Permit y CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00270
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/09/2009
Parcel: 1 S133DD05400
Jurisdiction: Tigard
Site address: 11568 SW LAKEVIEW TER
Subdivision Lot: 0
Project: Criss
Project Description: Install furnace and heat pump.
Owner: • FEES
CRISS, KENT E/TERESA L Description Date Amount
11568 SW LAKEVIEW TERRACE Air Conditioning or Heat Pump 06/09/2009 $14.00
TIGARD, OR 97223
Furnaces < 100K BTU 06/09/2009 $14.00
PHONE. 12% State Surcharge - Mechanical 06/09/2009 $8.70
Minimum Fee Adjustment - Mechanical 06/09/2009 $44.50
Contractor:
OHAC INC
PO BOX 241
DUNDEE, OR 97115
PHONE: 503 - 538 -2953
FAX: 503 - 691 -8556
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: P V n /l tQJ1J Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This - permit - card - shall -be- kept -in-a- conspicuous - place - on the site until completion of the project. - -
Approved plans are required on the job site at the time of each inspection.
06/05/2009 9:24 503-691-8556 OREGON HEATING PAGE 01/03
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Mechanical Permit Application , ,. FOIVOITICE USE ONLY' ' 'i ' ,;. '1':,..'-''' ',''- '-'•,i
, ., ,`:;::-.,. City of Tigard VAN P
1/4 Rece
........ Permit No.: 2 • &j .00 '2
, ' • ''''' ' n 13125 SW Hall Blvd., Tigard, OR 972 3 C.,,,,:g v, .- - ' ''
III Date By..
Flan Remew
Other Permit:
Phone: 503.639.4171 Fax 503.598.1 (.. '• cyc!,'Ir. S Date/By:
FIGAR losPection Line; 503.639.4175 ,\ Qi '3 L.
O Date Ready/By: Juris: Ei See Page 2 for
Internet: www.tigard. n r, Noted/Method; 11 C Supplonaentni jo
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''ct`4ii; 17i, :'' Ili ;' 1 , '?,.', . ",,,- r • a i!i-'. ''• r,owli 0 . 1 - ""' 1,
AMMON OS INR , , ,.1 , ;''r l'1• Ui7 1 .14 0q111.1 1 4 2,, WA ',. ';ftii ,ti, „. .:;i ' 4...P4 ::-.
..)%tL-1 petnait fee are based on the value of the work s*
111 New construction IN Additionlalteratigeplacem cat Mechanical pe
peiforme,d, Indicate the value (rounded to the nearest dollar) of all
0 "Demolition III Other: • mechanical materials, erLuiEment, labor, overhead, and profit
RiliAllitiKplr: "PIO 461,1 . , . , *1 ,_ , , , bil, Is Ntiol 4;11,1 1 Ale t kv Value: $
kit 1.t.t'•4 , , , t:...i 4 1* RI v. , ,, 6a1u. , , , .■.t , f ,, AAII .),R: IA 441 1 Ac, !OA,' ail;; i, A, 4', ; A, A A A f A fA 1 f ' AAf 1 A f PiliiipitIAfii$0 If ' , ' '.' , j;' If 'f eAtk f allifp.
I 1- and 2-family dwelling 0 Commercial/induStria1 0 Accessory building ii2i6itiMii4■.', ,.
,:. -'4.!! If ItMT41,M; ,iTM.■, ,! it/,,n4
For ,special infonration use checklist.
0 Multi-family 0 Master builder 0 Other: Description Qty. 1 Ea. I Total
, '' A.', AAIAO 4•(;A. 4){,inFl i . "f , ■i ) '1 .1 Ni ig V ■■ ■ 1
"Filligtl g 7 ° AV : ' ' i'li ' ' W i l l ° ;' ' i t 1 1 q ‘ P ) 1 ' ' i 1 4 lq 1 I T 1" l i i 1111 ' i ileatit
Air conditioning or beat pump
Job site address: 1 ‘ Dc N.)_,_ri„.\.s.el.iie1&)q. ( lequ i rs sits plan showing placement) ‘ , 14.00 MO
City/State/al': T' 'P'rO. M'aQ3 Furnace 100,000 131 (ducts/vents) 1 14.00 k two
- Furnace 100,000+ BTU (ducoNcuo) 17.90 ----
Suite/bldg./apt. no.: Project name:
Gas beat pump 14,00
Cross street/directions to job site: Duct work 10.00
Hydronie hot vvater system 14.00
Residential boiler (radiator or
bydrottic) 14.00
Unit heaters. (fuel-type, not elects
in-wall, in-duct, suspended, etc. 14.00 ,
Flue/vent for any of above 6,80
Subdivision: Lot rto.! '
• - Other: 10.00
Tax snap/parcel no.: Other fuel appliances
1 i l 1 1 e Water heater 10.00
WIFIDES111, 4 ..". ' ' . 4 '1. ' Vad :1'3: 1 '.. dill ' • . ' 6 ' • Gas fireplace
' ....A:•U • ,t: IL: L.:11 . 1 r : 11 . 'L.', .:1 s, . Lc...4,, ..,,„
10.00.
