Permit CITY OF TIGARD MECHANICAL PERMIT
o COMMUNITY DEVELOPMENT Permit #: MEC2010 -00532
T t G 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2010
Parcel: 1S133DD08400
Jurisdiction: Tigard
Site address: 11646 SW 128TH AVE
Subdivision: VILLAGE AT SUMMER LAKE NO. 4 Lot: 121
Project: Padbury
Project Description: Replacing furnace and heat pump.
Owner: FEES
PADBURY, CRAIG E & JULIE M Description Date Amount
11646 SW 128TH AVE Heat Pump 11/03/2010 $61.06
TIGARD, OR 97223 12% State Surcharge - Mechanical 11/03/2010 $13.92
PHONE: Furnaces >= 100K BTU 11/03/2010 $54.91
Contractor:
WATTS HEATING & COOLING INC
580 PORTLAND AVE.
GLADSTONE, OR 97027
PHONE: 503 - 786 -2858
FAX: 503 - 786 -2807
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $129.89
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
is - . ce, or if wo '- suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
tility Notification Cente . 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 ; t 03. '46.6699 or 1.800.332.2344.
Issued By: & Z Permitt=
1�I
CaII 503.639.4175 by 7:00 a.m. for an inspection t • usiness 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, 25. 2010 10: 28AM WATT T lV No. 1210 P. 1
Mechanical Permit A licatio E • FOR OFFICE ilSIC ONLY
City of Tigard Received
. 0 n 13125 SW HeII Blvd., Tigard, OR 97223 OCT 2 6 2010 I]ale/I :
Plan Review / il/ V _lit i •
Phone: 503.639.4171 Fax: 503.598.I960 edg OtherRrmtit:
T I t, A li D Inspection Line: 503.639.4175 CITY OF TIGARD Dale Ready/By
Internet: www.li and -or. ov Supplemental SeePane2
g g BUILDING DIVISIO Mo oedlmethod: Tnfotma600
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
['New construction . la' Addition/alterat Mechanical permit fees* are based on the value of the work:
performed. Indicate die value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
- CATEGORY OF CONSTRUCTION Value: S
RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
,Ja' and 2 family dwelling ❑ Commercial/industrial 9 Accessory building
For special Wortoonon use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total
,LOB SITE INFORMATION AND LOCATION Heating/cooling
�/ A . Air conditioning
Job site address:
t' /If `l' e �kJ. /4 & /4Ve, (requires she phn showing placement) 46.75
City /State/ZIP: —77 Ore. g 7 Z.2.-Z, Furnace 100,000 BTU (duels/yews) 46.75
Suite/bldglapL no.: I Project name: iyG �'�,"" , Heat pump 100,0001- BTU (duds/vents) ( 54.91 _
Heat pump ! 61.06 4/_ o4
Cross streei/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),
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: I Lot no.:
Other: 23.32 _
Tax trap /parcel no,: _ Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
,l Gas fireplace 33.39
�L� „ R „ - r,p.,,�, mg' 11/712% Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pcllct stove 33.39
Wood fireplace/insert 2132
PROPERTY OWNER 0 TENANT Chimncyllincrlfludvcnt _ 23.32
Other. 23.32
_
No tne: q� Environmental cabalist and ventilation
Range hood/other kitchen
Address: //4 .O.Ge./ , i 0 ,. _ equipment 33.39
City/Slate/ZIP: —77 Jae 47 Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: (5Z7 3) 4, ir , ZSE0 Fax: ( ) toilet compartments, utility rooms) 2132
- APPLICANT ❑ CONTACT PERSON Allicicrawlspacc fans 23.32
Business name: . ,J Other: _ 23.32
✓ ,,g. AL.. , h tG Y d7�� //J N� Fu el Tin:
Contact name:' L 5-40,4„6/5-40,4„6/0. ‘-' \ , f S14,15 for first four $4.03 for each additional
Address: sea 4 , .. A d fir/ tt S C . t,,. - -I V F umace, ate.
Gas heal pump
City/ State/ZIP: 77 . 0 , Y V 7o t ' F t ‘'_ Wall/suspended/unit heater
Phone: (rby) 7 , yi o a Fax: : ( ? j 7F,j , ; o 7 Water heater
Fireplace
E -mail: ,-z, b 00 kaah4. 4l, j U Range
CONTRACT Barbecue
Business name: Clothes dryer (gas)
Other:
Address: _c/dt'e J ‘441 - MECHANICAL PERMIT FEES* City/Stale/ZIP: Subtotal //e e a -
Minimum permit fee (590.00)
/Phone: ( ) I Fax: ( ) Plan review (25% of permit fce)
CCB lic.: /3 ft, 4 0 e_. Slate surcharge (12 %ofpermit fee) 0-g'
TOTAL PEILDIIT FE iT f
Authorized signature Thla permit application expires it a permit is not blsined w118!
dare after It has been accepted as corn
Print name- ‹gsff. 6 / .. I Date: i t - 8 4 4 ‘ , ' I • Fee methodology set by Th- Counly Building Industry Service Board
I:awildia,a1Pernit \MEC- Pem,iupo.doe 10/01/09 440.4611T(1I/02/COMPWEB) fr.' ).q .