Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00417
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/07/2012
Parcel: 1 S 133DB12200
Jurisdiction: Tigard
Site address: 11380 SW PALM PL
Project: Cohanciuc Subdivision:3CHOLLS FERRY ROAD TOWNHOME: Lot: 48
Project Description: (1) push/pull gas furnace installation
Contractor: A TEMP HEATING & COOLING INC Owner: COHANCIUC, ZITA Z
16000 SE EVELYN ST 11380 SW PALM PL
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97223
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 08/07/2012 $46.75
. Type of Use: SF 12% State Surcharge - Mechanical 08/07/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 08/07/2012 $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: d jd A-PPU c,44- Nakt
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.
•
'liC '
Mechanical Permit ADDlicad �'� � ; 1'OI:1)11,1i r: t
i t L Reooived • City of Tigard Da der: , 1 I _ i •M
a 1 13125 SW Hall Blvd, Tigard, OR 97223 AUG 07 2012 Pion Ravines piy,yp
• Phone: 503.718.2439 Fax: 503.598.1960 DatrJBy:
Line: 503.639.4175 '�/ J 1 r Dote Raedy/by: )�' RI Sex Pogo 2 for
:1 !; 1 1D ' O° V I l 1f �� 1 R 4 1D Nolited/Motbod: �' Co sUppn:moptat WOrmuti'
imornet; www.dgurd- or.gov
BUILD G DIVISION
'� .. eon 04: '.. VLE - USE i+: P.T • 1 Kp h or W Mechanical p fees' are based on the valtu of the work
❑ New construction tiAdditionialterationheplacemmit performed. Indicate the value (rounded to the nearest dollar) of all
❑Demolition ❑ Other mechanical labor, overhead and
_ Value: $
CATEGORY or C Ri TION' _ >i1 DF,1trT1A1:fiQ . PISYSI OJS'Fl ti'
dwelling mdusurial ❑ Accessory building F ar ap eci ti yr�o,ors,ee ekiddigt
$� 1 - and 2- family $ ❑ Comm�aU Fa. Total
D �1i_y ❑ Master builder 0 Other- em
e u°°
c
40I3 SlTE.'1NIU1t1 AT1ON Al LOCATION Air conditioning
Su (roquices alto rite ehowoa Pluoo
im®t) 46.75
Job Site address: 113 Tut PA�Nt � kd , •G Q Furnace 100,000 owO (duets/vents) ( 46.75 11. City /State/ZIP: i J .2...3 Fur ace 100 BTU (ducts/vents) 54.91
Srate/btdg. /apt. no.: Project name: C G , t l I/ pump
l ( requaei site plan showing Pdaccaau) 61.06
Cross street/directions to job site: Duct work _ 23.32
Hydrouie hot water system 23.32
Residential boiler (radiator or
-- a drone 23.32
Unit heaters (they -type, not electric)
m wallin-duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Subdiviaitm: I Lot no.: 23.32 _
Other:
Tax map/parcel no.: Other fuel t
Waf hector 23. 2
` A 1N 4R:. .' _. g_es tu,eplae 33.
v A ■ i' 1 4 - ,. ("t • e n A Flue vent for water heater or gas
fireplace 23.32
L0 1 qos) 23.32
W stove 33.39
Wood fireplacefinter 23.32
0' 1 kx[A�IT Chrmucy/ close • . 0 23 32
ta12 bPJiI3i... Q*f It Other.
Name: t t. a , C , C Environmental exhaust and ventilation;
Range hood/other 1citahen 93.39
Address: 11:3 Qt V 119 k O c — dt l
"� Clothes dryer exhaust 33.39
CitylStauJZlPr ,, 1 Single duct mtaust (bathrooms,
Phone: ( ) Fax: ( ) toilet ati , uti s
room 23.32
.- PP lti ApiirJ°awL9' ` fans 23.32
,ARY'II . •:Q' - Ot er 2 3.32
Bubinesi mune: _ . t Je J' :17 . 0, r • - . _ . t ` . . lend Whitest: Contact name: 16000SE . e • ` .St. $14.15 for first four, $4.03 for each additional
Address. Undannas, OR MS Furnace, inc. .-
C i t y / S t a t e / Z I P : W a l l ! - . , , . -' heater
Phone: ( ) I Fax : (93 654-'2-ii 0 Fireplace -
Ermail: Rang.!
COP4TRAiTOR .. • Barbecue —
-
Clothes dryer
Business name: Amy :I- • M t\ 4- : ►1 • "lie h. C. I t r Other- -
Address: 16000 SE Evelyn St. .M CHAP11cAL pb rr Fes'
mss, 6 97(15 Subs mt t/1 .
City /StabilZlP; 5 p.5 014 Mininuan pmmit r ($90,00) L 1 . 0
Phone: ( )
e c 6 Dg ) 5S IA °l0 'pi= review (25% of permit fee)
State surcharge (12% of permit fee) 1 . .
CCB tic.: ' • TOTAL PERMITFEE ilk 1 .,1 V
1
This permit UpP D "des ire permit is got .... . within 180
Authorized sign:
&
days othrr is has been accepted us completes
$ • Fx nthedeteby act by Tri•Couaay BtuldinB lndmt<y Service Bead
Print name: a: !/ o , � � Darr: m
I:) glalGinglpt7rt1iIa1MEC - PetmiinPl^
doe ammo 440 -4017T 1 UOJ" CoM/VIEB)
ZO 39t7d 9NIld3H dW31 d 066ZL59605 9T :bt ZTOZ /L0/80