Permit CITY OF TIGARD MECHANICAL PERMIT
` 'I 2 - COMMUNITY DEVELOPMENT Permit #: MEC2012 -00666
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/17/2012
Parcel: 1 S135DA02803
Jurisdiction: Tigard
Site address: 11290 SW 90TH AVE
Project: Alexander Subdivision: GRAHAM ACRES Lot: 29
Project Description: Replace gas furnace.
Contractor: ANCTIL HEATING & COOLING Owner: ALEXANDER, REBECCA
4320 N WILLIAMS AVE 11290 SW 90TH AVE
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE: 503 - 281 -0752 PHONE: 503 - 639 -7622
FAX: 503 - 282 -5722
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/17/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/17/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/17/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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: / AB Permittee Signature: d 6.7-770
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.
12/14/2012 11 : 58 FAX 5032825722 Anctil Heating & Cooling 1J 0001/0002
Mechanical Permit ApplicatRfCEIVED FOR OFFICE USE ONLY
City of Tigard Received
11, q 13125 SW Hall Blvd., Tigard, OR 9722L EC 17 ,_
2012 Date/By: A /2 ,.
Plan Review ttlf& Permit N. e a ,
11 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
9
6
503
Li
t
specion Line: .3.4175
TIGARD In CITY OF TIGARD Date Ready/By: FIE la See Page 2 for
Internet: www.tigard
BUILDING DIVISION Notified/Method: Supplemental Information
.: OF 1:liciWill:1::: .-. :: .:,. •i.H:'.y.,.! '; : i; cOmmErt044,.,:scHEDITLE'-4 USE.ciEwmaarsT 1
Mechanical permit fees* are based on the value of the work
0 New construction El Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
:
Value $
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AT GOY -, ''''' '''' l' ' ' '''''''-' ';:' '-',,;, ''f f'f•i:n!-': .S010111,ACEQTJIPI1iENTPSYSITIvISTEES
0
1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
D Multi-family 0 Master builder 0 Other: Description Qty. I Ea. Total
: '1.';:1:H!':"16 A H i e r a c t o i n :c j li c Z 1 i i n n o g :
Job site address: 11290 SW 90 AVENUE (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 1 46.75 46.75
City/State/ZIP: TIGARD OR 97223
_ Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: #40505 Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map/parcel no.:
Other fuel appliances:
0.1SOIPtiGO*LVOA1(.: 1. '.:-'::; ::: : Water heater 23.32
33.39
PUSH/PULL GAS FURNACE Gas fireplace
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
. ,pgoptkV: ...: Chimney/liner/flue/vent - 23.32
23.32
Name: REBECCA ALEXANDER
Environmental exhaust and ventilation:
Address: 11290 SW 90 AVENUE Range hood/other kitchen
- equipment 33.39 _
City/State/ZIP: TIGARD OR 97223 Clothes dryer exhaust , 33.39
' Single-duct exhaust (bathrooms,
Phone: (503)639-7622 Fax: ( ) toilet compartments, utility rooms) • 23.32
*ittiit;: Attic/crawlspace fans 23.32
,
Business name: ANCTIL HEATING & COOLING
Other:
Fuel pi 23.32
ping:
Contact name: CHRISTINE BARTON $14.15 for first four; $4.03 for each additional
Address: 4320 N WILLIAMS AVENUE 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
Fireplace
E-mail: 1NSTALL®ANCTILHVAC.COM
Range
0OI114tiOtt',;! Barbecue
Business name: ANCTIL HEATING AND COOLING Clothes dryer
Other:
Address: SAME AS ABOVE
:::.' ... . I.
City/State/ZIP: Subtotal
Minimum permit fee ($90.00)
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lic.: f ell dc ... ..— - - - State surcharge (12% of permit fee)
TOTAL PERMIT FEE / ,e0 k"
This permit application expires if a permit is not obtained within 180
Authorized signature: " days after it has been accepted as complete.
Print name: CHRISTINE BARTON Date: 12/14/12 . Fee methodology tel by Tri Building Industry Service Board
1: \Building \ Permits\ MEC-PermitApp.doc 09/09/10 440-4617T (11102/COM/WEB)