ir\M-cok -C-uvnace 1 Q.,..MP--_a_i Flue vent for water heater ofgas
firoplocr • 10.00
r.di • - Log lightel;.(es) 10.00
Wood/pellet stove 10.00
Wood ftreplace/insen 10.00
1. ' '''''' " ' ; '.' ; ' ";' ' • ' ' 1 " ;• 1.;PR"'' 1;, .. :.• , . ChilaineYflitkEet1PelVent 10.00
i iii t ' 1E 'l l li 4VI : g • 1 ' Ili ,, IL iliftMllit .3111111 othg - 10.ce
Name: '‘'■\- Cyi . Environmental exhaust and ventilation
Range hood/other kitchen
Address: ,) _ ei ,,, av r
equipment 10.00 1 -
City/State/ZIP: --k-- (Ala. clogtes dryer exhaust 10.00
Single-duct cxlianst (bathrooms,
Phone: (503) 5 Lk (zpq Fax, ( ) . • toilet compartments, utility rooms) 6.80
' • I ' l'i'l " i ,' ' w" ' ,' r . ... '' i: ''' lij '1' ' ... . 11 P
ri ! Attic/crawls ace fans
1:1 •: i,'f ilit_f iflil ilAiilit .„klko anke. ,I 3
„•i ' 's A s.t • sl S ■11 I s 1: : AS 00
. 1 0.
Other 10.00
us
mess name: 4 1 6 ., 4 _ ci , . ..... k as t ekL
Fuel piping
___,..... -----
Contact name; t,:A pl $5.4 0 for tint four; $1.00 for each additional '
Rurnace, etc.
Address'. "1 L\ i
Gas heat purnp
City/Srate o kyr - Ic \ e , °11 1 Wall/suspended/unit heater _
Phone: (50 ) --.,F). 1- (9 649. i Fax" ( 3 ) boll- 8-556 Water heater .
Fireplace -
E-mail: • Range
r.i ,t,l, , .• ,o, ,,, , ! A, 7.■ A ' A' f ' AA'' 'f , i7,10 1 ' '
lintilil ' s , ts r r i tr.ri r l' It -Fp i' ii li 111,1WI [ .111
Barbecue
I flit§ id 4 •tiP 1 ,,, 1,t, , ,r:; A c 4 ,, 4 P44 1 1 4 4 41 4 • 1 14 , 4 144 ■ 4 ,. 41 tx -
Clothes dryer (tas2,,...,
Business name; 0 \ . qe l , C i• ....
Other. .
Address: R) b Q Z‘ t tiggreiragOgaNOVOWItt? j210,Ini
91 \ k 5 _ s,Abto,si
Phone:60'3 Cfoi-c-,169c Fax;(, 13 (6C0- 5 .) Mixtinat!tu permit c($720)
Plait review (25% of pemiit fee)
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CCB lie.: ‘ \ 'a State surcharge (12% of pennit fee) 1? 0
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TOTAL PERINIXT FEE
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Authorized signature: j -14._ This permit applieatioit expires ff a permit 1s itot obtained within 180
1\j„,, ),.7 ,---C2=4-0----- days atter it has beesi accepted 1.1 complete.
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Prin name: RCA 03.19 - Vx-,1ber Date; (v 10c1 * Fee methodology set by Tri-County Building Industry Service Board
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CONTRACTO A/C - HEAT PUMP - INIT SITE P LAN • D IRECIOON ul
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CTISTONT. F044ATON
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NAME: ictf- 4 *. cia c5 t.0 .
'is (Di( 9 t) 1.06,faut.)
ADDRESS:
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PLEASE FAX APPLICATION WI III SITE PLAN m
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