Permit CITY OF TIGARD MECHANICAL PERMIT
• 2 COMMUNITY DEVELOPMENT Permit # MEC2011 -00478
Date Issued 10/26/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 25104DC04400
Jurisdiction Tigard
Site address 13563 SW CLEARVIEW PL
Project CAIN -RUECK Subdivision BENCHVIEW ESTATES Lot 44
Project Description Gas furnace replacement
Contractor ANCTIL HEATING & COOLING Owner CAIN - RUECK, DORSEY
4320 N WILLIAMS AVE 11894 SW 125TH CT
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE 503- 281 -0752 PHONE
FAX 503 -282 -5722
FEES
Specifics. Description Date Amount
Furnaces < 100K BTU 10/26/2011 $46 75
Type of Use SF 12% State Surcharge - Mechanical 10/26/2011 $10 80
Class of Work ALT Type of Const Minimum Fee Adjustment - Mechanical 10/26/2011 $43 25
Occupancy Grp
Stories
Fuel
Fuel Types Natural Gas
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 questions to OUNC by calling 503 232 1987 or 1 800 332 2344
7 /
Issued By p Permittee Signature ��--�
_ si
Ara
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
10/25/2011 11 41 FAX 5032825722 Anctil Heating & Cooling ZI 0001 /0002
Mechanical Permit Application \1C(5) ix\
FOR OFFICE USE ONLY
City of Tigard DateBy 1 I�
I
- ° 13125 SW Hall Blvd , Tigard, OR y 2 q Q�� Plan Review I `„ %/ /
- -- Phone 503 718 2439 Fax 503 59 19`0, s. C 1 - Date/By Other Permit
TIGARD Ins Line 503 639 4175 �-` V p ?Q 1 , Date ecadylBy turn 21 See Page 2 for
Internet www tig -or gee C � . ,1 ' de\ Notified/Method 7I m
el p Suppl lnforanon Vai
TYPE of woR[d1` t � �`� =Sett, lgar ua axa .a :lx S II x.laZIAefwi
, Mechanical permit fees' are based on the value of the work
Ill New construction E Addition /alteranorc cement performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials, e•ui.ment, labor, overhead, and •roftt
Value $
CAtEGORY OF CONSCRiICl'JON - - - - RESIDBNTtAL'EQtWMEr'TLS STEMS FEES+ -
E I- and 2 -family dwelling ❑ Commercial/industnal ❑ Accessory building For specie! rnfornarion use chechfist
❑ Multi -family ❑ Master builder ❑ Other Description Qty Ea Total
" JOB SITE INFORMATION AND LOCATION Heatin- coolino:
Air conditioning
Job site address 13563 SW CLEAR VIEW PLACE re•wres sue •lan shown •lacement 4675
Ci ty/State /ZIP TIGARD OR 97223
Furnace 100000 BTU (data /vein 1 467 Furnace 100,000+ BTU (decisivents) 54 91
Suiteibldg /apt no Project name #29738 6106
Cross street/directions to lob site Duct work 23 32
i H dronic hot water s stem 23 32
h dronic boiler (radiator or �
h ronic
Unit beaters (fuel - type, not electric),
in -wall, in -duct, sus. . ed, etc 45 75
Fiue/vent for an of above 23 32 I
Subdivision Lot no
Other 23 32
Tax map /parcel no Other fuel a.. lrances
DESCRIY,TION OF WORK ' Water heater 23 32
Gas fire lace 33 39
PUSH/ PULL GAS FURNACE Flue vent for water heater or gas
I 5re.lace 23 32
Low h_hter as 123 32
Wood/. •Ilea stove 33 39
Wood fire•lace /insert 23 32
Chinn Amer/flue/vent 23 32
PROPERTY OWNER 0- TENANT Other 2332
,I Name DORSEY CAIN - RUECK Enveronmental exhaust and ventilation
Address 13563 SW CLEARVIEW PLACE Range hood /other kitchen
e•m•ment 33 39
City/State/ZIP T IGARD OR 97223 I Clothes d er exhaust 3339 i
Single -duct exhaust (oathrooms,
Phone ( ) 503 Fax ( ) toilet cori.artments, utility rooms 23 32
' - ® APPLICANT-' - .: - - 7 ❑ CONTACT; PERSON ' Attie/crawl .ace fans 23 32
Other 2332
Business name ANC TIL HEATING AND COOLING Fuel pion•:
Contact name CHRISTINE BARTON 514 for first four, 84,03 for each additional
Address 4320 N WILLIAMS AVENUE Furnace, etc 1111111111
Gas heat cum• I I
City/State/ZIP PORTLAND OR 91217 Wall /sus.ended/wrt heater i
Phone (503) 281 -0752 Fax (503) 282.5722 Water heater
Fire .lace
E -mail INSTALL @ANCTILHV&C -COM Ran _e __-
- - CONTRACTOR' - Barbecue
Business name ANCTIL HEATING AND COOLING Clothesd er (e -s
Other i
Address SAME AS ABOVE ' t1IECHANICALYERMTrPEESf ''�
City /State /ZIP Subtotal
Minimum permit fee ($90 00) fl M
Phone ( ) Fax ( ) Plan review (25% of permit fee) _
CCB lie 8897 1 State surcharge (12% of permit fee) d - R
(� TOTAL PERMIT FEE hid_ ,r 1
I �� A. /\
This permit apycaexpires daePnu as ro ncoopl within lNO
Authorized signature \ `l 1 J \ 1 �[((/ ) days after er m has •f accepted complete
Print name CHRISTINE BARTON Date 10/25/11 * Fee methodology set by Tn -County Braiding industry Seance Board
i tBuiiding\Permis\MEC Rim App doe 09/0950 440-4617T (t it02/COM MEB)