Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2013 -00197
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/11/2013
T [ " '� R O g Parcel: 2S103CB05800
Jurisdiction: Tigard
Site address: 12225 SW HOLLOW LN
Project: Mills Subdivision: QUAIL HOLLOW - EAST Lot: 7
Project Description: Replace existing a/c unit. Placement of a/c unit must comply with manufacturer's clearance requirements.
Contractor: SHAMBURG HEATING LLC Owner: MILLS, BRENT W & KIMBERLY A
PO BOX 829 12225 SW HOLLOW LN
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -5563 PHONE: 503 - 720 - 2051
FAX: 503 - 691 - 6855
FEES
Specifics: Description Date Amount
Air Conditioning 04 /11/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04 /11/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /11/2013 $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: :-I :\.IIII:: ( C „ n Permittee Signature: n
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. I'
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.
04/10/2013 13:07 5036916855 SHAMBURG HEATING LLC PAGE 02/02
Mechanical Permit ApplicapiEcEi ED Ete to / 5 �j PemtNo.: fi�( 5 -00 / IN i 13125 5W Yell Blvd, Tigard, OR 93 P R 1 0 z P Rev
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Phone: 503.7182439 Fax 503.598.1 D ate /B y: OdierPe'mit:
T ! L- A h. u Inspection Line: 503.639.4175 CITY ti TIGARD Date ReadyBy h°": El See Page 2 far
Internet: www.tigard OF NoticsedR letbo ; supplemental Ini rtnatien
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New construction 6 Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
nP performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value: S
P. - and 2- family dwelling ❑ Commercial/industrial 0 Accessory building For spedallnformstion use diecklist
❑ Muhl- funnily ❑ Master builder ❑ Other: Description Qty. I Ea. I Total
r , , , , eahng/c ln
' '' Air conditioning
g
Job site address: g 0b I Lei (requires site plan show placement) i 46.75 44 * /C
City /State/ZIP: 7 , Cl Ole- / 2i,3 Po Furnace 100,000 BTU (ducts/wets) 46.75 1
mace 100,000+ BTU (dus�•=nts) 54.91
Suite/bldgJapt. no.: Project name: 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, induct suspended, etc. 46,75
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
i Wata beater 23.32
`
Gas fireplace/insert 33.39
W Q _ ,, . � a al r t✓ F lue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
/liner /9ue/vent 23.32
Chimney
23.32
. .. Other•
Name: i e , di Environmental exhaust and ventilation:
Range hood/other kitchen
Address: ZZ5' _ ,.. l. / equipment 3339
City /State/ZIP: • 44 4 eve- 9 y ,3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( , 22-0• / J Fax: ( ) toilet compartments utility rooms) 23.32
∎ . Attic /crawlspace fans 2332
Other: 23.32
Fuel piping:
Contact name: 514.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State/Z1P: Wall/suspended/unit heater
Phone: ( ) Fax : - ( ) Water heater
Fireplace
E -mail: Range
, , , r,_ . "'s1 :.! , • ■ ,,, ,,,r Barbecue
Business name: l k E , 4/7 Clothes dryer (gas)
Other
Address: • or b ' � -9 ., ,
City /State /ZIP: _ / V '' / i'? S ubtotal ' •
'" s') " L� 2✓6- s�' w�, Fax: (5 ) 10 7 / Minimum i(25% r mit fe e) 9Di�
Phone: � .
r Pl an review (25°h of permit fee)
CCB lic.: 4 ? 1 .' f/ / State surcharge (12% of permit fee) / on
TOTAL PERMIT FEE /Os rF
Authorized Si This permit application expires if • permit is sot obtained within 130
/ days after it has been accepted as complete.
Print name: Date: 9' �i • Set met set by xti.COy Building industry Service Board
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12225 SW HOLLOW LN, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
04/24/2013 00:00
MEC2013-00197
PASS - No C of O
Violation Summary:
Inspector Contractor