
9998- T69 -E05 L0 :5t OIOZ /Et /0t