Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2011 -00512
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/15/2011
TIGARD Parcel: 2S102AA02501
Jurisdiction: Tigard
Site address: 12170 SW MAIN ST
Project: Under Water Works Subdivision: TIGARD HIGHWAY TRACTS Lot: 3
Project Description: Push /pull furnace and A/C.
Contractor: ANCTIL HEATING & COOLING Owner: FREY, HILDE C
4320 N WILLIAMS AVE 21745 SW HEDGES DR
PORTLAND, OR 97217 TUALATIN, OR 97062
PHONE: 503 - 281 - 0752 PHONE:
FAX: 503 - 282 -5722
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/15/2011 $185.72
Class of Work: OTR Type of Const: Plan Review 11/15/2011 $46.43
Occupancy Grp: Occupancy Load: 12% State Surcharge - Mechanical 11/15/2011 $22.29
Stories:
Project Valuation: $4,250.00
Fuel Air Handlers
Fuel Types: Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $254.44
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports,(Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
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: j — Permittee Signature: (94/ 0,6 j /elrl
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.
. .
Mechanical Permit Application .
. FOR OFFICE USE ONLY
Received
• City of Tigard
1ZECEIVED Date/ By . / if ,y v - Permit No 40 / ...._,,,•,,,,.
11, q 13125 SW Hall Blvd., Tigard, OR 972,, Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By Other Permit:
Inspection Line: 503.639.4175 N 0 V 1 4 2011
T 1(1 A RD Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard Notified/Method. 1
Supplemental Information
CITY OF TIGARD
"46H
'Mechanical permit fees* are based on the value of the work
0 New construction El Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $ $4,250.00
stiovonagatrowtoco:**7.. ivilinationei :7.svrgitb
El I- and 2-family dwelling El Commercial/industrial 0 Accessory building For special information use checklist.
El Multi-family 0 Master builder . 0 Other: Description I Qty. I Ea. ! Total
MM,1:
Heating/cooling
Job site address: 12170 SW Main St (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City/State/ZIP: Tigard, OR 97223
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name....-thatizugaterWiwits Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Ipacg. (AM iido2k--c 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:
"'FA, Water heater
leillaratillgi)':*****1?• Silo :::.:..,: 23.32
Gas fireplace 33.39
Push / Pull Furnace and AC
Flue vent for water heater or gas
fireplace 23.32
771 ozo /..o - /A/ ..2_6--v,---e,) Log lighter (gas) 23.32
Af6f T / Wood/pellet stove 33 39
• Wood fireplace/insert 23.32
?? esisvi tinyp Ch i m n ey/I i ner/flue/vent 23.32
Name: Underwater Works Environmental exhaust and ventilation:
Range hood/other kitchen
Address: 12170 SW Main St
equipment .. 33.39
City/State/ZIP: Tigard, OR 97223 Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: (503)620-6993 Fax: ( ) toilet compartments, utility rooms) 23.32
tom, wiii A tt i c/crawls p a ce fans 23.32
Other: 23.32
Business name: Anctil Heating and Cooling
Fuel piping:
Contact name: Brian P Murphy $14.15 for first four; $4.03 for each additional
Address: 4320 N Williams Ave • 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: brian@anctilhvac.com •
Range
VIONAMSAV,INXONOITO Barbecue
Business name: Same as Above Clothes dryer (gas)
Other:
Address: RairartC4E:4.,j,:L,,' :=00
City/State/ZIP: Subtotal
Minimum permit fee ($90.00)
Phone ) Fax: ( ) Plan review (25% of permit fee)
i CB lie.: 8897 , ' State surcharge (12% of permit fee)
1
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: • '; - . 3.---;> 7 ,•■ 4- _
days after it has been accepted as complete.
-.-
Print name: Brian P Murphy Date: 11 * Fee methodology set by Tn-County Building Industry Service Board
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