Permit I
y CITY OF TIGARD MECHANICAL PERMIT
II I • COMMUNITY DEVELOPMENT Permit #: MEC2009-00374
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/24/2009
Parcel: 2S103BB07901
Jurisdiction: Tigard
Site address: 12350 SW 124TH AVE
Subdivision: LAKE TERRACE Lot: 8
Project: Hinds
Project Description: Replace 4 ton A/C unit
Owner: FEES
HINDS, TOM M & JUDY G Description Date Amount
12350 SW 124TH AVE Air Conditioning or Heat Pump 07/24/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 07/24/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 07/24/2009 $58.50
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE: 503 - 692 -1565
FAX: 503 - 691 -1879
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: t:; Permittee Signature: ,gy
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. "' �
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.
• ' • 07/22/2009 11:53 5036911879 ARROW MECHANICAL PAGE 02/02
Mechanical P'er>dmit .A.aylxcatio!. 1 ort-i( IT 1'S1 ()NIA
City of Tigard E '
i fil • 1 3125 SW Hall Blvd., Tigard, OR 97223 Ptah ' oriew other PenniT.
Phone: 503.639,4171 Fax: 503,598.1960 ato/B
Inspection Line: 503. 639,4175 JUL 2 2 20 (gate Rea y: fi Rode,, Eil See Peat 2 fer
I ! <i;l f:ll Internet: www.tigard- or,gov Notititxl/Mtithod: Supplemental Interm.ttoe
CITY OF based on the value o
TiGA - +1
." ''I '' •fir yL�,Oliry 'i.?. I l.I s `,k 't etll<7� PEt I11(l)r);L`. -• u : ;
VUOIt , s K'r .'�. I W VKR}. '_ e. e' 31 ' 4 Vt � R M r al e permit foes" a ... , .
••• J ••� . _ Mechanical the work
New con es„ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, c. i.ment. labor, ovcrhea• and. kilt,
Demolition 0 Other: , — Value-.
T .. . ,. . Y# Itv or co lStair loN:
•
bri AL EQNt /:'I 'S ivis ": 01 1.',..,:',-,
14 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building P'or spacia information tion ura checklist
Multi- family 0 Master builder 0 Other: Description _ I Qty. 1 13a, i Total
Jo$ 13ITE Il4FOR14);AiliON 'AND LOCATION ' Ile d uttfcoolht .
Air conditioning or hint pump 14.00
Job Site address: I &5D i Z /lie Ayr ( tr tires site pIan showingpine____)
4 lltrnace )00,000 13TU (duels/vent4 14.00
i- City /5tat j i - „. a O le 4 "7ZZ -^^ Furnace 100,000 +13Th (duets /gents) 11.90
Suite/ bldg. /apt. no.: Project name: 1 ht c i y 1Lty Craa heat ,su mp ,14.00
_ Duct work 10.00
Cross street/directions to job site; 14.00
ydtonic ltot water system T -
T Residential boiler (radiator or
h dron 1
Unit heaters (fuel -type, not electric),
in -wall, in- duct eta- 14.00
, •— - - - Flue/vent for any of above 6.80
Lot no.; 10.00
Subdivision: - _ _ _Other: _ Tax map /parcel no.: Other ticel appliances
Water beater 10.00
DESCRIPTION OF WORK' Water
fireplace 10.00 ..
1 .lt- P i F44' y.'T -1 - A 16 - V 1 U LT ,„ 1 lue vent for water heater or gas 10.00
firojtlacc -
- . Log lighter (gas)______ 10.00
Wood /pellet stove 10.00
F --- Wood fireplace/insert , 10.00
Chimney /liner /flue/vent 10 -00
C.] PROPRRTY OWNER I 0 TENANT Other: - 10.00
Name Environmental exhatist and ventilation _ Range hood /other kitchen
' Address: °9nipmlcnt 1,0.00
Cis /Statc/ZIP: m Clothes dryer exhaust 10.00
Y ., - -r Single -duct exhaust (bathrooms,
Phone: ( ) I Y Fax: ( ) ' toilet comportments, utility rooms) , 6.80
,APPLICANT 1i
CONTACT PERSON Attie /crawispace ,ns - 10.00
.. _, Other: 10.00
Business name: A g1Ra, f kalic, -H Ak( f jA._ .. . Fuel piptag
Contact name: is FF _. uY — $5.40 for first font; $1.00 for each addltlonsd
p Furnace, etc -
Address: e ' c) �- 6r/� tAI Gas heat Fur -
City /State /ZIP• U� I K -T-104 .. _F p liA i L70 / 7- � T _ Wall /suspended/unitheater , ^____„^,__,.
�jJ / `j _n ) 6 n I'' a �m Witter heater
Phone: ( � ) � l '� '� F ax:: ( r7 _.._ Firepla ,
E -t aII: _ Range .
CONTRACTOR 13arbccuo _
Clothes drycr-(gus) _
Business nam ,r
L CD / / 4.C5' G �o�E 6 GA r� - - otheh
_... _ / . g
nad ME ANICAL PF,RM1'f FEES*
irsR: tnvn �7��w.."L�.t1 G. i/`1 K _ •..
•- Subtotal City/State/7_1_, - - O
._ — 1 : "�i/\ - - � . 7 L! (5 1i Minimnmpermit lec(S72.SU)
/� /ma / � 7 ,
Phone' (Sl} ) �c I ^ � , 1� m 1 r ' ,3 ) f9" F y !v 7q w - • Plan review (25% of'permit foe) 0
CCB lie.: cz I 7 State sutchargc (12% of permit fee) i sl 70 _
- .- ..1 =_II -' '
... — • - . __ .. , • __ TOTAL PERMIT 1'rr rte , Z.�
nix permit applic5ttoh expires it a permit is not obtained within IRU
A.
Aulhorizcd signninrc: " - _ dart after it has I.ecn accepted ne complete.
I'i „�,.. 'r� f z J / /h * Fa tnethndoinev ,cl b y Tri_Cc,unty rsuildlne!mimir Service Board
'Pe t i /Lt A. le / f 1 i ll T
' 07/23/2009 13:12 5036911879 ARROW MECHANICAL PAGE 02/02
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