Permit CITY OF TIGARD MECHANICAL PERMIT
'_ COMMUNITY DEVELOPMENT Permit #: MEC2011 -00274
Ti 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/16/2011
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Parcel: 25111 CA07300
Jurisdiction: Tigard
Site address: 15210 SW 100TH AVE
Project: BENHAM Subdivision: GULF SIDE ESATES NO. 2 Lot: 17
Project Description: Ductless heat pump installation.
Contractor: ABLE HEATING & COOLING Owner: BENHAM, SUSAN JEANETTE
16285 SW 85TH AVE #105 15210 SW 100TH
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503 - 579 -2250 PHONE:
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Heat Pump 06/16/2011 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 06/16/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/16/2011 $28.94
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: • � 'ermittee Signature:
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.
Mechanical Permit ApplicatimRE ,
FOR OFFICE U se ONLY
114 City of Tigard J D Received •
" 13125 SW Hail Blvd., Tigard, OR 97223 Date / �, Penn" ND.I _
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Phone: 503.718.2439 Fax: 503.598.1960 f �f N Plan Review ,. lns ectionLine: 503.639.4175 1 5 2p�1 Dare/By: Other Permit:
TIG AX17 p Dale Juris:
Internet ww.tigazd�r.gov ®See Page 2 for
CITY OF TIGARD Notified/Method: Tor p Supplemental Informati
sv on
BUI►.DI� G IDIVISI ®1V
TY OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
El New construction Mechanical permit fees' are based on the value of the work
® A ddition /alteration, replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Q Other:
mechanical materials. equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES*
® 1- and 2 - family dwelling ❑ CommerciaVindustrial ❑ Accessory building For special information use checklist
❑ Multi - family ❑ Master builder .
❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating,/cooling:
Job site address: 15210SW 100TH Air conditioning 1
(requires site plan showing placement) 46.75
City /State/ZIP: TIGARD, OR. 97224 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100.000+ BTU (duct_vvents) 5.4.91
Suite/bldg./apt. no.: I Project name: BENHAM Heat pump
Cross streeVdirections to job site:
(requires sire plan showing placement) I 6 L06 61.06
Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -t pe Nat electric),
in -wall, in -duct, suspended, etc, 46.75
Subdivision: I Lot no.: Flue /vent for any of' above
Ta.Y map/parcel no.: Other. + 2 24 3 3 . ' 3 37 2 25
3 32 2332
Other fuel appliances:
DESCRIPTION OF WORK Water heater 23 32 •
INSTALL NEW DUCTLESS MINI SPLIT HEAT PUMP SYSTEM Gas firepla ` 33.39
Flue vent for water heater or gas
fireplace I 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
® PROPERTY OWNER I ❑ TENANT , Chimney/liner /flue/vent 23 32
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• Name: SUSAN BENHAM Other 2332 _
Environmental exhaust and ventilation:
Address: 15210 SW 100TH Range hood /other kitchen
equipment 33.39
CityrStateiZIP: TIGARD, OR. 97224
Clothes dryer exhaust 33.39
Phone: (503)624 -2589 Single -duct exhaust (bathrooms,
Fax: ( ) toilet compartments, utility rooms) 23.32
0 APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Outer: 23.32
Contact name: Fuel piping:
$14.15 for first four; $4.03 for each additions!
Address: Furnace, etc.
CityrStaterZ[P: Gas heat pump 11
Wall/suspended/unit heater
Phone. ( ) Fax: : '
( ) Water heater
E-mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: ABLE HEATING & COOLING, LLC. Clothes dryer (gas)
Address: 16285 SW 85 AVE. SUITE 4 105 Other:
MECHANICAL PERMIT FEES"
City /State/ZIP: TIGARD, OR. 97224
Subtotal 61.06
Phone: (503) 57} 2250 Fax: (503) 620 3980 Minimum permit fee (890.00) 90.00
CCB lie.: 184392 Plan review (25% of permit fee) '
x,11 State surcharge (12% ofpemtit fee) 10.80
TOTAL PERMIT FEE 100.89
Authorized signature: This permit application expires if a permit is not obtained within 180
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I days after it has been accepted as complete.
Print name: KELLY i rA 111E i Date: 06 - - 2011 I * Fee methodology set by Tri Couruy Building industry Service Board
[ Me ildinglPerraCs\MEC- PemitApp,dac 09/09 @C
440 -46177 (11102'COM/wEB)
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:1, •' = 8900 SW Burnham Wham St Sufte F5 Air Conditioning Site Plan ' �;e i C= j ' ` ?, [ I 1 TIGARD, OR 97223
` ' ` f (503)443-2058 Fax (503) 620 -3980
^ Email: ablehvac2@aol.corn
CCB #184392
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" Address
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