Permit CITY OF TIGARD MECHANICAL PERMIT
• — COMMUNITY DEVELOPMENT Permit #: MEC2009 -00524
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009
Parcel: 1S133DD15100
Jurisdiction: Tigard
Site address: 11711 SW 128TH AVE
Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 188
Project: Orr
Project Description: Install furnace
Owner: FEES
ORR, JOHN Description Date Amount
11711 SW 128TH AVE Furnaces < 100K BTU 10/07/2009 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 10/07/2009 $10.80
PHONE: 503 - 524 -9428 Minimum Fee Adjustment - Mechanical 10/07/2009 $43.25
Contractor:
SPECIALTY HEATING & COOLING INC
7500 SW TECH CENTER DR STE 120
TIGARD, OR 97223
PHONE: 503 - 620 -5643
FAX: 503- 681 -0793
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
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 -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 t-e Permittee Signature: /�
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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.
?�:T70 12:54 PM R FAX No, P. 002
Mechanical Permit Application R FOR OFFICE USE ONLY
- City of Tigard Received P tmitNo -a9 -cr �1-
t - 'e 13125 SW Hall Blvd., Tigard, OR 97223 i r . U . ' P a R
Phone: 503.639.4171 Fax: 503.598.1960 4 y: Other Permit:
TWA - 10) Inspection 1 ine: 503.639.4175 CITY OF TIG ' '4* � dy/By, dude; S!7 See Page 2 for
Internet www.tigard-or,gov BUILDING DIVI a p dfMethod' Sup pletnentnt Information
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❑ New construction 1 iI' ddition/alteration/replaeement Mechanical permit fees are based on the value of the work
performed, Indicate the value (rounded to the nearest dollar) of all
❑ Demolition • Other: mechanical materials. equipment, labor, overhead, and profit
{ Value: $
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0 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ` ? 1 " „
L.[,Lt,�l �iolil �,t r rstu'u?� � I t.r�.t._t ,,Al-1 .. .,. t;l,t,u+ Aa.,i
For special triforrnarion use checklist.
❑ /vlultt family ❑ Master builder ❑ Other Qty. EL Total
Description � L E
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Job site address; ('1 S.,..) 1 ').-0 ` • Air conditioning or heat pump
(requires site plan shutting placement) 14.00
City /State/ZIP: Furnace 100.000 BTU (ducts/vents) / 14,00
Suite/bldg. /apt. no.: Project name: Furnace 100,000+ BTU (duets/vents 17.90
Gas heat •ump 14.00 OM
Cross street/directions to job site: Duct work ■ 10.00
H dronic hot water -tem 14.00
Residential boiler (radiator or
h dronic . 14,00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no : Flue/vent for any of above 6.80
Other: 10.00
Tax map /parcel no - F Other Mel a ..lances
1 1 i rl i J f _ � x wrw'v a, l }) {t l i� � f �� 1 '{ All I I T n is 1 i1,
r , I t , t , k s ki 1 R k o ,-._1,4 Its Rlq 14 ! 41 I , i i N � I I I 1 11 # watt,- heater 10.00
r
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Flue vent for water heater or gas
fire • lace 10.00
It. 1 v' Q 4P " '' ' - '''t - il -
Lc,:li:hter as 10.00 EMI
Wood/pellet stove 10.00
Wood fire .lace/insert 10.00
f td 1: W 11*, y, � 1 > I ; ft l f 1 18r . .' r is � {7t^{ # #I l r g 7• 4-1t1'r4{rt r ll r i e it 1 Chimney/liner/fiue/vent 10.00
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..,fu ! _ ,k ,bi; I ,,.tr...,.,v , Id„ 1 oth 10.00
Name; Orr, John R09299 Environmental exhaust and ventilation
11711 SW 128 Ave - Range hood /other kitchen
Address: • uipment 10.00
City / Statc/ZIP: Tigard, Or . 97223 Clothes d er exhaust 10.00
(503)524 -9428 Single -duct exhaust (bathrooms,
Phone: ( ) toilet compartments, utility rooms) 6,80
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. . d, ,;, t , .. r f ,. , i Ot fans 1
Business name: Other 10.00
w e Fuel piping
Contact name: 55,40 for first four; $1.00 for each additional
Address: Furnace, etc. 1
Gas heat . um i
City/ State/ZIP: Wall/suspended /unit beater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E - mail: Range
l� t r a r. l I I l I t r. i .,. it
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Business name: Specialty Heating & Cooling, Inc. Clothes dryer (gas)
Other:
Address: 7500 SW Tech Center Drive #130
City / State/ZIP: Tigard, Or. 97223 oal
Subtotal IMIM
Minimum permit fee ($72.50) (t -
Phone: (503) 620 -5643 Fax: (503) 681 -0793 Plan review (25% of permit fee)
CCB lie,: 665'78 State surcharge (12% of permit fee) 0 ,' j
TOTAL PERMIT FEE 7 .�,
Authorized signature: (�/ `) „"„�' J This permit application expires if a permit is not obtained within 180
{ 0 J
e days after it has been accepted as complete,
Print name: Andrea Dripps bate ! D) * Fee methodology set by Tti- County Building Industry Service Board
IlBuildimpermiteUEC- P°tmicnpptine 01/14/07 440- 4617T /021COM/WEt)