Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00555
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2010
Parcel: 2S111CB01721
Jurisdiction: Tigard
Site address: 10250 SW KABLE ST
Subdivision: HOOD VIEW NO. 2 Lot: 20
Project: Dorr
Project Description: Furnace and NC installation with fuel piping to furnace and fireplace. A/C unit must meet
minimum 3 -0 rear and side yard setbacks.
Owner: FEES
DORR, PATRICK M Description Date Amount
JANICE M, 10250 SW KABLE ST
TIGARD, OR 97224 Air Conditioning 11/03/2010 $46.75
Furnaces < 100K BTU 11/03/2010 $46.75
PHONE: Fuel Piping 11/03/2010 $14.15
12% State Surcharge - Mechanical 11/03/2010 $12.92
Contractor:
ASSURED HEATING & COOLING INC
PO BOX 835
WILSONVILLE, OR 97070
PHONE: 503 - 682 -3590
FAX: 503 - 682 -3590
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $120.57
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. �
Issued By: Permittee Signature: c!4
i
Call .• by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
09/28/2010 12:47 5035981960 CITY OF TIGARD PAGE 01/03
Mechanical Permit Application Foil of I rci: ( ( ) N o N
City o! Tigard c I) E . 13125 SW Hall Blvd., Turd, OR 97 LL 1 Phone: 503.639,4171 Fax: 503.59$.1 . 0 p ev OtberPamit:
Date/BY:
T t C,, :1 I: t_7 it tion Line: 503.639.4175 \I {
Internet, www.tigard -or,gov V Date S Se Page J for
N� .0�1 Notified/Method! N s , soaprt Za l mina
❑ New construction Addition /alteration: Cement Mechanical permit fees* are based on the value of the work
❑ Demolition ❑ Other. performed indicate the value (rounded to the nearest dollar) of all
mechanical
y. e� tnaterialsequipmcnt, labor, overhead, and profit
..:1 :.:. & t -1 M' T . +h �, 1 I' ., n,�.9 , ,�" :r I {fµt��{' ; : 7':VG •..:: : ue:
'... M'. 1, '� ,: f.JM .�., 1r.i... i..:.i :1 `:�:' " 'i. • '. .'• . '.' � .!ti '` f
+' r
Val
and 2-family dwelling ❑ Accessory R .:,...',s ,.l �... .., : `
Ci
i
Y g ❑ Commaoial/industrial Accesso buildin For specsl information use checklist.
❑ Multi-family ❑ Master builder ❑ Other:
Description 1 Qty. I Ea, I Total
,,.
P.'.r• '. _. r...,l Gr 4...:..`,::-'.(°1 " ",..)'.? I :i, , t:N 7 Heatiuglcooling
Job site address: O _ S 0 (,Q • Air conditioning _
(requires site _plan showing placement) 46.75 1 1 L .1S
City/Stato/ZiP: Ti Grf} a Oce. Z 9' Furnace 100,000 BTU (ducts/vents) / 46.75 lAo, 75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/b1ds, /apt. no,: Project name; {1 Y.r Heat pump 61.06
-
Cross street/directions to job site: �/ Duct work 23.32
Iiydronic hot water hem 23,32 _
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric).
in -wait, in -duet, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.: .
Other: 23.32 _
Tax mapiparcel no.: Other fuel appliances
. ;ice K. :al. t;r,:' :4 : d i n - gai ";n,;l•�'• "e -;c ? y . ,. j;,;.'..':- "'S;;:;r:_ Water heater 2332
dU STALL (74.:s ... tz NAC t.r
Gas vent w 33.39
alpine { � 1 (� f l� �� Fine vent for water heater or gas
k / G "'c/ e H 4/c Cl h) • 1i 23.32 ,
Loglighter(gaa) _ 23,32
Wood/pcllet stove 3339
Wood fi lace/ir rt 23,32
'•_.: ; ' ; ygl :y • .Ip FC1 "t x.75. � %. <' 'u
-I .. : :_ , r. I y chimney/finer/flue/vent t 23.32 ,
/
Other 2332
7
Name: `4 N / t. t - t Pct'// ' A, Ogg Environmental exhaust and ventilation
`•/ L
Range hood/othcr kitchen
Address: `0 2 37) SG./ / ST eq,pmcnt 3339
City/State/ZIP: 1 GA i eD 0 ` 2 2 Clothes drier exhaust r 33.39
,
T Single-duct exhaust (bathrooms,
Phone:
(k, 3) 6 3 / _1100 Fax: ( ) toilet compartrttents roonts) 2332
5. ., : r i ;; . O '. Eitt- li.. ;.,:[„ : AtticJcrawlspace fans 2332 —
Business name: Other: _. 2332
Fuel pipit
Contact name: _ 314.15 for first four, 34.03 for each a dditional
Address: Furnace, etc, J / 1 \ _
Gas heat pump
City /StatcJZiP: Wail /suspcnded/unit heater Li. I
—
Phone: ( ) I Fax: : ( ) Water heater
E -mail:
Fireplace /
°,.r1;T:Y ? F 'F: " ". +rlri6e :.;:: w Range
. ": ,.. .. 1 4.040 : '`i., P -: :. . Barbecue
Business name: A s'5 f jj e D i C if o C � /i / c, Clothes dryer (Ras}
!+ /� � �Y /V Other
Address. V A S ;' " :" (_;: i J �._,.,:.
City/State/ZIP:. , �
llUis..spit/ -h 2 f 2 ' 707a k.....__ ...� �.. 1 a 7, Ur
( } F ax: �•. ) L -15 Minimum permit fcc (590.00)
Phone:
s0 3 4y).— 3S 90 ft S 6 ri Jv _ Plan review (25% of pennit feel
CCB lie.: 8.2 C� � { 76 ,y,/� I State surcharge (12% of permit fee) i t WY
— � J TOTAL PERMIT FEE , lx) , 7
Authorized signature: This permit npplkatlon expires ifs permit is ant obtained within 180
days after it lass bean accepted as eempkte.
I Print name: t°,c bgoi(Gvyk [pate: A., �lV�() methodology ' Femethodology C
sot by Tt ourty Betiding Industry Service Board I: u3rrtk10ratvmmitosEC- Pereinan total4e' 440 -16!rr 111/n7/COM/WEB)
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