Permit - t
!NI a CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Pe COMMUNITY MEC2009 -00191
Date Issued: 05/01/2009
Ti G A R O 13125 SW Hall Blvd., Tigard OR 97223 503 639.4171 Parcel: 2S104BA00300
Jurisdiction: Tigard
Site address: 12010 SW WESTBURY TER
Subdivision: Lot: 0
Project: Delucia
Project Description: Replace gas furnace, ductwork for existing w /h.
Owner: FEES
DELUCIA, LINDA R Description Date Amount
12010 SW WESTBURY TERRACE Furnaces < 100K BTU 05/01/2009 $14.00
TIGARD, OR 97223 FlueNent For Any of Above 05/01/2009 $6.80
PHONE: 12% State Surcharge - Mechanical 05/01/2009 $8.70
Minimum Fee Adjustment - Mechanical 05/01/2009 $51.70
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. Natural Gas
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
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Issued By: w - Permittee Signature: -40 \n
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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 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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• -,Me`�hanical Permit Applicat , 1\ _ FOR (>i i i(.:t: Iitil': ONI.�
�' - '
City of Tigard
p2 9 2009 RReceived Date/By. , aq . c)• _ ,, Permit No : 11 • Ice. nog
13125 SW Hall Blvd., Tigard, OR 97223 p ,, Plan Review
= Phone: 503.639.4171 Fax. 503.5981960 _
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Inspection Linc: 503 639.4175 1° Date /By . Other Permit.
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T I G A R U p r ` � 1 1 t Da te Rc /By 7u rls; 91 See Paae 2 for
Internet www.tigard- or.gov �y1gq1 ®��
1 D���S0�1� Notified /Method ¶ 1 ( ` Supplemental Information
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0 New eonstnrction ® Addition/alteration/replacement
ration/replacement Mechanical permit fees* are based on the value of the work
performed indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: . mechanical materials, equipment, labor, overhead, and profit.
% lni ?,'j,�+,.,td 1 {',� I t u!n(9 I'd }' y � {' a t, n ,. , {Ta at' ,or 641 k "lu�, ' A,U, p li 14 ^'l Value: $
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lidll,M1.1r •C' 4 jfi, ., t .
® i- and 2- family dwelling 0 Commercial /industrial p Accessory building
For special information use checklist.
0 Multi- family E] Master builder [] Other; _ Description Qty. I Ea. 1 Total
"'�sy �') . r << "��, ;V�x ti ' '• • a = .; - k ����y. `` tt �`k�`� t' 11{{i�i�,f };(5,�t,�; C�
'?" - 4 J7 A . ;i: p . '','axaa�i 3 t ' ( aeraacsS WYn y t .. f t i.i0litlli"i>✓f�F ial Heating/cooling
Air conditioning or heat pomp
Job site address: 12010 SW Westbury Terrace (requires sue plan showing placement) 14.00
City /State/ZIP: Tigard OR 97223 Furnace 100,000 BTU (ducta/venu) 1 14 00 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no. j Project name: #28076 Gas heat pump 14.00
Cross street/directions to, job site- Duct work 10 -00
Hydronic 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 i 6.80 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
M' i t q :4 F" ' �,yn.^). �iF" N ,v 1 , a�, .r yr rr,,ui, .a._ r , Waterheator 1040
urN�IVA ('ear i {¢��n: ", r !" i ''0O a e � t... "p e.;7 ti'
,tr a 7iZl� . k.1 r, r;v�n., fpa ',�', ,a4a,�' SrsF +, ut•u'�IW((r<af.tlti)s /t 1r'avu
Push /pull gas furnace Gas fireplace 10.00
Flue vent for water heater or gas
Vent existing water heater fireplace 10.00
Log lighter (gas) 10.00
Vent furnace Wood/pellet stove 10.00
Wood fireplace/insert 10.00
:4°.1j.' IC t rp'f; n i r�' w r'� lit __ I{ p�l l '�aY I4 q n 1 �. + ? w �?`i ;,�, f ?.4..,. , . µ >, I ,,ii Chinnicx /lnteritiue/veat 1 10.00 10,00
°I Winter= I Other: 10.00
Name: Linda delucia Environmental exhaust and ventilation
Range hood/other kitchen
Address: 12010 SW Westbury, Terrace equipment 10.00
City /Statc/ZIP: Tigard, OR 97223 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone. (503)349 -3231 Fax: ( ) toilet compartments, utility rooms) 6.80
.,F r S,,4 j i . i vi "'i: • ': '-'; ' i ; 7 I ,� . � . . � .. �,� , ," }�7, i n' Alt ickriwl' 10.
+(t,.��'a,,�ul��: ��p „'B C„ ,t$Yl ' U V P �., tlr,tiyn�' s, - , ( ,. i �. K H � , ' " . .. �.,"r 1j1y�1x spac fans 0
0
Business name. Anctll Heating and Cooling
Other 10.00
�., ..�.-.._... Fuel piping
Contact name: Christine 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 heater
Phone: (503) 281 -0752 Fax: : (503) 282 -5722 Water heater
Firmlace
E-mail. installtganctilhvac.coml
_ �„ i i i! rr rill ,i '1a_.t "^ Range
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f •, -, r ;. �.�`'i1'i�� -'� �,w. w ; -�.,f: ,..,"�jh�'rh'•;� Barbecue ...
Business name. Anctil Heating and Cooling Clothes dryer (gas)
Other:
Address: 4320 N Williams Ave i , �,� ' �I'i�' , r Q
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OR 97217 i � °'��� ��°' � 5 i` �'">' .. / ; � � , .�kw' ;' q
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City /Statc/ZIP: Portland Subtotal 30.80
_
Phone (503) 281 -0752 _.. [ Fax (503) 282 -5722
- Mini mum permit fee ($72.50) 72 50
Plan review (25% of permt fee)
CCB Ito,: 8897 __ _ State surcharge (12% of permit fcc) 8,70
TOTAL PERM FEE: 81,20
Authori zed SiGttature: , n ��/ 1 This permit application expire %if a permit is not obtained within 180
- ylJ -�I _ Ja after it h.x been accepted as complete.
Print name. ` +
(d 1 1 7 _i Or, )at 4/29/Uy Fee n1eIIfOJ <lyy aet by I ri- (b11111y Building iuduvtry Service meant
I rivrld lanercnnitv4II.c.',,,,.,IAITdor 01 I,),0i a4(I.45I71 (II
Td Wd62:170 600E 6E 'add ZZLSEBE 20S : '0N dNOHd 6u11000 'g 6u1VeaH 1I10Nd : WOZId