Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00318
T1GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/08/2011
Parcel: 1 S134BC90020
Jurisdiction: Tigard
Site address: 10825 SW 121ST AVE
Project: Miller Subdivision: Lot:
Project Description: Install new ductless mini split heat pump system.
Contractor: ABLE HEATING & COOLING Owner: MILLER, DAVID L
16285 SW 85TH AVE #105 10825 SW 121ST AVE
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 579 -2250 PHONE: 503 - 349 -4036
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)
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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 qu ns ,QUNC calling 503.232.1987 or 1.800.332.2344.
Issued y: 006I Permittee Signat th �'f/
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.
',lechanical Permit Application / OFFICE USE ONLY
City of Tigard �� 1� � r A. Received Q
Y ( 1, 1''\ Date/By 7 1/ /' Permit No.: �l a0,'/ �Q p1( O
a 13125 SOU Hal] Blvd., Tigard OR 97 ^ D
Phone: 501718.2439 Fax: 503.598.1 yyyyy ` Plan Review
Q e : , m Other Permit: tRe.s TLVAhD inspection Line: 503.639.4175 �� � e �eaay/B
InterneInternet: www.tigard- or.gov , S See Page z for
Notified/Method:
ethod: I Supplemental information
C 4
TYPE OF WORK v .�
1T' Mechanical permit fees* are based on the value of the work
❑ N ew construction ®Addition /alterationlre acetnent COMMERCIAL FEE* SCHEDULE - USE CHECKLIST p
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
dwelling RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
® 1 - and 2 g ❑ Conunercial /industrial ❑ Accessory building For special information usechecllist.
El Multi- family ❑ Master builder ❑ Other: Description L Qty_ I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 10825 SW 121ST (requires site plan showing placement) 46.75
•
City /State/ZIP: TIGARD, OR. 97223 Furnace 100,000 BTU (duets/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: MILLER Heat pump
(requires site plan showing placement) X 61.06 61.06
Cmss street/directions to job site 11 1!q u.Ork 11
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
subettvlaton: ' L ,nr rm. - Flue/vent any of above . 23.32
Other: 23.32 I
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
INSTALL NEW DUCTLESS MINI SPLIT HEAT PUMP SYSTEM Gas fireplace 33.39
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
g PROPERTY "OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Other. ' 23.32
Name: DAVID MILLER _ Environmental exhaust and ventilation:
Address: 10825 SW 121 Rangehood/oUterkitchen
equipment 33.39 _
City/State/ZIP: TIGARD, OR. 97223 Clothes dryer exhaust 33.39
Phone: (503)349-4036 f Single -duct exhaust (bathrooms,
Fax ( ) toilet compartments, utility rooms) , 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Other: {23.32 j
Fuel piping:
Contact name:
514.15 for first four: 54.03 for each additional_
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wali/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 It 105 Other:
.MECHANICAL PERMIT FEES*
City /State/ZIP: TIGARD, OR 97224 . Subtotal 61.06
Phone: (503) 579 - 2250 l Fax: (503) 620-3980 Minimum permit fee ($90.00) 90.00 I Plan review (25% of pen)* feel
CCB lie_: 184392 State surcharge (12% of permit fee) 10.80 '
• TOTAL PERMIT FEE 100.80
Authorized signature: 4 Z C t ,, i a i�^c. This permit application expires if a permit is not obtained within Itt
i C _� days after it has been accepted as complete. /} ��
Print name: KELLY 1{IT .Date: 07 - 06 - 2011 * Fee methodology set by Tri County Building Industry Service Board'
I: etuitdia g)Pamits'NEC- PcrmitApp.Boc 09'09;10 440 - 4617T (I 1/02/COMWEn)
6 086£ - £09 6ull000 +g 6ugeeH elgb' d06:ZO I. 6 LO lnf
171 '',..--) rrj 7 : 3 8900 SW Burnham St Suite F5 Air Conditioning Site Plan
• -.: ) :3 r-
- *.', ri t : -Li TIGARD, OR 97223
(503)443-2058 Fax (503) 620-3980
d'--...)c-a.. ''..'-'.. ' ----= Email: ablehvac2@aal.com
-.1: 1.: . -- -.:-: : ::: : ..... -
CCB 4184392
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