Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 00511
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2010
Parcel: 2S102BA03600
Jurisdiction: Tigard
Site address: 12071 SW 96TH PL
Subdivision: DUBLIN PARK Lot: 6
Project: Watts
Project Description: Furnace installation.
Owner: FEES
WATTS, NICHOLAS DAVID Description Date Amount
12071 SW 96TH PL
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:
SKY HEATING & AIR CONDITIONING, INC
1637 SE NEHALEM ST
PORTLAND, OR 97202
PHONE: 503 - 235 -9083
FAX: 503- 235 -0454
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 5' • • • • • 1.800.3 4.
Issued Permittee Signature: d"
Call 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.
10/19/2010 20:17 5032350454 SKY HEATING AND AC PAGE 01/02
Mechanical Permit Appli^ Milt 01 t tit•: ()NIA
Cl of Tigard EIV Received Permit No.: i
ty Date/By; i 0 pc
i• : —
1114 1 —00-
13125 SW Hall Blvd., Tigard, OR Plan Revtcw
Phone: 503.639.4171 Fax: 503.598 Other Permit:
U 2 0 2010
Date Re
t I 4.; A iZ I) Inspection Line: 503,639.4175 e RcadylBy: Judi. ffi See Page 2 ref
Internet: www.tigard- or.gov Notified/Method; -ra Supplementallnformation
CITY OF TIGARD
TYPE WIG DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
El New construction Addition /alteration /rcplaccment Mechanical permit fees* are based on the value of the work
performed, Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical ma terials, c ui men[, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION • Value; $ _�
. , RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
j 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist,
❑ Multi-family ❑ Master builder 0 Other: Description I Qty. l Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
y� Air conditioning
Job site address: i 1 tJ ^, (requires siteplan showing placement) 46.75
City /State/ZIP: / • d 0 P c 7 a.�3 Fumacc 100,000 BTU (ducts/vents) t 46.75 _ ,
Fumacc 100,000+ BTU (ducts/vents) 54.91
Suite/bldg, /apt, no,: Project name: Heat pump 61.06 ,
Cross street/directions to job site: Duct work 23.32
_ydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
.. Unit heaters (fuel type, not electric),
in - wall, in - d uct S us p ended, etc. _ 46.75
Subdivision: Flue /vent for any of above 23.32
Lot no.:
.. . Other: 23.32 •
Tax map /parcel no,: Other fuel appliances _
DESCRIPTION OF WORK Water heater 23,32
Gas fireplace 33.39
��.� �AiIr� Flue vent for water heater or gas 1
fireplace 23.32
L_.... _ Log lighter (Ras) 23.32
Wood /pellet stove 33.39
Wood fircplace/inscrt 23.32
Chimney/liner /flue/vent 23,32
ROPERTY OWNER f Q TENANT
Other; 23.32
Name: D'V \Aw _', 1 _ l j Environmental exhaust and vcntllntion
». ---- Range hood /other kitchen
Addre s s . . r i equipment 33.39
City /Slate / .11':/- t / Clothes dryer exhaust 33.39
I L/ Single -duct exhaust (bathrooms.
Phone: (93) .. 3 ( t f� Fax: ( ) toilet compattmcnts, utility rooms) 23,32
� , ❑ APPLICANT ❑ CONTACT PERSON • Attic/crawlspacc fans 23.22
Business name: Other: 23.32
Fuel piping _
Contact name: 514.15 for first four; 54.03 f or each additional
re J C c) � A > Furnace, etc.
Address:
Gas heat pump
City /State/LIP: Wall/suspended/unit heater
I'honc: ( ) Fax: I ( ) Water heater
E-mail: • Fireplace
Range
CONTRACTOR • Barbecue __
Business name: Clothcs drycr (gas) T
\ Gt . L Other:
Address: /6P 5 G ,,,f/ '-€ i.-V't S 4-. MECHANICAL PERMIT FEES*
of permit fce)
City/State/ZIP: 9 Subtotal _ I'
y . �or a r.� c , +�
Phon ) ZJ� el 07 YFax:�3 V 3 O L,Se)/ Minimumpermitfee(590.ce)
Plan review (25% ee)
c (:fs tic.; 57)2-4 f [ { S tate surcharge (12% of permit fee) __
_ TOTAL PERMIT FEE ��L
Authorized signature; ` %(/..c.��
Mi per mit applicnlian expires if a permit is not obtained within 180
�.� days after it hos been accepted u enmptctc.
L Print name: I Date: 6 a� -/ f D ' Fee methodology set by Tri County Building Industry Service Hoard
ate.
r'. 6 dt , iiny1PmmitoWTEC- PermitApp, 10101/09 44.. 177(11 , COMPWEP)
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