Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: MEC2010 -00598
1 3125 SW Hall Blvd., Tigard 503.718.2439 Date Issued: 11/18/2010
.TIGARD. OR 97223 g Parcel: 2S104DA00400
Jurisdiction: Tigard
Site address: 12567 SW QUAIL CREEK LN
Project: Frazer Subdivision: Lot: 0
Project Description: Replace furnace.
Contractor: HYBRID HEATING & AIR CONDITIONING CO. Owner: FRAZER, TAMMY
PO BOX 329 12567 SW QUAIL CREEK LN
CORNELIUS, OR 97113 TIGARD, OR 97223
PHONE: 503 - 357 -5663
PHONE: 503 - 648 -7701
FAX: 503 - 357 -0668
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/18/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/18/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/18/2010 $43.25
Occupancy Grp:
Stories:
•
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject t� 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 1.800.332.2344.
Ai
Issued By: _ / _ Permittee Signature: 'Ai 1.> e,Jp
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.
11/18/2010 12:02 5033570668 HYBRID HEATING PAGE 02/03
Mec� l Permit Anplicati 1 ! FO
ECEVEI ROfl' l(. E I'SE ONLY '
R eceived P enn" ° D�S- j
1,1 City of Hall v d NOV 2 010 Date gy: %/ / � /0 !2
M 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Permir.
11 Phone: 503.639.4171 Fax: 503.598.1960 Date./By: •
1 A
•
III) Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By, �� See Page 2 f or
I nternet: www.tigard -or.gov BUILDING DIVISION Notified/Method: t Supplemental information
COI] ;;IW L'E +C3OkECKLIS' - . .
Mechanical permit fees* are based on the value of the work .
❑ New construction El Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition b Other: mechanical materials, equipment. labor, overhead, and profit. •
Value: $
. CATEGORVOF :CONSTRUCTION'
T
R . 5 . !:. ial,� �9PP. T / S' 5 S'I'Eh 1S
.1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. I Total
• JOB.. Sr I NFORM4ION A ND LOCAfIO µ Heating/cooling
_ Air conditioning
Job site address: C f y L. q • C (requires site plan showing placement) _ 46.75
City /State /ZIP: ,y Furnace 100000 BTU (ducts/vents) 1 46.75 r 7 - 5
Fumacc 100,000+ BTU (dints /vents) 54.91
Suite/bldg. /apt. no.: Project name_ i_, "2 Heat pump 61.06
Cross street/directions to job site:
Duct work 23.32
Hydronic hot water_systerri 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Fluc/vent for any of above 23.32
Subdivision: Lot no.: .
Other: • _ 23.32 _
Tax map /parcel n0.: Other fuel appliances
. :I) E SCRIPTION: , OFy; W; ORI£.. : . . 23.32
water heater
Gas fireplace 33.39
. '' Flue vent for water heatcr or as
J G��. ^ C�, 2 fireplace 23.32
Log lighter (gas) 23
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner/flue/vent 23,32
PXrOPERTY OWP3ER . 7'::TEPIANX Other: _ 23.32 •
Name: IA t� �, Cr Environmental exhaust and ventilation
L • Range hood/other kitchen
• Address: _ 5 .. -) C. ••., L,t`zek. 4� equipment 33.39
City/State/ZIP: 7 (). x"1 '1 c2 0 'Ti Y Clothes dryer exhaust 33.39
. , U F ( toilet compartment bathrooms,
y � � � � a-rct ( Single-duct exhaust ( utiiity rooms) 23.32
r
Phone: Eta ) 2332
.. ' 0 : APPtAC. f . Attic/era pace fan., 23.32
:;GUI�71'ACI`:�1PTRSO?�T
other:
Business name: Fuel piping •
Contact name: 514.15 for first four; 64.03 f or each additional
Furnace, etc. •
Address: — - Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
- Water heater
Phone: ( ) Fax: ' ( ) Fireplace
E -mail: Range
CONTRAi'C1012.:.
( Clothes dyer (gas) ) • Business name: 4E41 ,Uri c l i t e � a r , __1 / • ( Other: — I I
Address: 'F ( �. C` <: :. A r xirxim.r > s ' ";,: ;.
To ,/_ G-7S
City/State/ZIP: / / --- ' • - Minimum permit fee ($90.00)
P • e:,( 4 ,. 5 /• �. Fax: is ) r- 0 /4 (C Plan review (25% of permit fee) ,
: / 1 CCB tier State surcharge (12% of permit fee) ;' G - c gs
'
l , - _ `� !"� TOTAL PERMIT PEE /Do. 80
(� This permit application expires if a permit is not obtained within 1S0
Authorized sigtta ` , • ciL e � G'(G'7� �L! days after it bas been accepted as complete
° Fee methodology Set by Tri -County Building Industry Service Board .
Print name: • 6.4' 1 )6-r A 0 0 r'I . it./ Date: 1 / j e ID
t: tBuil &MEC- PermitApp.d0C t 0/01/09 440.4617T(11 /02/COM/WEB)