Permit CITY OF TIGARD MECHANICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit #: MEC2010 00512
T I G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2010
Parcel: 1S134CC04800
Jurisdiction: Tigard
Site address: 12465 SW WINTER LAKE DR
Subdivision: CAPSTONE Lot: 15
Project: Hathaway
Project Description: Furnace replacement.
Owner: FEES
HATHAWAY, BRIAN J & ANN MARIE Description Date Amount
12465 SW WINTER LAKE DR
TIGARD, OR 97223 Furnaces < 100K BTU 10/21/2010 $46.75
12% State Surcharge - Mechanical 10/21/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/21/2010 $43.25
Contractor:
GRESHAM HEATING & AIR CONDITIONING
1560 NW 3RD ST
GRESHAM, OR 97030
PHONE: 503 - 667 -7594
FAX: 503 - 667 -3769
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 or 1.800.332.2344.
Issued By: ` , � Permittee Signature: ✓ / ` J ,
/1
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 Application ® vole OFFICE I sf.()No
�� Received
City of Tigard ' p nnen3 i k) 0 7I Permit No.: E c o- tl d SI �-
13125 SW Tull Blvd., Tigard, OR ' /.
. .. V ` plan Review
`� _ Phone 503.639.417! Fat: 503. ' : s C' . I , 4 p timer Pamir
T - ,, „ o Inspection Line: 503.639.4175 OC" V r P�� , , Dan Ready/By: IM See Page 2 for
Internet www.tr�d-or.gov °4%t "\V',` O at�od/1 cthod Supplemental Information
TYPE OF WORK v` � " V COMMERCIAL FEE* SCHEDULE. -- USE CHECKLI
❑ New construction .ArA ddirion/alteration/f acement � P it fees' are based de the value of the wade
performed Indicate the Oahu (rounded to the neatest dollar) of all
❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF OONSTRUCUON Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
lg 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information rem dieddist
Multi fan1ily ❑ Master builder ❑ Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site addrr ss: Air conditioning or heat pump
i 2 5 J V��1 I � e fi (rewires site plan ahorviaRplacsmcal)
City/State/ZIP: Ti 0 f . (IR c 12 Z? Furnace 100,000 BTU (ducts/vans) I
f Af Furnace 100,0004- BTU (ducts/veins) 17.90
Suite/bldgfapt. no.: V J m
Project nae: Ja l l iia L' a V Gas heat pump 14.00
Cross street/directions t0 job site: j Duct work 10.00
Hydronic hot water system , 14.00
Residential boiler (tadiaeor or
hydronic) 14.00
Unit heaters (fuel, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision r Fkrdvart for any of above 6.80
I Other: 10.00
Tax map/parcel no.: Other fur appliances
//�QQ DESCRIPTI OF WORK /� Water heater 10.00
12 ep la �.1� TS W r (( dace
Flue r et for water heater or gas 10.00
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace msat 10.00 .
E 'C PROPERTY OWNER I_ ❑ TENANT Chimney/liner/flue/vent
10.00
Name: , • ! , / OA 4 �� ,
r Environmental exhaust and ventilation .
Address: 1/St� Rl /[/f � l elggehood/otherkitchen 10.00
City, /State/ZIP: ��; w 0 f - / S r 1 q ; zz� enthralls: 10.00
ph 1/ ! 7 F ax ( ) toilet campartmenmterr ) .I Single-duct tt(ua<trior ts, utility ro o
1l � „!! // oms) 6.80
❑ APPLICANT 0 CONTACT PERSON Arrieit awlspace fans 10.00
• rn( G. O 10.00
Business name: is 1 4 1, id r' ! 4- ' ` Friel piping
Co t act name: 1 , � 21J..� $5,40 for first four 51.00 for each additional
''/ -- t nfilil Furnace. etc.
Address: Gas beat pumsp
City /StateiZLP: . • Wall/suspended/unit heater
Phone: ( ) i Fax: : ( ,cam )
Water hater
E-mail : -/ ,
0 fn (iQ q Shaj n r a / / • (OK-- Range
CONTRACTOR Barbecue
• • rJ 1, • • ' Clothes 1f . ■ (_ —
Dullness Ba lg� 2. 1 t = _ t 1 i i i
Address.. / �� I-F MECHANICAL PER FEES' 1
City/State/ PP: it ° 2� o Subtotal !.1(.,,,'75"
Moor. 5D� tii . 1 , Ll Fax � ( 03 ryl�n 31W 1 � a I1 Minimum permit fee (122.61g Gl().UU
( /� Plan review (25 % of permit foe)
CCB tic.: CJ 1 Li "l I Stale surcharge (12% of permit fee) i.(1. j
TOTAL PERMIT FEE la) F-E)
This permit application expires if a permit is not obtained within 188
Authorized signature: days after a his hove acs:pted as cnmptete.
46%1n . Qt rr-
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