Permit CITY OF TIGARD MECHANICAL PERMIT
s' COMMUNITY DEVELOPMENT Permit #: MEC2009 -00273
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/09/2009
Parcel: 2S104DD09100
Jurisdiction: Tigard
Site address: 12873 SW MORNINGSTAR DR
Subdivision: Lot: 0
Project: Jacquemin
Project Description: Install heat pump.
Owner: FEES
HANSON, STEFANIE A & Description Date Amount
JACQUEMIN, THOMAS F, 12873 SW Air Conditioning or Heat Pump 06/09/2009 $14.00
MORNINGSTAR DR 12% State Surcharge - Mechanical 06/09/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 06/09/2009 $58.50
Contractor:
ANCTIL HEATING & COOLING
4320 N WILLIAMS AVE
PORTLAND, OR 97217
PHONE: 503 - 281 -0752
FAX: 503- 282 -5722
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: Permittee Signature: S (j n ' /gy p l 1c� c
v 1 !( Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
1 1 ' ,
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.
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Mechanical Permit•A.nali ■�l�' �IVED FOR OFFIC1; 1-Iti1: (MIA'
• City of Tigard II I � O 5 2��9 I)atelB : I Permit No.: Li I,. r j � � ' `1 '
13125 SW Hall Blvd., Tigard, OR 9722 Plan Review -
• Phone: 503.639.4171 Fax: 503.598.1960 rh„ Other Pemut:
t ' l i. n ! n inspection Line: 503.639.4175 CITY CF TIGARD Date Ready/13y; H see Page 2 for
Internet: www.tigatd- or.gov r� Notified/Method: BU DIVIS Supplemental information
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d 112?r, Sr'dV""`Fl)h,'.F�{,S .t NIZEW"RY:71�.t5� EINEE rJ,.�FAl m -gr "',i grl' ),J
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Mechanical permit fees* are based,on the value of the wool:
CI New construction ® Addition /alteration/replacement
❑ Demolition ❑ Other: mechanical Indicate the value (rounded lathe nearest dollar) of all.
mechanical materials, equipment, labor, overhead, and•pro
( 3 �I �[ [ ftt.
r:; � r h A Sr ilr[M� :,111ANNIk",- ty'M�,yiphi� � `2�i9v;t,fv.:Ahi i:mGvA� } t r y, i , tq l d.�C1yri di! r,-.,n.ct� '
Value: r r a t'.. ,.,,tnr-•-v'slnrav L, 7 •
k P i�� � ����.L16�9����It4l� xry' ,J ii�� ti L �r', � 7 +11� 1QS'�Y {� }.Y',� J�hF �ry i .
® 1- and 2- family dwelling El Commercial /industrial ❑ Accessory building
1 i 1di 'ir:u:Xti IYl�ICs N11. @iv 1,ry T�i:3IJ.:1 ?,44:Fi rlil!C,.��a.,:Ilik .d:S t irt4 I
❑ Multi family ❑ Master builder ❑ Other: For special information use checklist
t`r� p Description I Qty. j Ea_ I Total
u t ?4-F"tS & Ili . k as `Y`�p'r" y U. w ; �,`:� o'l `l�f ` ,' e , 4 iPl Vii) I p riF`°y
� .k � 'r ' tc°a� caps r„- rs�ulsd ,,!>:zt'*:�se�,a��hl+tix�a�i.lm? .ra � <,.�" 1 1f11Ht4.. I I��11dk�..�t;Ii_ .- �cK' Beating/co oling
Job site address: 12873 SW Morningstar Alt' conditioning or heat pump •
(requites site plan showing.placement) 14.00
City /State/ZIP: Tigard, OR 97223 Furnace 100 BTU (Mum/veins) 14.00
Furnace 100,000+•BTU. 17.90
Suite/bldg./apt. no.: Project name: #28149 _ Gas heat pump 1 14.00 14.00
Cross Street/directions to job site: Duct work 10.00
Hydtonic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
--- Other: 10.00
Tax map /parcel no.: Other fuel appliances
�� y4 1 r la IR�311' ,stet•, z 8 T +�
l-- "s:�i ; @ ) I :�3�,}}�, L./�r,,, 1/ it �` t � " e l't2 F° .ef; . ' �) „ I%l"?�i r ll.+ `'1WI a 00
Al �N. ��,G° t'��'2i ':'��� Y �� flkl. If 1S 1. � � � Water heater 10.00
Install heat primp Gas fireplace 10.00
_Gas
vent for water heater or gas •
fireplace 10.00
•-• Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
�' r 5t;lsr.(, a.. 1 r ua: s. rrr . Chiron /liner /fl v ent
1' ' ' �ti'7`: H 2 1 n u' h r t q(. Ali, r ey lie/ 10.00
�J,a,�a��+ .7.t other 10 -00
Name: Tom & Stefanie Jacquentin Environmental exhaust and ventilation
Address: 12873 SW Morningstar Range hood/other kitchen
equipment 10 - 00
City /State/ZIP: Tigard, OR 97223 Clothes dryer exhaust 10.00
Phone (503)704 -6984 Fax: -. Singlo-duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 6.80
WM? ` F 1,T n {MntI , / E , r , I - e; ef;,: e'ri r 'm ° +aT 1, 1; Attic /era wlspace fans 10.00
Business name: Anctil Heating and Cooling Other: I 10.00
Fuel piping
, Contact name: Christnc Barton $5.40 for first four; $1.00 for each additional
Address: 4320 N Williams Ave Furnace, etc.
Gas heat pump •
City /State/ZIP: Portland OR 97217 Wall/suspended/unit hearer
Phone: (503) 281 -0752 Fax: : (503) 282 -5722 Water heater
E -mail: installganctilhvac.com - Fireplace -
7 mr i�, - ri y A Range
5; 3_ l'k� `ti "1.1 �1 i e a rti.7,','.!," •iii I1t,�e!' 171ih='� i }{ t. �mylr (y+�,hy-ty�
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..: ,�.'�,.:'t: i•ai! , 'tG� „ �! ">x'4 L'6L'•',NS!��CM`�`r eg Barbecue
Business name: Anctil Heating and Cooling Clothes dryer (gas)
Other:
Address: 4320 N Williams Ave 1i , ) ; I. ,ws F 'i vt � '� 2 [ IIfy( ;v r f
# n p • hl; i rm , ;.1. ;. i,Fi
�.-- J. . /i�.u;Ga ..^.LaL':1;117,51G Y ea. J
City /State/ZIP: Portland OR 97217 _ Subtotal 14,00
Phone: 503 281-0752 Minimum permit fee ($72.50) 72.50
Phone: ( 503) _ Fax: (503) 282 -5722 �� Plan review (25% of
permit fee)
CC8 lie.: 8897 _ _ _ l State surcharge (12% of permit fee) 8.70
TOTAL PERMIT FEE 81.20
Authorized signature: . . + This permit application expires if a permit Is not obtained within ISO
days after it has been accepted as complete.
I Print name:
�._, _ i_IS , Q tl / Da IC: 6/5/09 + • Pee nKahndoioty kr by Tn- County Building Industry Service I,toard
I:. it. IA"q: Arp.dnc UV 17n)7
4a0 a6171 (I I!n ?R'(lAq/W0U)
Td Wd6S : S0 6002 S0 'unf ZZLSZBZ E S :' ON dNOHd 6 u t l ooh g 6u t l e H 1 I lJNd : WOi'Id
1 FROM : MNCTIL Heating & Cooling PHONE NO. : 503 2825722 Jun. 05 2009 06:00PM P2
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