Permit CITY OF TIGARD MECHANICAL PERMIT
: COMMUNITY DEVELOPMENT Permit #: MEC2012 -00681
T [GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/26/2012
Parcel: 1 S134AD07600
Jurisdiction: Tigard
Site address: 10589 SW WINDSOR PL
Project: Carrington Subdivision: WINDSOR PLACE Lot: 13
Project Description: (1) gas furnace replacement
Contractor: SUN GLOW INC Owner: CARRINGTON, CHARLES & NITA
2428 SE 105TH 15089 SW WINDSOR PLACE
PORTLAND, OR 97216 TIGARD, OR 97223
PHONE: 503 - 253 -7789 PHONE: 503 - 624 -9628
FAX: 503 - 253 -7693
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/26/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/26/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/26/2012 $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: / fly Q !/ n � / Permittee Signature: D u a PP(. c 4 11
2,I
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.
Mechanical Permit A licatio
City of Tigard El Received Pormith�
III
13125 SW Hall Blvd,. Tigard, OR 97223 Darc/iiy: � }4 � ` ` r /U �.U11 - o0 �� !
m Plan PC
Phonc: 503.718.2439 Fax: 503.598.1960 i Uthor hcnt t
D C 2 6 2012 Datc /�
T I G A u I . ) Inspection Line: 503 639,4175 Date ReadvBv: Avis: RI Sre Page 2 for
Internet- www,tigard- or.Rov Nntificd/Methpd Supplemental Information
CITY OF TIGARD (o
' ,,, � �-
° :: ''I'. is a.. , ,.... r r S :::: .
. +' ;1r`;9 a; . _ A'Y lP '' �. k . >t.. .,• " : ,.:,. i i�r ,. ti ' . TU a'1K n 'Il v tb 4 ', J,l:l' "1 i ��i, i • Mechanical permit fees"' are based on the value of the work
❑ New construction 5 .ddition /alteratioNreplacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition D Other: mechanical materials, equipment. labor, overhead, and profit.
tlfr r y Value $
� � + t I l��'1�,01\J�11tUU � r � 3't {� M � ,... �. „-
y S��'a � .
1 -end 2-family dwelling .-.. ... •. t �s , '�- �` , , . .�� +:
Q Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: • Description ! Qty. 1 Ea. Total
'r , r ., 3titr rmgre Miry i 2t t1'' � "' :j'7;. Heatin /coolin
.,' i t !.i... :...._.. c
.' .:. • _ ..._. -.,_ 1 ..., ..:i._ Air conditionin5
Job site address: ! C) 5 L] C� G 1 3 j t...0 0 , R vc - e � _J (recall= (recall= ?itc plan ^•ho�vinr placement) j 46.75
_ Furnace 100.000 BTU (ducttgvents) 1 46.75 444,75
Cit /State /ZIP: �` • r q 1 a-a-3 _ Furnace 10(x000+ BTU (ductsivenir) 54.91
Suite/bldg. /apt. no,: Project. name: Heat pump
(requires site plan ahowingplaccmcnt) 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. i 46.75
Subdivision: Lot no.: ' Flue /vent for any of above 23,32 ,
Other; 23.32
Tax map /parcel no.: Other fuel appliances: -
..- ,. , - -- 6ti`SC ti'fslto)H'1'ko �i'
4� F d ,r;r:J.t W Water heater 23.32 ,
Gas fireplace insert 33.39 •
R .$ J QiLs-¢�� p��ra •I r 1\ A .-lam/ Flue vent for water heater or gas ,
O fireplace 23.32
--- -- - Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
;H `"'t k ttit+lsrc Chimney/liner/flue/vent
23.32
Other: 23.32
Name: C ,ti A,) ov environ exhaust and ventilation:
r , P ], f
Range hood/other kitchen
Address: 1 Q 33.39
4S q S �� l� } il equipment 1
City /State /Z1P: •-' Q R C -7 a-- a•- _ Clothes sl exhaust 33.39
-1 Single-duet exhaust (bathrooms.
Phone: .5" G a 4 v,a t Fax: ( ) ilet compartments, utility rooms) 23.32
n, ��Pt�t�� y�. i `,�(� " y 0 COTACt �ttt�41V,h. r At p tic/cnnvl ace fens 23.32
,�i -r�
Other: 23.32
Business name: SUN GLOW, INC. Fuca i in
rp :~:
Contact name: 44$1.7N HEATING & AiR CONDITIONING $14.15 for first four; $4.03 for each addltlnnnl
2428 SE 105th Avenue Furnace. etc.
Address: •LO ,. Portland, Oregon 97216
(503) 253 -7789 FAX (503) 253-7693 Gas heat pump
City /State /ZTP � Wall/suspended/unit heater
Water heater 1
Phonc: ( ) Fax: ! ( ) 1
- Fireplace i
E -mail: Ch c a'S \ �ci i n s t la i.,) tr .. C-£?v� Range .
tom -
i': V '..-' ..i;;» ( (i',` tK'A O12.' ,r . - . '1 ir " j r.' Bal'bee=
Business name: Clothes dryer (gas)
SUN GLOW, INC. - Other
Address: •.UN HEATING & AIR CONDITIONING 3 a7g y ..' t, r0 ,
LOW 2428 SE 105th Avenue Subtotal ' 75 1
Cit /Stale /ZiP: Portland. Oregon 97216
(503) 253.7789 FAX (503) 253-7693 Minimum permit fee ($90.00)
Phone: ( ) r� Plan review (25% of permit fee)
CCB fie.: y % 13 C _ w State surcharge (12% of permit fee) i0 . n
TOTAL PERMIT FEE 1 O D .50
n ^ n This permit application expires If a permit is not obtained within 180
1i'�
Authorized signatsignature: L . _ c - days after it has been accepted no complete.
Print name: Cr, (- t 5.-..\- 1 , � ` `-"� � t� a (l Date: / 2_ r f f- • Fee me k' thodn y set by Ti - County Building 'Industry Service itnortl
1.1 RaitillrecrmitoiMEC- PetmitApp 03/07/12 440- •15 ;7T (I1 /02 /C0M /VAR)