Permit CITY OF TIGARD MECHANICAL PERMIT
111
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00649
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/14/2010
TfC ARD Parcel: 2S112CA13100
Jurisdiction: Tigard
Site address: 15532 SW 76TH AVE
Project: Assad Subdivision: RENAISSANCE WOODS NO. 2 Lot: 55
Project Description: Replace gas furnace and air conditioner.
Contractor: IMPACT HEATING & COOLING LLC Owner: ASSAD, SHERIF & NEVEEN
309 NE 16TH AVE 15532 SW 76TH AVE
BATTLE GROUND, WA 98604 TIGARD, OR 97223
PHONE: 360 - 931 -3878
PHONE: 480 - 370 -3702
FAX: 360- 843 -1471
FEES
Specifics: Description Date Amount
Air Conditioning 12/14/2010 $46.75
Type of Use: SF Furnaces < 100K BTU 12/14/2010 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/14/2010 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $104.72
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 No • ation e : . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dire questions to OUN • • . • .232.1987 or 1.800.332.2344.
Issue By: / Permittee Signature: vv
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 Applica `u CE V ED FOR OFFICE USE ONLY
City Of Tigard Date/By: /'� /Q / Permit No.: /�
ard, OR 9722D 1 4 2010 E '� /��� CP��
t- ° 13125 SW Hall Blvd., Ti C g t Date/By: Review
- Phone: 503.639.4171 Fax: 503.598.1960 DatelBy: Other Permit:
TIGARD Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction
®Addition/alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ $6,930.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site address: 15532 SW 76 Ave
(requires site plan showing placement) 1 46.75 46.75
City/State /ZIP: Tigard ,OR 97224 Fumace 100,000 BTU (ducts/vents) 1 46.75 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Sherif Heat pump 61.06
Cross street/directions to job site: sw ashford St ,sw 79 Ave 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: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Replace gas furnace and air conditioner Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
® PROPERTY OWNER Chimney /liner /flue /vent 23.32
❑ TENANT Other: 23.32
Name: Sherif Assad Environmental exhaust and ventilation
Address: 15532 SW 76th Ave Range hood/other kitchen
equipment 33.39
City/State /ZIP: Tigard ,OR 97224 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (480)370 -3702 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: Tigard ,OR 97224
Fuel piping
Contact name: Nikolay Pilat $14.15 for first four; $4.03 for each additional
Address: 309 NE 16 Ave Furnace, etc.
Gas heat pump
City /State /ZIP: Battle Ground ,WA 98604 Wall/suspended/unit heater
Phone: (360) 931 -3878 Fax: : (360) 843 -1471 Water heater
Fireplace
E -mail: nickpilat @hotmail.com Range
CONTRACTOR , Barbecue
Business name: 'Figa� ,H p, 4 . v C � 4,L e.
Clothes dryer (gas)
Other.
Address: 309 NE 16th Ave MECHANICAL PERMIT FEES*
City /State /ZIP: Battle Ground ,WA 98604 Subtotal 93.50
Phone: (360) 931 -3878 Fax: (360) 843 -1471 Minimum permit fee ($90.00)
Plan review (25% of permit fee) -------
CCB lic.: 166622 9A 3/1 F State surcharge (12% of permit fee) 14, 22
TOTAL PERMIT FEE 4 ZP—
This permit application expires if a permit is not obtained" within 180
Authorized signature:: days after it has been accepted as complete.
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