Permit CITY OF TIGARD MECHANICAL PERMIT
11 1 COMMUNITY DEVELOPMENT Permit #: MEC2011 00319
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/08/2011
Parcel: 1 S134BC90019
Jurisdiction: Tigard
Site address: 10827 SW 121ST AVE
Project: Christian Subdivision: Lot:
Project Description: Install new ductless mini split heat pump system.
Contractor: ABLE HEATING & COOLING Owner: CHRISTIAN, LORRAINE
16285 SW 85TH AVE #105 10827 SW 121ST
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 579 -2250 PHONE: 503 - 590 -9125
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Heat Pump 07/08/2011 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 07/08/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/08/2011 $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 Notif .-nter. 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► C b calf g 503.232.1987 or 1.800.332.2344.
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Issu •d By: ,I� I • Permittee Signatu .� 4/11 �er
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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.
Mechanical Permit Application S"j� FOR OFFICE USE ONLY
6 y
City of Tigard ` + Received
71 7 ' f f/ / Permit No.: N�e�o�� —do�3/ Q
13125 S W Hall Blvd„ Tigard, OR it's A r t \ Plan R
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Phone: 503.718.2439 Fax: 503.59 N '60 Plan Review
Q QQ _ Date Other Permit:
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Inspection Line: 503.639.4175 P1" l s `► pate Read iBy: he
Internet: www,tigard- or.gos JJ �� S� 5 0 See rage 2 for
0 � tdolined /btetbod:
I I Supplemental Information -
TYPE OF WO l�� COMMERCIAL 1 FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ® Additionialterati /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
Z 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building Forspecful information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. I Ea. Total
JOB SITE LNFORMATION AND LOCATION Heating/cooling:
Air conditioning I
Job site address: 10827 SW 121 (requires site plan showing placement) 46.75
Furnace 100,400 BTU (duets/vents) 46.75
City /State/ZIP: TIGARD, OR, 97223
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite /bldg. /apt, no.: Project name: CHRISTIAN Heat pump
} (requires site plan showing placement) X 61,06 , 61.06
Cross street/directions to job site: I 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 2.3.32
Other: 1 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
INSTALL NEW DUCTLESS MINI SPLIT HEAT PUMP SYSTEM Gas fireplace 3339
Flue vent for water heater or gas
fireplace 2332
Log lighter (gas) i 23.32
Wood/pellet stove 33.39
Wood fireplace/insert i . 23.32
® PROPERTY OWNER ❑ TENANT
Chimney/liner/flue/vent 23.32
Other: 23.32
Name: LORRY CHRISTIAN Environmental exhaust and ventilation:
Address: 10827 SW 121 Range hoed/other kitchen
equipment 33.39
•
City /State /ZIP: TIGARD, OR. 97223 Clothes dryer exhaust 33.39
Single - duct exhaust (bathrooms,
Phone: (503)590 -9125 Fax: ( ) toilet compartments, utility rooms) . 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.3
Business name: Other: 23.32
Fuel piping:
Contact name: S14.15 for first four, 84.03 for each additional
I
• Address: Furnace, etc. I
Gas heat pump •
•
City/State/ZIP: W'allisuspendedlunit heater ,
Phone: ( ) Fax: : ( ) Water heater
E-mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: ABLE HEATING & COOLING LLC Clothes dryer (gas)
' Other:
Address: 16285 SW 85 AVE. SUITE # 105
MECHANICAL PERMIT FEES"'
City /State /ZIP: TIGARD, OR. 97223 Subtotal 61.06
I Minimum permit fee ($90.00) 90.00
Phone: (503) 579 -25250 Fax: (503) 620 -3930 Plan review (25% of permit fee)
CGS lie.: 184392 State surcharge (12% of permit fee) €0.80 .
TOTAL PERMIT FEE 100.80
Authorized Signatur , f This permit application expires if a,permit is not obtained within IRO c ity
a • 7 days after it has heen accepted as complete.
Print name: KELLY ; 1L E Date: 07-06 -2011 1 * Fee methodology set by Tri- County Building Industry Service Board
1:113,uilling '',Permits'MEC-PermitApp.doe 09109/10 440 -461 fl' (I l /021COSSIWEn)
£' 086E 6u{{000 v 6ui2eeH eIq dbg :ZI. 1.1. LO lnf
Tr ) E.!' '7 8900 SW Burnham St Suite F5 Air Conditioning Site Plan
TIGARD, OR 97223
1 iii ..--- (503) 443-2058 FEX (503) 620-3980
L . - Email: abiehvac2@aol.corn
CCB #134392
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