Permit ,, CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00035
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2012
Parcel: 2S114BB07400
Jurisdiction: Tigard
Site address: 16233 SW 104TH AVE
Project: Blakely Subdivision: SWANSON'S GLEN Lot: 15
Project Description: Replace gas furnace.
Contractor: ARROW MECHANICAL • Owner: BLAKELY, ROBERT & REBECCA REV LI
10330 SW TUALATIN RD 15762 SW 79TH AVE
TUALATIN, OR 97062 TIGARD, 10 97224
PHONE: 503 - 692 -1565 PHONE: 503 - 706 -2398
FAX: 503 -691 -1879
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/17/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/17/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/17/2012 $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 • if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Ut' Notification - ter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
direct questions to O NC • allin• 503.232.1987 or 1.800.332.2344.
I ued By: / : P / // Permittee Signature: ?P/ . ; /Pr /
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.
01/13/2012 11:14 503691187 r ...„ 1
rticuEIVED ARROW MECHANICAL PAGE 02/02
Mechanical Permit Application FOR OFFICE USE ONL1
City of Tigard JAN 13 2012 _
R il trigirM Permit No.: ill_e .../00„.„0603
y:
7111 " 13125 SW Flall Blvd., Tigard, OR 97223 ,,,,,,,
2 ' Phone: 503.7182439 Fax: 503.598.1960U 1 Y OF TIGARD iffill11.111111111 othcrpcnnii,
TMARD
Inspection Line: 503.639.4175
BUILDING DIVISiON D'im Rci)#713'! lill WI See Page 2 for
Internet www.tigard Notified/Method: Supplemental InformatiOn
-
rYEE OE WO* ' COMMERCIAL VW 5OIA9 IA0A : !IAA aitclaitsT ,
- Mechanical perrnit kcs* are based on the value Of the work
El New construction ad Addition/alteration/replacement performed, Indicate the value (rounded to the nearest dollar)of all
El Demolition 0 Other: mechanical matcdals cquipmen _ead and profit.
• Value: $
CATE(7,0Rir. OF Cr.•sgrittrtrtiOri: :
.. . RESIDENTIAL 24 21 6 0 1 0ST:lFr* 145 ,F4S *
vJ I - and 2-family dwelling 0 Commercial/industrial 0 Accessory building - For spedal Information use cher_kUsi,
CI Multi-family 0 Master builder 0 Other: DescrI J Total -
• 3003 MICE' IlsilP.PAYATVS ASA LOCOPOS • • Air conditioning
Job site address: I ( 7 1 „I (requires alto plan abOwinit placomont) 46.75
Furnace 100,000 BTU (ducts/vents) I 46.75 4
City/Statc/ZEP: Til,,,,itO 0 g g 7 7 vi Furnace 100,000+ ETU (duets/vents) _ 54.91 . .
Suite/bldg./apt. no.: Project name: 13( k r ,,,, ppm (..e- rick puirip
. jtensiras the plan thowinp_placement) 61.06 _
Cross street/directions to job site: Duct work 23.32 .
- - Hydtonic hot water system J 23.32
. . . . Residential boiler (radiator or
hydronic) 23.32 ,
- • Unit heaters (fuel-type, not electric),
in-wall, in-duct, suseendcd, etc. , 46.75
_ . . . . . . . .
Flue/vent for any of above 23.32
• Subdivision: Lot no.: -
.. • - . Other: 23.32 I
Tax map/parcel no.: Other fuel appliances: _
. .
. . . ::. . lEStii0T/ON'tilr;*OttiK. :, :.. .:.. ., ' : , „ . Water heater , 2332
Gas fireplace 33.39
kweiA44 - 6-66 r, Awl...,6. nue vent for water heater or gas
fiteplacc 23,32
— _
- . Lorar gas) 23.32
— - Wood/pellet stove 33.39 . .
.
Wood fireplace/insert 23.32
Chimne /liner/flue/vent 23.32
:•'• :: „ 1 '..: . ; :::C5PPIXAkt.ATY : : : ;:ik ' :: ' ,: :.::.:' : 1. . t1-1/01:: :: , ' : :
23.32
blame: g t B ( A kgii Environmental exhaust and ventibidon: _ .
Range hood/other kitchen
Address: -1 71 7 AV
f %,,/ 1 4e- equipment 33.39
City/State/ZIP: -r bokito 0 , et 71-2,q Clothes d r exhaust 33.39
_
Single-duct exhaust (bathrooms,
Phone: (1):31 ) - 7,r7 (, — 2Z1 p Fax: ( ) toilet compartments, utility rooms) 23.32
• .' ::cf• pumftitort, :.;.'..,,,,: ;:,':': . :14,,i010:80f ftiOitorit. : : ; ',. Attic/crawispace fans 2332
Other: 23.32
Business name: A 15‘ AA a , 6 p4 ( L, - -
— Fuel piping: . „.
Contact name! a 0 f F /40- a - I AO)/ ¶14.1 for first four; $4,03 fir each additional _
Furnace etc.
Mdress: 10 33 ,se4 - Ft, A I ATt A4 i d , ... , ...
Gas had pump ..
City/State/ZIP: To x I 4.11,4 (2_4-1 1764Z Wall/suspcnded/unit heater . .
Phone: (9,3) 6 ? 2.- is-tg I Fax: : (476 ) 49,9-16 Water heater .
-- Fireplace .
E-mail: • . Range
:::::. 0t90,04:: „,:;: Barbecue .. .
(agaL
U City/State/
l Address 41 itAThJ l Business "am' Clothes dryer A. kttbv..f M. E ut-fam t chi
: i , ..... - City/State/ZIP; ,., -- 7 - 91 1 1.____T._.ta....j.22(;(____ Othcr:
T:''' ' .: ' ' ::: '
,
Warrant 11 fro Af:_
Phone: () 6 q 7. •
• Fax:( _
503) 6.1?- 17 man review (25% of permit tee) -er- • --
CCB lie,: 6 05 • — State surcharge (12% of pcnnit fee)
TOTAL PERMIT FEE I I> 0. I, SO
Authorized signature: 09 /A----'' • nth permit xpi e xpires if a pent* in not obtained within ISO
days after it ban been accepted as complete.
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