Permit n CITY OF TIGARD : 3 / MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00110
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/4/2008
PARCEL: 2S108BA -02300
SITE ADDRESS: 15835 SW COLONY DR ZONING: R -7
SUBDIVISION: WEST COLONY PARK LOT: 002 JURISDICTION: URB
PROJECT: MAXEY
Project Description: Installing A/C and gas furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODS UNIT
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Owner: FEES
DAVID MAXEY Description Date Amount
15835 SW COLONY DRIVE
TIGARD, OR 97224 [MECH] Permit Fee 3/4/2008 $72.50
[TAX] 12% State Surch 3/4/2008 $8.70
Phone: 503- 709 -5046
Total $81.20
Contractor:
OREGON HEATING & AC
PO BOX 241
DUNDEE, OR 97115 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -538 -2953
FAX 503 -537 -2172
Reg #: LIC 172126
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: i Permittee Signature: �� /C/i
Call 50 . • 39.4175 by 7:00 a.m. for inspections 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.
Mechanical Permit Application • D Receiv
FOR OFFICE USE ONLY
R a
City of Tigard b , P E Y \' Date sy: 3 of I Permit No.: A . —, ti
" 13125 SW Hal] Blvd., Tigard, R Plan Review
I / _
l7 Phone: 503.639.4171 Fax: 503.598.1 Q Dare/By: , Other Permic
T I GA RD Inspection Line 503.639.4175 3 2UU8 Date Ready: By: Susie ® See Page 2 for
Internet: www.tigardor.gov Notifiedilvlethod: Supplemental Information
CITY OF pIV DI
•
VISION TYPteR L COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
6eJI�t Mechanical permit fees* are based on the value of the work
• ❑ New construction Addition /aiteraiiort/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION . Value: S
I- and 2 dwelling RESIDEMtAL EQUIPMETT/ SYSTEMS FEES*
y g ❑ Commercial/industrial 0 building
Multi - family El Master builder For special information use checklist.
❑ Other: Description i Qty. 1 Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Q Air conditioning or heat pump 1
Job site address: ^ L
�(/ 3 5 6 � Coop /� � � / 1 �• (requires site pion showinEplacerrxntl / 14.00 �� � �
City /State /ZIP: 6-f _ 224 Furnace 100,000 BTU (ductslvents) 1
14.00 y �Lt
Furnace 100,000+ BTU (ductsivents) 1 17.90 +
Suite /bldg. /apt. no.: P roject name: X Gas heat ump 14.00
F .
Cross street'directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, em. 10.00
Subdivision: Flue/vent for any of above 10.00
Lot no.: Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
�� /�
J Gas fireplace 10.00
-TN Sr / t /jji A `C,i 1 Flue vent for waver heater or gas
/J fireplace 10.00
Log lighter (gas) 10.00
Wcodipellet stove 10.00
•
Wcod fireplace/insert 10.00
Chimney /liner/flue/vent 10.00
_ ($` PROPERTYOWNER , . "J . ❑ . TENANT Other. 10.00
Name: no v P 1v1 A ye
Environmental exhaust and ventilation
� Range hood/otherkitchen
Address: + 5 f-2 `) 5 ___ o_I P , equipment 10.00
City /State/ZJP: ""r l &��t1 1 A C) 7 Clothes dryer exhaust i 10.00
9 Single-duet exhaust (bathrooms,
Phone: ( '7(), `5C "ltd Fax: ( ) toilet compartments, utility rooms) 6.50
[k.PPLICANT .. ❑ CONTACT PERSON Attieterawlspace fans 10.00
Business name: (n� r � /� Other: 10.00
l /�V' COQ Yi+ I 4 \ rs /CJ Fuel piping
Contact name: ` / I �" '• $5.40 for first four; 51.00 for each additional
`l/' 111 ���►��� Furnace, etc.
