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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) • 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 M • s. ,-. Customer 's >,—,- s 4 ‘ ' , --- ... , h.... 1 . ... i 1 ,• . 3 1 I I '1 1 1 .. 1 i i 1 / i......— 8 , ; I . - 1 . i 1 . . . . , - : : - 1 i i . 1 / i i 1 • 1 , . 1 i. .. 1 W ■ I. 1 ' , ! 1 z d 086£ Oupoo v 6u!leeH eiqv d179: Z I, l,l,LOInr