Permit CITY OF TIGARD
MECHANICAL PERMIT
- 3,i • DEVELOPMENT SERVICES PERMIT #: MEC2004 - 00076
.c'' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 ----- DATE ISSUED: 2/24/04
PARCEL: 2S103CA -01100
SITE ADDRESS: 13260 SW HOWARD DR
SUBDIVISION: WOODCREST ZONING: R - 4.5
BLOCK: LOT: 010 JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Install exterior A C unit.
Owner: FEES
JORDAN, MICHAEL P + JENNIFER A Description Date Amount
13260 SW HOWARD DR
TIGARD, OR 97223 [MECH] Permit Fee 2/24/04 $72.50
[TAX] 8% State Surcharr 2/24/04 $5.80
Phone: 503 -590 -7817 Total $78.30
Contractor:
AAA HEATING & COOLING
2915 NE MARTIN LUTHER KING BLV
PORTLAND, OR 97212 REQUIRED INSPECTIONS
Phone: 503-284-2173 Cooling Unt Insp
Final Inspection
Reg #: LIC 222
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR
952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246 -6699
Issued By: r ✓r , =Ui1. Permittee Signature: ' Oa(
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
.Mee . apical Permit A • tion FOR OFFICE, USE ONLY
R ece i ve d Mechanical
G C Date/By / `�J 0 7 9V Permit No : /�/e.; % — UOv i'
CI o Tigard RE CE Planning Appro , al Building `, Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other ,
rr
Tigard, Oregon 97223 .O 226 2004 ,4 Date/By.: Permit No.:
Phone: 503- 639 -4171 Fax: 50 l 601GA Post - Review land Use
; �,,ili3�' + ■ : , Date/By: Case No.:
w
Internet: ww.ci.tigard.or.us {� G ON .�, 1 i Contact Juris.: N See Page 2 for
24 -hour Inspection Request: 5 u � 1 175 '`" Name/Method: _� /t Supplemental Information.
I - : . `TYPE'OF..WORIC;Zii: :: ,,,;, - • . .••"C OMMERCIALFEE *- SCIJEDULE= USE_CHECKLIST. ;:;
New construction ❑ Demolition Mechanical permit fees* are based On total value of the work
_
performed. Indicate the value (rounded to the nearest dollar) of all
® Addition/alteration/replacement ❑ Other:
..., ,. CATE
.. . ,, ,^, ,..; . -. ;- -- .�. . ,- mechanical materials, equipment, labor, overhead and profit.
,. . GQRY�OF '_CONSTRU..G;I�ION�_€��; -,._�� �Y. ea g
Ni 1 & 2- Family dwelling ❑ Commercial/Industrial Value: $ See Page 2 for Fee Schedule
❑ Accessory Building ❑ Multi- Family ° -' "RESIDENITAL EQUIPMENT/SYS 1P:MS°FEE* S,OB EDUI E ^-
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: Heating/Cooling
MY44.O1fSITE INFURMATIONiandLUCATIUNt ° °::' ' Furnace - add -on air conditioning** i 14.00 !
Job site address: 1 3 0 & 0 Su) )L- [QLIJtt4e4 Die. Gas heat pump 14.00
Suite #: 1 Bldg. /Apt. #: Duct work 14.00
ed a-oxd M� Hydronic hot water system 14.00
Project Name: m Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heaters (fuel, not electric)
(in wall, in -duct, suspended, etc.) 14.00
Flue/vent (for any of above) 10.00
Subdivision: 1 Lot #: Repair units 12.15
Other Fuel Appliances .
Tax map /parcel #: Water heater 10.00
.- E7 .. , .'` 1ESCRIP,TIONi0F °WORIC V ` ; ;;: ` ' r - . " Gas fireplace 10.00
._.2 t4 Sfa,ll , 4t2 eondt.'ti !'h 4 Flue vent (water heater /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
sPROPERTY::UWNER•� , � . " ®uTENANT : -
Name: Ir}� t'P.blA e ! fcri.d,�` l _ a u h Environmental Exhaust & Ventilation
Range hood /other kitchen equipment 10.00
Address: j 3 2, L. Q 6 De. Clothes dryer exhaust 10.00
City /State /Zip: T'G G ,,ted ! ,Z 3 Single duct exhaust
PhOnfP ).- In-7 Fax: (bathrooms, toilet compartments,
® APPLICANT ✓; ,. `;'. . -n_, . i ,a `GONTACliPERSONi ;'` utility rooms) 6.80
Name: Attic/crawl space fans 10.00
Address: Other: 10.00 _
Fuel Piping
City /State /Zip: * *($5.40 for first 4, $1.00 each additional)
Phone: Fax:
Furnace, etc. **
Gas heat pump **
E-mail: Wall /suspended/unit heater **
- - - • :CONTRACTOR - "' f.,' Water heater **
Business Name: ,4-, A yt-(,Q 6,6)14 f do / Fireplace **
Address: ZCl /, 4/L= // J Range «*
**
City /State /Zip: f / 8i ?7Z'7 Clothes Clothes dryer (gas) **
Phone: 50;3 - Z .2L/ is Fax:S( -Z rrt/ -/5 Other: **
CCB Lic. #: ZZZ Total:
Mechanical Permit Fees*
Authorized
Signature: Q,/4 (.& &[ &A- Date: Z- /t4 /03 Subtotal: $ l �: tip
Minimum Permit Fee $72.50 $ -7 a , 50
64A Plan Review Fee (25% of Permit Fee) $
(Please print name) /7.1 State Surcharge.(8% of Permit Fee) $ -.
TOTAL PERMIT FEE $ i rg 4 0
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan required for exterior A/C units.
i:\Dsts\Permit Forms\MecPermitApp.doc 01/03
AAA HEATING & COOLING
2915 NE MLK JR BLVD
PORTLAND, OR 97212
503- 284 -2173
FAX 503- 284 -1552
CCB #222
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