Address: . ?x & 21 41 n Gas heat pump
City /State /ZIP: r I nr'� p � , ( -1 7/15 Wall/suspended/unit heater j
� i � = / - +� ° Water header
Phone: ( 533 -206-3 -3 Fax: : .j - 17,
+ /) Fireplace
E-mail: C a 1 C�`'Pr ht l ��YY iil (Urn Um Range •
CONTRACTOR Barbecue
O m e
Clothes dryer (gas)
1' �
Business name: i
Other:
Address: MECHANICAL PERMIT FEES*
Cityi State /ZIP: Subtotal
Minimum permit fee ($72.50) --tirr 50
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB tic.: I ri 2 zt State surcharge (12% of permit fee) S .71)
TOTAL PERMIT FEE [ �j�, 2D
L� Thi perm application expires if a permit Is notobtain d within 180
ogy set by Tri County Bu:ldtng I
Authorized signature: da y s after it has been accepted as complete.
Print name: it -" , 1r' Date: �3 -a? Fee methodo!Actuary Se vice tseard
I :`Bu:tiing•Rermia.MEC- PermitApp dm 04:066 440 -4617T (I It0::COMIWEB)
L• d ZLLZ dZ£ZO 80 co aeW
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Basement
1
® 77 efm
0 77 cfm
Basement ® cfm
•
Z
® 77 dm
0 77 cfm
•
4
3
.lob #: Oregon Heating & Air Conditionin... Scale: 1 /8" = �,o„
Performed or Page 1
Dave Maxey PO Box 397 / 992 Hwy 99W Right Residential
15835 SW Colony Dr Dundee, OR 97115 6.0.106 RSR39325
Tigard, OR 97224 Phone: 503 538 - 2953 Fax: 503 - 537 - 2172 2008 - Mar - 0215:42:08
Phone: 503 - 703 - 5046 C:1Documents and Settingslsalesl 1...
Tom§oregonheating.com
Z'd ZL 6Z - £09 dZ£ :ZO 90 co Jew
Community Development
TIGARD Request for Permit Action
•
TO: CITY OF TIGARD
Building Division Services Coordinator
13125 S\V Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard - or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor k Ci ty Staff
(check one)
REFUND OR Name:
INVOICE TO: (Business or Individual) l / C /fr-i7t7 p r9'C--
Mailing Address: fa' &X a-t--1 ( tf, i/c_ 0 2
VOID City/State /Zip: t2c4' I t '-2 ot2 q - 7 / /S
ZAf/0"." /eg
Phone No.: j 3 - S3 3 X
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑ CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
INVOICE FOR FEES DUE (attach case fee schedule and explain below).
. ❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit). .
Permit #: ci9�C_ 4 9 - t.C} &— 00// C.)
Site Address or Parcel #: / 5 x3,6 5t4.2 (i/(ry yQ,,,
• Project Name: 719plx C /
Subdivision Name: l,( ,1eS f d fG/'V y /i 4 Lot #:
EXPLANATION: /r0 , k. nrrcir Q /c/r'eSS .S
cruet 7 ;de cr f r ✓ cAr i /c7S oyv. .
Signature: ..d. _ _ –........r` Date: S APF013-
i
Print Name: Sre - N 76- ctie0i*
Refund Policy W
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
e) not more than 80% o of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original layer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date By Rte to Bldg Admin: Date By
Refund Processed: Date By Invoice Processed: Date By
Permit Canceled: Date ��. /cam B ii - • arcel Tag Added: Date By
Receipt # Date Method _ Amount $
1:\ Building \ Forms \RegPcrnitAction.doc Rev 07 /26/07
t. •,
6 4 /
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CITY OF TIGARD 3/13/2008
13125 SW [tall Blvd. 2:16:19PM
Tigard, OR 97223 503.639.4171
TIGARD
Receipt #: 27200800000000000691
Date: 03/04/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
MEC2008 -001 10 [MECH] Permit Fee 245- 0000 - 431010 72.50
MEC2008 -001 10 [TAX] 12% State Surcharge 100- 0000 - 207020 8.70
Line Item Total: $81.20
Payments:
Method Paper User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard STAN STUPOR / OREGON BTT 014031 Fax 81.20
HEATING & A/C
Payment Total: $81.20
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