Permit CITY OF TIGARD MECHANICAL PERMIT
111 I COMMUNITY DEVELOPMENT Permit #: MEC2011 -00498
Date Issued: 11/04/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel 2S104CD07400
Jurisdiction: Tigard
Site address: 13526 SW BRIM PL
Project: BAILEY Subdivision: HILLSHIRE ESTATES Lot: 74
Project Description: Gas furnace replacement.
Contractor: ANCTIL HEATING & COOLING Owner: BAILEY, ROBIN
4320 N WILLIAMS AVE 13526 SW BRIM PL
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE 503 - 281 -0752 PHONE:
FAX: 503 - 282 -5722
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/04/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/04/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/04/2011 $43 25
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 questions to OUNC by calling 503 232 1987 or 1 800.332.2344
Issued By: OP' Permittee Signature: _
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.
11/03/2011 13 : 35 FAX 5032825722 Anctil Heating & Cooling Z10001/0002
Mechanical Permit ApplicationRECEIVED FOR OFFICE USE ONLY
City of Tigard Received , i ',
Date/By. i 1 /
IP Permit No.: ''', I) — (JO et ;1
III q 13125 SW Hall Blvd , Tigard, OR 97223 NO V 0 3 2011 Plan Review
- Phone: 503.718.2439 Fax: 503.598.1960 Date/By Other P. it
TIGARD' sp
Inection Line: 503.639.4175
CITY OF TIGARD Date Ready/By: r 0 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
. ,. :;, -,.: fia - .,, ..,;, : - :,-H.,commx.Agme;.FT,p , . scgptikE pst ca4c -
- -,-, „- -‘, :,.' ''",.: ..' "--: - ; ,. - - H ' - , - --..- . - " - '' ." ""'" .. ' — ' -'" ' ' ' " ' ' Mechanical permit fees* are based on ithe value of the work
0 New construction 0 Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
D Demolition 0 Other: _ mechanical materials, equipment, labor, overhead, and profit.
Value: $
1 piAwct1 , ,x4i9.f . .19m . ,- ; .,._ , ,,,,„,.,.11: 3 - i .,',, :',' , :■;.'! , ':' , '11: ''ff . . if ': ";'3606SMENTA
0
1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. I Ea. Total
7 , : , ,i;.c:,:,V . :7 , ::',. ‘.;;::;;;zGi5.7;,:40ii*i.t44.146/64AlcitkiantiOjiiM,,?...,/,•:;:i:24`:.;: : .Z: 1 :.=..:4 :. % ,
Heating/cooling:
lob site address: 13526 SW BRIM PLACE (requires site plan showing placemen() 46.75 .
, j ,/C ity/State/ZIP: TIGARD OR 9722
Suite/bldg./apt. no.:
e 97223 Project namee22.7.89" 6.1 , [Iv Furnace 100,000 BTU (ducts/vents) 1 46 75 46.75
Furnace 100,000+ BTU (ducts/vents)
Heat pump 54.91
(requires site plan showing placement) 61.06
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
Dt5eROP:Ok:Ot`;' ':''
Water heater 23.32
Gas fireplace 33.39
PUSH/PULL GAS FURNACE 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
.'. ;. Chimney/liner/flue/vent 23.32 ,
- ' —. ..: 7.13 ",.. ,: ,',;. ii ' ' ''', '.'' "': *SOT: .-: .. • '.:1-::
23.32
Name: BILL BAILEY Environmental exhaust and ventilation:
Range hood/other kitchen
Address: 13526 SW BRIM PLACE equipment 33 39
'
City/State/ZIP: TIGARD OR 97223 Clothes dryer exhaust 33 39
- Single-duct exhaust (bathrooms,
Phone: ( )503-524-4648 Fax: ( ) toilet compartments, utility rooms) 23.32 . -
Aptodoi.-:: , „;, , ::: -,„ ;;;: .,' .,..-, -- Attic/crawlspace fans 23.32
Other 23.32
Business name: ANCTIL HEATING AND COOLING
Fuel dping:
Contact name: CHRISTINE BARTON $14.15 for first four; $4.03 for each additional
.
Address: 4320 N WILLIAMS AVENUE Furnace, etc.
Gas heat pump
City/State/ZIP: PORTLAND OR 97217 Wall/suspended/unit heater
Phone: (503) 281-0752 Fax: : (503) 282-5722 Water heater
Fireplace
E-mail: INSTALL@ANCTILHVAC.COM Range
.c ::;:, Barbecue
Business name: ANCTILH EATING AND COOLING Clothes dryer (gas)
Other.
Address: SAME AS ABOVE - i!;.;; : '!„ - :!;i;:'' , ';''. : , ;, ; ;:1400140 . 4V.A . LiP.ONOIAES!''
Subtotal Pk , - 75 -
City/State/ZIP:
Minimum permit fee ($90 00) 0 76 CA
Phone: ( ) , Fax: ( ) Plan review (25% of permit fee) — _
CCB lic.: 8897 State surcharge (12% of permit fee)
TOTAL PERMIT FEE t B
.. )1 This permit application expires if a permit is not obtained within 180
__
Authorized signature: . \ .. A . )I) - h i c , \ f____ F days after it has been accepted as complete.
—
Print name: CHRISTINE BARTON Date: 11/3/11 * Fee methodology set by Tn-County Building Industry Service Board
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