Permit CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: M EC2011 -00219
Date Issued: 05/20/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S111DCO2400
Jurisdiction: Tigard
Site address: 15765 SW ALDERBROOK CIR
Project: Morgan Subdivision: SUMMERFIELD NO.8 Lot: 471
Project Description: Installation of NC. Unit must meet 3' minimum rear and side yard setbacks.
Contractor: HEAT RELIEF CO Owner: MORGAN, JACKIE
13122 NE DAVID CIR # 800 15765 SW ALDERBROOK CIRCLE
PORTLAND, OR 97230 TIGARD, OR 97224
PHONE: 503 - 261 -9915 PHONE: 503 - 620 -3790
FAX: 503- 261 -9814
FEES
Specifics: Description Date Amount
Air Conditioning 05/20/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 05/20/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/20/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 1.800.332.2344. /
Issued By: . L Permittee Signature: YN /5 1/."77 4 / c',9 --�
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.
05/19/2011 THU 9 : 14 FAX 5032619814 j001/O03
PG QeS
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
Date/BP: --C1 oelgq
! t‘2.
" 13125 SW Hall Blvd., Tigard, OR 9722V'‘V
Permit N WEreZeifre 9 0 2 /5 7
PI .. Plan Review/
- " Phone: 503.718.2439 Fax: 503.598ltt ‘,.../ Date/By: Other Permit:
TIGARD
Inspection Line: 503.639.4175
91 1 Date Ready/By: Iris. 64 See Page 2 for
Internet: www.tigard 1. NotiSed/Method: , ll .. /W Supplemental Information
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Mechanical permit fees* are based on the value of the work
0 New construction A Addition/alteratiAV t` l ent performed. Indicate the value (rounded to the nearest dollar) of all
8 !) t) mechanical materials, equipment, labor, overhead, and profit.
0 Demolition 0 Other:
Value: $
0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family . 0 Master builder 0 Other: Description I Qty. I Ea. I Total
Eln-FT-r,1,..rliFf..,, - - ii-ecii; , iffiewiNis.wis.; Heating/cooling:
Job site address: 1 5' r2 65 51J A 1 fl B /Zoo( CA (requires site plan showing placement) ' 46.75 46,7D
Furnace 100,000 13TC (ducts/vents) 46.75
City/State/ZIP: - T - -; GA fi) , 0 9 (7ac:94 Furnace 100,000+ BTU (ducts/vents) 54.91
/
Suite/bldg./apt. no.: Project name: Heat pump
(requires site plan showing placement) 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
Subdivision: Lot no.:
Flue/vent for any of above 23.32
I
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
MT Tr" .4N54:10M Water heater 23.32
Gas fireplace 33.39
N . 0 EIN 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
Kalt5ka7:765 chialneY/lineriflue/vent 23.32
.A other: 23.32
Name: TA( _(TE K-)R6160 Environmental exhaust and ventilation:
Address: 1 5 $U- 1 I_1 -.izp)Rqxr_R Range hood/other latchen
equipment 33.39 :
City/State/ZIP: - - r r - G ND 6I 4-7a,,,(41 Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: v ) 4 ,, il . 11/ 0 Fax: ( ) toilet compartments, utility rooms) 23.32 l
E.N5 5 ai rM
reM.W Wili Attic/crawlspace fans 2332
- 41,i;;;Y,.. , :s,A,24 , p,b,N4r.:, r4w4t.iemerly _1, 3 , • ..a_.„1 „..qat4.4
Other 23.32
Business name: I/.7_ •g 1 / ec-
Fuel piping:
Contact name: .- $14.15 for first four; $4.03 for each additional
. Fumace, etc.
Address: . D P I " af _1111
_ . .
49 / .. ,
• _ Gas heat pump
City/State/ZIP: 3C) R Va_rd , QtP c),7341! Wall/suspended/unit heater
Phone: (•= 61- 976- I Fax: : ( 5:3 r 9_6/., 14 Water
ace heater
Firepl '.
i
E-mail: 1 fl. mi t al • at _.4A- -- roe . • AI Range
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1.....'Fxs-Ue'gg.**7.,--., - - ,,,, t,....figt11. 1 M717.7ETtilVtIFIA-PhizikilVm`.-- • , ;...:.-4.1
Barbecue
Eirt#8 P 4... 'Pr&Z.MLIPArl* -a
Business name: ..„.._.1.411C c:
- Clothes dryer (gas)
Other.
Address: :,.NAiVtlii. Ani MI - 7,„
City/State/ZIP: Subtotal
Minimum permit fee ($90.00) V0 , (71)
Phone: ( ) Fax: ( ) -
Plan review (25% of t fee) permi
. ,
I i CCB lic.: i 6 6.9 State surcharge (12% of permit fee) /0 • hr
TOTAL PERMIT FEE /a , led ---- , i
...,""- This permit application expires if a permit is not obtained within 180
Authorized sign l ture:
ai.,..y 1)
days after it has been accepted as complete.
Print name: i ro Afl ce) Date:
* Fee methodology set by Tri-County Building Industry Service Board
1 \Building Texmits WEC-PermitApp.doe 09/09/10 440-4617T (11/02/COM/WEB)
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