Permit CITY OF TIGARD MECHANICAL PERMIT
11111 ;7;
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00321
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/02/2009
Parcel: 2S110AA92941
Jurisdiction: Tigard
Site address: 10825 SW CANTERBURY LN 104
Subdivision: Lot: 0
Project: Debusman
Project Description: Install gas A/C. Must maintain 3' rear and side yard setback
Owner: FEES
DEBUSMAN, MARTIN R & DIANA M Description Date Amount
10825 SW CANTERBURY LN #104
TIGARD, OR 97224 Air Conditioning or Heat Pump 07/02/2009 $14.00
12% State Surcharge - Mechanical 07/02/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 07/02/2009 $58.50
Contractor:
HEAT RELIEF CO
13122 NE DAVID CIR # 800
PORTLAND, OR 97230
PHONE: 503 - 261 -9915
FAX: 503 - 261 -9814
Type of Use: MF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 6Ylja" Permittee Signature: i'� /�/ /`�/�
1 1
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
4 , L-, 't
Mechanical Permit Application FOR OFFICE USE ONLY
Ili City of Tigard RE
CEIV ED Date /By Pertnit No.:tiee4evq, 00 I
_ q 13125 SW Hall Blvd., Tigard, OR 97223
0 1 2009 Plan Review
' "- Phone: 503.639.4171 Fax: 503.598.1960 J i I � L J Other Permits U Date/By:
TI GARD Inspection Line: 503 Date Ready /By: Saris: El See Page 2 for
Internet: www.tigard -or.gov CITY OFTIGARO Notified/Method: Supplemental Information
_ �+ t ISION
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Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
,f ,- tiols .� 'air, � � U4a T ' Value: $
I and 2 dwelling " - .a — L tltPl E1 ,S ES „�'
ID y g ❑ Commercial /industrial ❑ Accessory building �
® Multi family 0 Master builder For special information use checklist.
'= .`r;,Q RAit1 ti ❑ Description Qty. Ea. Total
Other
L , � . > a� �, _ .;„4 63.74Z-4----T., . „i Heating/cooling
Job site address: (� %rp2J� Air conditioning or heat pump
W w l' L���IJ�y ��� (requires site plan showing placement) / 14.00
City/State /ZIP: l �! i , Furnace 100,000 BTU (ducts /vents) 14.00 irE Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: b Project name: �j'� �r/ Gas heat pump 14.00
Cross street/directions to job site: C /`� Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
`,t Water heater 10.00
(121L----- Gas fireplace 10.00
.—Z/°/1/14 Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
Other: 10.00
Name: / 1 /", 9 / / Environmental exhaust and ventilation
Address: tJ C Range hood/other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility moms) 6.80
a Attic /crawlspace fans 10.00
Business name: HEAT RELIEF Other: In mimes
Fuel piping
Contact name: MARK DEFRANCISCO $5.40 for first four; $1.00 for each additional
Address: 13122 NE DAVID CIR DR # 800 Furnace, etc.
Gas heat pump
City/State/ZIP: PORTLAND, OR 97230 Wall/suspended/unit heater
Water heater
Phone: (503) 261 -9915 I Fax: : (503) 261 -9814 Fireplace
E -mail: Range
(, - ,= " Barbecue
Business name: HEAT RELIEF Clothes dryer (gas)
Other:
Address: 13122 NE DAVID CIR DR # ` i '
City/State/ZIP: PORTLAND, OIL 97230 Subtotal
Minimum permit fee ($72.50) 1 7;2 .
Plan Phone: (503) 261 -9915 Fax: (503) 261 -9814 an review (25% of permit fee)
CCB lic.: 122424 State surcharge (12% of permit fee) e / 70
TOTAL PERMIT FEE / 7 Lv
� This permit application expires if a permit is not obtain thin 180
Authorized signature: i��y41 4 G -, days after it has been accepted as complete.
Print name: MARK DEFRANCISCO Date:
* Fee methodology set by Tri -County Building Industry Service Board
I:\Buildine \Permits \MPC- PermitApp. doe 04/06 /06 440 -4617T (I 1 /02 /COM /WEn)
06/29/2009 15:09 5036126725 SEARS PAGE 06/07
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