Permit ipq CITY OF TIGARD MECHANICAL PERMIT
. O .'- COMMUNITY DEVELOPMENT Permit #: MEC2010 -00632
T1GA�tI?
13125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Date Issued: 12/07/2010
Parcel: 1S134CB15000
Jurisdiction: Tigard
Site address: 12235 SW ANTON DR
Project: Anzellotti Subdivision: ANTON PARK NO. 2 Lot: 77
Project Description: Furnace replacement.
Contractor: MECHANICAL INC Owner: ANZELLOTTI
PO BOX 19569 12235 SW ANTON DR
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE: 503 - 244 -1730
PHONE: 503 - 639 -7536
FAX: 503 - 245 -7613
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/07/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/07/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/07/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 que ns to OU • calf • . 503.232.1987 or 1.800.332.2344. `
Issued By .A... / / Permit a Signature: if /r'i�
_ - . i /// _:ice - iJ '
_ ' / / /L�/ l
\-------
CaII 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.
PDec, .6.___2_01 0a10.12AM No 3852 P. 1 vacation l 1 Olt - OI ' 1 U. I t
City of Tigard Tally"
" 13I25 SW Hall Blvd,, Tigard, OR 97223
Permit No.
q _ -v � 6' y
' .. Phone 503,639,4171 Fax; 903, DEC lan Review' Olpr J
Inspection 548.1960 EC — ' 2 D ate/8
:6I ;Ann p on Line: Q �Q Y Other Fermir
Internet: www.tigard- or,gov
CITY DateReadyBy;
OF TAG C NotiSed�Mothod Su Sae 2 rot
BUILr in . r 4R Supplem eatalloformado
y
CI New construction I: Addition /alteration/replacement Mechanical permit fe e A a re b on the value e e
0 Demolition work
❑ Other: performed, Indicate the value (rounded to the nearest dollar) of all
9, k� qq,. mechanical materials, e•ui•ment, labor, overhead, and •rofit.
aia $, 'a 'll . �i . y � y '� Value:
4111' 111$ $
P.: I and 2- family dwelling 1 � ro ti � `"x3'' � 1 °. m a, a `i' n�
g ❑Commercial /industrial ❑Accessory building
+ >�a a u� , W t
F
❑ Multi family ❑ Master builder or :pedal t orm ation use checklist
ht ❑ Other:
p +l/ t.
il}R 6' h;W,�. 'a ar�'Ip. u > ! a t4e1r o Description Qty, La, Total
s> >t��li7�t5 }�11�u' ill Heating/coolin
Job site address: 2, I Air conditioning
(requires S ite plan showing placement
City /State/ZIP: h , (�"r—) ' �•—�. Cii 2. 2, 46.75
V Furnace 100 000 BTU (ducts/vents 46,75 -
Suite/bldgiapt. no,: Project name: { . Furnace 100, 000+ BTUsducts/vrntg) 54.91
Q.
0 1 ' Heat pump
C
MN
ross street/directions to job site: 6
"�—
Duct work r�t.06
HYdronic hot water system e -
Residential boiler (radiator or ���
hydronic)
Unit heaters (fuel-;;me, not electric),
in -wall, induct, suspended, ate,
Fl/ 46.75
Subdivision: Flue/vent for an of above
Lot no.: 23.32 MI
Tax map /parcel no.: Other:
1 r'N ttp. up� ! t Other lel a • • minces
st�`tl 11 111 ea• q, • o ° KCa
w,. ,.a�«x4y Watenccater IMMEMIMIll
Gas fleet lace 2333:3 9 IIVIIIIINIIIIMIIIIIIIIIIIIIMIMIIIMII Flue vent for water heater or gas fireplace Il J A- .. t �lace 2 J Log lighter (gas) 22
Wood/pellet stove 3
t t J 01, Wood fireplace /insert
to a' a a�d n a io l 1, a \, �1 ,
jm 'gli1;t 1 1 Chimney/liner /flue /vent 23.32
E r ,�`' Other:
• 23,32
Address: Envtronmentai exhaust and ventilation
S S (—,) b e Range hood/other kitchen
City /State /ZIP: O� 1 _ equipment 33.39
a 1 Z3 Clothes dryer exhaust 33,39 NMI
Phone: )4► �^ 7 / , I F ( ) Single -duct exhaust (bathrooms,
m... }}r�41 ` J l t ��rr toilet con•aliments, mitt rooms
; 'lt ll t1 1 23.32
_ a iCxi tu yl AttWcrawispace fens
Other: IIIIIIMIIIIIIII
23.32
Contact name; 1 � MIIIIINIMIM Fuel • I • Iu_
$14,15 for first four; $4,03 for each al
/ C"7 q Furnace etc,
Address:
Ci � � � ?'1 ( o / Gas hea�turp ���
ty /State/ZIP;
jr e t Wall/suspended/unit heater 11..11
Phone; 5IS - a/ --) 30 — ' -
M Water heater
E-mail; !
1 �q m Q. �N )) C Fire •lace
t ����.„�. .i.'• g_ -:i • X4 1 � 'h rti , . Al ` n a ,` ` : I N °A 7, q V Rye 11.11.10111111.1 a.r, :8 , A Barbecue
Business name: Clothes d or (:as)
Address: rte ' Other: t �� ,
City /State/ZIP:
S
`+II • :,"` .p.w` aii F a ubtot l
,: , ` t.4 i�„
Phone; ( ) �— Subtotal
Fax: ( ) Minimum permit fee ($90.00) I. d . a
CC$ tic.: Gi '1 Plan review (25% of permit fee)
State surcharge (12% of permit fee) / G .: d'
Authorized signature: ' L 12F—.4- •&, TO AL PERMIT FEE J /a ). _
Tab permit application expires Ira permit b not obtained within 190
'tint name: '1. days after It has been accepted as complete.
' , e��Q , Date: " Fee methadalogy set by Tri- County Budding Industry Seruioe Board
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