Permit q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00207
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2011
Parcel: 2S 104 BA03000
Jurisdiction: Tigard
Site address: 12070 SW WILTON AVE
Project: Smith Subdivision: COTSWALD MEADOWS NO.3 Lot: 119
Project Description: Replace gas furnace with like kind.
Contractor: AAA HEATING & COOLING Owner: SMITH, MILLIE M
5017 NE GRAND AVENUE 12070 SW WILTON AVE
PORTLAND, OR 97211 TIGARD, OR 97223
PHONE: 503 - 284 -2173 PHONE: 503 - 590 -4010
FAX: 503 - 284 -1552
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/11/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 05/11/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/11/2011 $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 Notifi enter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direc uestions to O NC by cal 503.232.1987 or 1.800.332.2344.
Issued y: Permittee Si nature: 4 11.1111W- Afs
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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.
From: 05/11/2011 11:02 11256 P.001/002
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Mechanical Permit Applic:Pii'ji, ,r EIVED ..N:::.:,gi:-....0.:N.:a.smig,:pi(oo'::::0)::!..!E'sI.J...sF-.ONIA.;:::::-.:,-,....::,.'.;11' j..::::::::;'::''''',:...'..:'...:.•.::1.;.'.:.:.
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:.-1 . : :::::::. - 1' ,: :: City of Tigard Received /WIWI
1 " 13125 SW Hall Blvd., Tigard, OR 97223
: -' 2 ..:: Phone: 503.639.4171 Fax: 503.598.1MAY 1 1 2011 Plan Review
Date/By: other Permit:
i i6 A ii b Inspection Line: 503.639.4175
Date Ready/By: Juris: See Page 2 for
-.-:- - -..--. .- - -.- Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
- — ._BUILI)INQ pivisioN
0 : : - ::-:.:..r . ' - t:! , ::.,..a. -- :'; •:
mdt fees* are based on the value of the work
0 New construction Addition/alteration/replacement Mechanical pe
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other:
mechanical materials, equipment, labor, overhead, and Profit
04:.t.t.0.01*::'':061414RUP7170Nr0.:65''=:;k"-'01•ii'-';:k. Value S
'- ..0 11 1**,..0; 1 :0.,:r 4 -0 4. 3402. 1 tMifili 7 iiiii . .41
Et‹2 and 2 dwelling 0 Commercial/industrial 0 Accessory building ?:,g:1**0
For special information use checklist.
12 Multi 0 Master builder 0 Other:
Description I Qty. 1 Ea. i Total
Ni.RNit ig lc o ks j .SITE: . :M 4 T ORmATI OTI=ANWI:**100**V:'?..F•YiW aeaangkooung
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Job site address: 1p"7 3k,t) k2t t--t-rn 11-V1)..e., Air conditioning
(requires site plan showing placement) - 46.75 m .,....
City/State/ZIP: m M Ot laa , Furnace 100,000 BTU (ducts/vents) \ 46.75 0(11,1
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: 0 Project name: .. Sil e Altiri
. Heat pump 61.06
Cross street/directions to job site: 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: I Lot no.: -
Other: 23.32
Tax map/parcel no.:
Other fuel appliances
MISAVERgliiiiinSiIN510140$0C1*ORKARENNEMETRASn Water heater 23.32 . 1 !
V..tt tak& 3 1 (—C IA,OnirtiX i/i.Cti, i Nil Gas fireplace
Flue vent for water heater or gas 33.39 •
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 23.32
33.39
Wood fireplace/insert
!INg-V;CI IFFACIPEiittri:'‘o4.01AMMAtri;;Mge-ARE111 KitliaNiggigigtg.,;Y: Oth ChimneYilinerifluevelit
i tik 23.32
23.32 .
Name: - i I [-re gMttler . ."'I r - - ' Environmental exhaust and ventilation -
Address: (7t7 SW \ 0 t t Ne Range hood/other kitchen
equipment 33,39
City/State/Z1P: Tkr - Ot I ' 9 —/ adz _Clothes dryer exhaust 33.39 .
Single-duct exhaust (bathrooms, •
Phone: F- D I- Ir) Fax: ( ) toilet compartments, utility moms) 23.32 •
g:' n CI ZCONTA 00*0*: Aftickrawls fans 23.32
Other: 23.32 ,
Business name: AAA Heating & Cooling
Fuel piping
Contact name: Victoria Allen $14.15 for first four; $4.03 for each additional .,
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Address: see below - Furnace, etc.
Gas heat pump •
City/State/ZIP:
Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) .. Water beater . .
Fireplace
E-mail: -
Range
'-; -..` -;-,.:'.; , ,.2- . :, - ,,., ::r,j-,',:‘,..:::.;': ';',-:!, ,- cos ' --.. ..,::::::''-2,.:•.. - •,: : ::: , : - . ',.:::;,:::--::' Barbecue
.
Business name: AAA Heating & Cooling Inc Clothes dryer (gas)
Other:
Address: 5017 NE Grand Ave iktifAr•A,Jc*.i..!'t-TE00**.::-:::i::',-;::::::::::,:i.-',..)
City/State/ZIP: Portland OR 97211
Subtotal
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Phone: (503) 284-2173 Fax: (503) 284-1552 Minimum permit fee ($90.00) CD
Plan review (25% of pennit fee)
CCB lic.: 222
State surcharge (12% of permit fee) 71 0
Authorized signature: V Thi TOTAL PERMIT FEE 1 DO • '0
s permit application expires If a permit Is not obtained within 180
/ . days after It has been accepted as complete.
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Print name: Victoria Allen , Date: Sil 1/ .0 Fee methodology set by Tr-County Building Industry Service Board
1: \Building \Permits \ MEC-PermitAmdoc 10,01/09 44 17T (l /02/COMAVEB) :