Permit ,, CITY OF TIGARD MECHANICAL PERMIT
IIIII - 1 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00288
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/22/2011
Parcel: 2S112CC04101
Jurisdiction: Tigard
Site address: 15795 SW 80TH AVE
Project: BAIRD Subdivision: BOND PARK NO. 3 Lot: 69
Project Description: Gas furnace replacement with vent for existing water heater.
Contractor: ANCTIL HEATING & COOLING Owner: BAIRD, ANDREW C
4320 N WILLIAMS AVE MESSINA, SANDRA A
PORTLAND, OR 97217 15795 SW 80TH AVE
TIGARD, OR 97224
PHONE: 503 - 281 -0752 PHONE:
FAX: 503 - 282 -5722
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 06/22/2011 $46.75
Type of Use: SF Flue Vent for Water Heater or Gas 06/22/2011 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: 12% State Surcharge - Mechanical 06/22/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 06/22/2011 $19.93
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 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 •UNC by ca jng 503.232.1987 or 1.800.332.2344.
Issued By: /� ,;.." Permittee Signature: 4-24--",
Cge- ; --\
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 Per mit .A,nnlicat tOR0 rt'1c`1 t;5h,('NI V
City of Tigar
Rived
a 13125 SW Hall litvd., Tigard, OR 97223 1 Plan .t:view
y' ilr . . i T i Sri'
I. 4 011 Plan ft
Phone; 503.7182439 Fax: 503.598.1960 • � 2 �' L 2 Date/By.
T r c:A R D Inspection Line: 503.639.4175 Date Reedy /By: gl See Page 2 for
Internet: www.tiganl- or.gov CITY OF TIGARD Notified/Method: Supplemental information
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❑ New construction Ivlecl>Rnical perm fees* arc based on the va)ue of the work
® Addition /alteration /replace performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, , equipment, labor, overhead, and profit,
❑ Demolition ❑ Other:
'RS s• r * r , . i s �, y Value, $
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® 1- and 2-family dwelling ❑ Comtnercial /industrial ❑ Accessory building For speciallnfbrma #on use checklist.
0 Mufti - family ❑ Master builder ❑ Other: Description
w r ol �, r Qty. Ea, 1 Total � . '�� 1 �, l � v • at la�:r s. � 9 �`t^r ' t t�rr a'' �' '�" tbA �riy Heatln�/e0ollt18:
' ,.4 to , •, a �teL.,>1.7 ,sra s . ., 1. r h at Air conditioning
Job site address: 15795 SW 80 AVENUE (requires site plan ahowinp placement) 46.75
City /State/ZIP: TIGARD OR 97274 Furnace 100,000 BTU ( ducts/vents) 1 46.75 46.75
Furnace 100,000+ BTU (ducts/vents) 54,91
Suite/bldg. /apt. no.: Project name: #29503 Heat pump V
-
^-- - -, ••• (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 (fitel -type, not electric),
in -wall, in -duct, suspended, etc, 46.75
Subdivision: Lot no.: Fludveni for an of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances: ,„,
� � M il v r .. 1 r'� h Er�lyq r ; t?P a ' "+ mp.
gyp f ppI >w y
'�I�d.l {; t rti adf e 'P r v '� :p a ��1� r 1�y.{> 1' �1rr "��i"'��� ",'1����`4�7r��rq'.� Waterheutcr 1 23.32
Gas fireplace 33,39
Flue vent for water heater or gas
PUSH/PULL GAS FURNACE fireplace 1 23,32 23.32
VENT EXISTING WATER HEATER L lighter (p 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23,32
10V
. '„ t r ummfam^l pYrYVr ERE• T ). S ,m Y
� 1 a� � F +r' a �i + + r " ' �1 � y Chlttin /liner /tlueJvcnt
t • ..rioast}i tsa r4>? �ar�rC Y INItt, r 0 cJ 1 , '8, r . dill l; x;4421,4 W hlki. 1 ;� 23.32
Name: DREW BAIRD Q thcr.
FEN
Environmental exhaust and ventilation:
Address: 15795 SW 80 AVENUE Range hood /other kitchen
City /Statc/Z1P: TIGARD OR 97214 ut.ment 33.39
Clothes dryer exhaust 33.39
Fax: ( ) Single -duct exhaust (bathrootna,
k ^` ,rhpp w ttot�rnn, ,�'�r` rpp � MG�;'�� `�' toilet compartments, utility rooms) 23.32
' ''411, , v "•,rGr r> /v m My(t1WV r"' A fy, r N c Po, +r l rdl�6e .r' � U! "'
��ta�•ai,ttt81 ,,,,,1, y Atlic /crawlspace fa 23.32
Business name: ANCTIL HEATING AND COOLING Other:
23.32
Contact name: CHRISTINE BARTON Fuel ping;
$14.15 for first four $4.03 for each additional
Address: 4320 N WILLIAMS AVENUE Furnace etc. IIII
City/State/2U'. PORTLAND OR 972y7 Gas heat .um ' -
Phone: (503) 281 -0752 Wall/suspended/unit' heater
_ ( Fax: : (503) 282 -5722 Water heater
E -mail; 11V STAL [ (u3ANCTTLHVAC.COM Fireplace -
j u�. • , u , t I 1 w 1`/ i i ik c ' r" G y , 1i , r A P l` iv •1 '''l r NUM Range
imi llIMMIIII
Business name: ANCTIL HEATING AND COOLING t #` Barbecue
Clothes dryer (gas)
Address: SAME AS ABOVE
Other.
City/State/ZIP:
�� „cr ;� t 4' , " pram we rwc
0, J:VI + w 9 we 1 •' � • i
Phone: ( ) Subtot of 70.07
- __� ax ( ) Minimum permit fee ($90,00) 90.00
CCB lie.: 889 _- Plan review (25% of permit tee) _-
State surcharge 12% f (.80
R ( u permit fee) I i
Authorized signature :, TO'T P EfiMI7 F f 00.80
`+ / It c p, a permit 1x not obtA;ncd wi 1g0 '_
C:HRIti7'[NE BARTON Print name: 7 3 c le�St ben ecepted as .0 te,
- -_ A - _ Date: 621/11 ftr
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