Permit CITY OF TIGARD MECHANICAL PERMIT
II - / '•. COMMUNITY DEVELOPMENT Permit #: MEC2011 -00290
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/23/2011
Parcel: 1 S134AC04800
Jurisdiction: Tigard
Site address: 10873 SW 109TH AVE
Project: LEEPER Subdivision: HARTS LANDING Lot: 19
Project Description: A/C and furnace installation. A/C unit must meet 3 ft. minimum rear and side yard setbacks.
Contractor: A TEMP HEATING & COOLING INC Owner: LEEPER, MICHAEL & STEPHANIE
16000 SE EVELYN ST 10873 SW 109TH AVE
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97223
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Specifics: Description Date Amount
Air Conditioning 06/23/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 06/23/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 06/23/2011 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
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 503.232.1, 800.332.2344.
Issued By: / C 'e7Yfittee Signature: • 1
Call 503.619 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.
06/22/2011 08:05 5035572990 A TEMP HEATING PAGE 02
Mechanical Permit A la.cation
O h(1R (;If l'Ii: I`: 1.51? O.Ia City of Tigard Received *,
0 � • I�ateBy / Pet,MNn,; ' A
' r * 13129 SW Hall Blvd., Tigard, OR 9 Rft �C i J — CO d
` 1' ,Plan ,RNiew
Phone: 503.639.4171 Fax: 503.598.1 960 \
0
1 Ii: V Pir Re
; A!,'I?. Inspection line: 503.639.4175 , O � .1 0 . 3 ' `Q nnu Rendy/Bv: Er 4af Page 2 fo
It rtemet: www,l.igard- or. gov V ��5 Notified/method; 7 Supplemental Information
TYPE OF WO t _ L.:a' COMMERCIAL FIE* SCHEDULE - USE CRECKLIST
CI New construction Addition /alter'a,+ - r eplac r Mechanical ptrcnit foes are based on the value of the work
poi folioed. Indicate the value (rounded to the nearest dollar) of all
❑ IDeliiolition ❑ Othte1;
mechanical ma equipment, labor, overhead and profit.
_ CATEGORY OF CONSTRUCTION Value: $
mm '�
I - and 2- family dwelling ❑ Commercial/industrial 1:1 Accessory building - RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
El Multi-family [] Master builder ❑ Other: For specta! information use checklist.
Description I Qty. I Fa- f Total
JOB SITE INFORMATION AND LOCATiON R rkcoo R
Job site address; 1 Q "7 3 5 W 9 ` l (9L( 1 c Air coaditioning l /
�" P _re site plan showingplacoma u
1 46.75 k )V.1 5 -
Ciry /Stan /TIP; T ,1 � ( cur- t 0 r ci 1 � !] ' ' Furnace 10(,000 BTU(ducrs/venta) i 46.75 6
V t Furnace 100.000+ BTU ( ducts/vents) 54,91
Suite/bidg, /opt. no.: Project name: Fleas m
.._...,.1'u p 61.06 _
Cross strcot /directions to job site; Duct work L 2332
Hydronio hot tinter sy 2332
. _.___. 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/vem for any of above 23.32
. Other: 23.32
Tax rnep /pareei no.: Other Rte! appliances
-
DESCRIPTION OF WORi{ Water heater _ _ 23.32
n L Gas fireplace y 33,39
11 \ V ,\ �/ f '- O.j �`. IN. Gas
vent for water heater or gas
fireplace 2332
Log lighter (gas) . _ 23.32
• • Woodellet stove - 3339
Wood fireplace/insert 23.32
PROPERTY OWNED Chimney /iinedfluo/vcm 23.32
0
Other _ 23.32
Name: ( A 1 �; fir- Envtronmetttal ezhanat and ventilation
Address: \ ��/ 5th. k bet • . � Range hood(crdrer
cquinment 33.39
City /State/ZIP: '-,t . • I. c- . r•1 Z Clothes dryer exhau 3339
mss' Single -duct exhaust (bathrooms, .
Phone: ( ) , Fax: ( ) toilet compartments, utility morns) 23.32
4 • ' LICA•NT Q CONTACT PERSON ,Attic /crawlapace farts 2332
13uefIless name: Other: _ 23.32
Fucl_piping
Contact name: r t�.• a a Wit' wi is 1 $14.]5 for lust four 54.03 for each add
,1;1.1 M l , additional
.
Address: Clackamas, OR 97015 Furnace, etc,
3U3- u-50I4 -- - Gas heat pat!"
Ciry /StatrJT_1P_ Wall/suspended/unit heater
Phone; ( ) Fax: : (5 > � .} Water heater
E -mail; J 4 Fireplace
Range .
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
- "11.1' .1' _ Ik t . all 04 k Q 1. Other:
Address: 16000 SE Evelyn St.
01 :r I , i MBCIEANICAL PERMIT FEES"
City/State/ZIP: SI ! t s 1
Phone: ( )
F ax: • (..) _ _Minimum permit fee ($90.00)
- (' ' Plan review (25% of permit fee)
CUB IiC.: State surcharge (12% of permit fee) S r
Authorized sRtr ' !t, This TOTAL PERMIT FEE _ d Q �.'"]Z
.� his permit application expires. If a permit in nor obtained within 100
clop alter it has been accepted as complete.
Print name. .� ,. • ' Date: � ( . Foe merboda logy sec by Tri- County Building Industry Service Board • d ...
. X9 i1dinalPcmnite {MitC•PcnmitAnp4oc ID /DI /04 44t- 16L7T(1L/ - D)rt /Wrs)
06/22/2011 08:09 5035572990 A TEMP HEATING PAGE 01
A -Temp- Heating & Cooling,
SITE PLAN
Prepared by:_a_2( 6. Date:_
,Customer Name: '7 � L v Address: /06 Sf.C// r. __....-- -_ -,•-
Customer ,Phone: rp ')2129"-: 74:
d cam?
Property Boundary Line
•
House
•