Permit - N
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00600
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2010
Parcel: 2S103BB13200
Jurisdiction: Tigard
Site address: 12270 SW ANN CT
Project: Chandler Subdivision: LAKE TERRACE NO. 2 Lot: 25
Project Description: Gas line to range.
Contractor: RITE WAY HEATING & A/C INC Owner: CHANDLER, STEPHEN L AND
PO BOX 1815 CHERRYL A
HILLSBORO, OR 97123 12270 SW ANN CT
TIGARD, OR 97223
PHONE: 503 - 359 -3613 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 11/19/2010 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 11/19/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/19/2010 $75.85
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.3 .2344.
Issued By: "Ir., % - � �— Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 Applicaa E D �F Tigard !'(4R cah'i ICE USE ONLY
Received
01713' �li [I Datel3r I A Permit No.: Iy): 01 U ` ,
e 'r 13 l25 SW Hall Blvd., Tiga OR 972 (� V 1 L o Plan Review
s' Phone; 503.639.4171 Fax: 503.598.196 Other Permit:
Date/By:
;T IGA}t [l Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: See Page 2 for
Internet: www.tigar'd- or.gov Notified/Method: Supplemental Information
ItM
BUILDING DIVISION •
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fsti 1. IlllS flal•tiIMI S iY4 hi I. f R li nitei l Mi t nl `. , :
Q New construction ►: Addition/alteration/replacement Mecllanical permit fees are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition [] Other: mechanical materials, equipment, labor, overhead, and profit.
�. �,.,.,� ..,. ,...t,..n +i..,.,..�,.jru..,h•, .,� „. .w, . wp. x,�, „,w,,,aa,ro,, ,� �u��,. utr <..,r�;�i,.,,.,,,, +� , r ,r,e.,,w :� ,,., re i � t i ! . n < << .,. p• �i 'E .Ir ?!'1 Value: $
SI!t�9 ?!'dl;!i�';9,pt do d t d p r i.d 1 V;7 ;Q � 1 i'�' r
' 1! 1 1 } 1 ' {'} �' lif�Ei9i 0000MPII OP E �t )�Iggii {g � z � � fd,t ' �` � �,;,
i:..i.:1f j;!{�-'. i 1d1 � � A a. 1 i hi, d Y s ,t; r„ / r d i '� u. s. r/ f '� �, �l� 11 �Y,iC4 I r N t'r 111, N.;+ m . mlq
7 : r 1 ' .,,� " .p ; 11 '1;),1 l l i. l JAW 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special iprfprmgtioir use checklist.
❑ Multi-family 0 Master builder 0 Other: -
• Description Qty. Ea. Total
i, d 3,; f Idi s i ik iii li0 i, lij t ' �j f� I r i' • MR? �i i iii $ •' " 1
1 1 1 : iii1,t71 le . `6 , 7'i t tiliit vat .. ? li .liAi :,i7 , i 1 . ' ittit Heating/cowing
Air conditioning
Job site address: / 2 Z 7o. ', 4IA Cr (requires site plan showing placement) , 46.75
°-^ furnace 100 000 BTU ducts /vents 46.75
CitylSa►tE /ZIP: /116,, , O e a� -
Furnace 100,000_+ BTU ducts /vents) 54.91
Suite/bldg./apt. an.: , Project name: Heat pump 61.06
Cross street/directions to job site Duct work 23.32
• Hydronic hot water system - 23.32
Residential boiler (radiator or
hydrooic) 2132
Unit hearers (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
• Flue /vent for any of above 23.32
Subdivision: Lot n0 -' Other: 23.32 e
Tax map /parcel no.: Other fuel appliances
1!;i .?�h'i' +;,i :i ii ! l. .1 t 4 r E t' g a ,y'f t' ir ,{ , 6 . t f i 's f 9q, Water heater 23.32
111 " 1? , Ii �(�j tI p u'':, i ! # I ; d 1 I # p 1
- 1t ; 1:11:1:p .., :ifg!.44 1. ni ,, 4Y {ll { n, vnvar „ k , i ' � •,, t� ���1 , f f ��1 ;11 � 1 g' ?11� Huai , ,
r a G ns . t i zeplace 33.39
" . A r 04 er ee- Ah Flue vent for water heater or gas -
fireplace 23.32
.M..::.. Log lighter (gas) 23.32
Wood/pellet stove 33 -39
�� p q Wood fireplace /insert 23.32
,{ �lil il .,il ° 'a it ."4'1)11;P llYi1d v ,1 ?u fi i, , �t }'11i+1ild i jRE @t1l Ship, Chhnticy/lincr/fluc/vcnt
23.32
,, s.,1si ',.• . ,� Other. 23.32
Name: Environmental exhaust and ventilation
-
Address: .--------
Range hood/other kitchen
equipment 33.39
City /State /ZIP: . Clothes dryer exhaust 33.39 •
--, --- - Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet com.artments utili rooms) 23.32
"" '� r' �i s i . i
t y ' # ` ij1 t`II � ° Attie/crawlspace fans 23.32 $ Ma
r l �}1l i Mil 1111 d + d r i lilt 1 f 1'9 t r 6 ti y �' t .� " p
{( lr, •'i �111�.4Sd �,. tv 4, 814,. . i . (r i„ �1ii� �,S 1� 17i'SiP! „ d;tif�it,.. nr , + � t��li 'tA�llf 11
Other: 23.32
Business name: A i t• o„ � - ""
e �� ls4 c. ,I° � `� Fuel piping
name: iU /bi'�J 14) $14.15 forfir5t four $4.03 for each additional
- Address: ? y d / §i,s- Furnace, etc. MEM
./ ' „ Gas heat limp
City /State /ZIP: IA Ws LLA ei OA g+ 4.14 1 7 /.2 1 Wall/suspended/unit heater ■
P 6 �) X 1 3 T s ,(C ! ,c . ) / ? i f c Water h eater _............. .
Phone: � f FA: ( rt7 I[ �� � f
E-mail: • Range
di i t4 i -i 1 d !.t�o(��m tY t!�IIi4t�rK�A+mF� NEB 4 �}}`�� ('
i1.11l 1, ,1 1 Ll1.11i ''. i.' ' lurid I� .im t iettii t l i tll l .. , LfW/ Barbecue
Business name: /� a T - 6,° i - C4. Clothes dryer (has)
,� Other
f"d
Address: 0 e I 4 1 i � ii 1! ;�j t t i l ± sel %� �t (�` a 1 ' F " i1 / (t 1
City /State/ZIP: {i .4.0t• • 1 Subtotal
;) 3 z �, f Fax: ( G �„ r �, Minimum permit f ee ($90.00) 0. t'
Phone:
�- -) i` 1 e�' _ Flan review (25% of permit fee)
CCB lie.: 7/ - . '1..2.
State surcharge (12% of permit fee) /02 .,
i
- _ TOTAL PERMIT FEE ..' D '. �'
Authorized signature: w e,: This permit app7icadon expires if a permit is not obtained within ISO
_ R ' days after it has been accepted as complete.
7 • F ee methodology set by Tri-County Building Industry Service Board
Print Warne: '� �l e4 �� . F y,� pate: � l�" if � ey Y rY g