Permit CITY OF TIGARD MECHANICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: MEC2010 -00679
T t G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/23/2010
Parcel: 2S103CC01400
Jurisdiction: Tigard
Site address: 11975 SW ROSE VISTA DR
Project: SMYTHE Subdivision: Lot: 0
Project Description: Gas furnace replacement.
Contractor: ARROW MECHANICAL Owner: SMYTHE, ROBERT L JR &
10330 SW TUALATIN RD SMYTHE, BARBARA PICKELL
TUALATIN, OR 97062 11975 SW ROSE VISTA DR
TIGARD, OR 97223
PHONE: 503 - 692 -1565 PHONE:
FAX: 503 - 691 -1879
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/23/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/23/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/23/2010 $43.25
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
/
Issued By: rmittee Signature:
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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.
12/22/2010 16:13 5036911879 ARROW MECHANICAL PAGE 02/02
Mechanical ]Permit Ap hhcati E CEIVED l' FOR O I i C I? 1.1s11 O N I,Y
City of Tigard R eceived
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503.634. Pas 503 398.1960 13125 S W Hall Blvd., Tigard, OR 97223 ei x ' , Penoit N / LG 1e' tO — i1/ r 7 '
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Irrspeetion Lino: 503,639,4175 °
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Interact: www2(gerd.ar.gov @I See Pane a Ibr
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Phone: (023) 6' , 65' Fax: (5-0,) 64i -18 7' Miltimu 25% fee permit fee) • p
flan raviovV 25% of permit tLc)
CCU tic.: ,4-1 Of 3 State Surcharge 12% of pcnnit foe) v 1 O
TONAL PERMIT FEE ay.
Authorized signature: °jI � Pills perralt appJlcatlsa ozplree if n peril it }e not obtalnod within 180
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