Permit •
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit A: MEC2012 -00314
TI G A rt. O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2012
Parcel: 2S 111 CA09300
Jurisdiction: Tigard
Site address: 15380 SW 100TH AVE
Project: Washabaugh Subdivision:STATES NO.2 A REPLAT OF "GULF SII Lot: 37
Project Description: NC installation Must meet 5 minimum 5' side yard setback and approved rear yard setback
Contractor: A TEMP HEATING & COOLING INC Owner: WASHABAUGH, MONA
16000 SE EVELYN ST 15380 SW 100TH AVE
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97224
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Specifics: Description Date Amount
Air Conditioning 06/13/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/13/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 06/13/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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, 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: Permittee Signature: i q PrL-1 e-Pq
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.
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Mechanical Permit Apalicati f EcEiv xe . I oh: ,il i,l(r t ,tit ( >IN II p 1 V
City Of Tigard lblray: _ • (l 1)- W Pmmit NOM ,)412-- 003 ( V
N _. , 13125 8W Hall Blvd., Tigard, Olt 97223 Plno Ri
• Phone: 503.718.2439 Fax: 503.598.1960 JUN 1 2 2 012 ,Bevy: ew Other Poona
lnapoc*iou lane; 503.639. Dna abadyBy: 1106 0 Seems 2 for
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ed. indicate the value (rounded to the nearest dollar) of all
p New construction 6 Addition/alteration/replacement Per �� labor, overhead, and prol'R
mechanical materials. espdp
❑01111on ❑ other: value: $
CA�T>.t3��Y Oil �4195'!'1�li4TYQP1 . .
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$I 1 -dad 2- fianily dwelling ❑ ColnmerciaUmdusl ial ❑ Accessory Description ma Total
El Multi- family ❑ Masita builder ❑ Other:
.. Renting/
maw
: � N O M4 Or1 A i3OCAT OS Air Condit+ i i I 46.75 �6 J
Go mw pins aba,.+aR Plavwnoot)
lob site address: 3 S �' J Fur sec 100.000 BTUsducts/v®rs) 46.75
City /State/ZIP: 1 • ar oy i (2., Ftnrmua 100,000+ BTU (dvoa>s)
Suite/bldg./apt. no Pro]oct rwat�, I . $ I a �l v t- t/ Staa�s Beat pump 54.91 ueeolee Lo e ) 61.06
Duct woad �, 23.32
Cross stroet/dincctiuna to job airs: H y d rpp i c hot water system 23.32
Retidetial boner (radiator or III
nydranic) � — 23.32
Unit heaters (fuel -type, not electric), 46.75
in-wall, induct, responded. etc.
Flnelven for V of ab ove 23.32
Subdivision Lot no.: Other: 23.32
Tax map /parcel no.: Other Inel appliene e;
33 39
GIa Sreylace 9
3 t2... i C Q I t 6 s f 11 4 , ntargUNIMI Flue vet for wafter holder or gas 23.32
fireplace IA _ . - 23.32
33.39
rsfiffffilrff 23.32 • �� 23.32
0 2332
` :'C�!� � `:. ' ' O t h e r
es
�p 1 ` gexhaust and ventiladoeu
Name; 1• l ti W , �S d r c. . BaGg6llQ�otller kitchen
Address: ' 0 SW I } 1 h ,
a � � 33.39
City /Stz ZIP: "T` s 0,... IId r S imgiadaet etdwttat(batitraoms,
Fate ( ) mild cam.:. • • ., : milk rooms 2332
Phone: ( ) ytirJraswhtpaee fans 23 32
:.. 2332
Business acme: . - Ii a. , I ' t I ' • ., !. _ . ■ a t. :.1 _, . - Fed �ld•St
s 51415 for first four $4.03 for each additional
0fTa
Contact name: 7D :. , SB I - St. 1 5 Furnace. etc. a �EMI
Address: = .... , wall/suapcndedt®it
City /StataalZl4: A Walter heater _^
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E -mail: _ —
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lothes ' 1
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Business name: A7EMP .1' • I : .I. •_e:a 1. t I o Other
16000 SE Evelyn St. ..msariANI .
■•ra Mleanl:'+ is i M SnbWtal � I .lI 1 M.. - t I ' Minimum permit fee (1990.00)
Fax: ( 2
D 3) GS4 ' ' 0 Plan review (25% of permit fee)
Moos; ( ) 5 surclmrge (12% of permit fee) I 0,
r Sua Service Bout!
TOTAL PERMIT FEE �1 I ',D
a mires If a permit is not obtained within 180
Ttgs perm o p ptle att®
�_ days altar h bas been accepted in eomP�°
Pr Print n ame sigpn • 1� �J • Feo methodology sot by Ili County Building stnBout! / VIPOIF Date: 41/�Gl IO
Print tttamo: o ,
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Somewhere between too hot and too cold there's.... ,
F A-TEMP
HEATING & COOLING, INC. www_ etempheating.com
16000 S.E. Evelyn Street (503) 650 -5014
Clackamas, Oregon 97015 FAX (503) 557 -2990
X TO: CI fr&r FROM: 4 " P
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ATTN: f W1iT J DATE:
PHONE: TIME:
T FAX: _ # OF PAGES:
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❑ URGENT
A WOR REVIEW
❑ PLEASE REPLY
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