Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Permit e: MEC2013 00354
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2013
Parcel: 2S102DB06900
Jurisdiction: Tigard
Site address: 9169 SW HILL ST
Project: Nelson Subdivision: CHELSEA HILL NO.2 Lot: 46
Project Description: Installation of A/C. Placement of NC or heat pump units must comply with the manufacturer's clearance
requirements.
Contractor: OREGON HEATING & AIR CONDITIONING Owner: NELSON, DOUGLAS S /JEANNE M
19300 SW 118TH AVE 9169 SW HILL ST
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 691 -9699 PHONE: 503 - 639 -9368
FAX: 503 - 691 -8556
FEES
Specifics: Description Date Amount
Air Conditioning 06/27/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/27/2013 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 06/27/2013 $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: / / Permittee Signature: ie/tJ / 7 � /-L , / �' X 1--7 C /
� Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. V
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.
06/26/2013 11 :52 503- 691 -8556 OREGON HEATING PAGE 01/03
RECEIV Mechanical Permit Application Application • Mechanical Holi of 1.. !up: I;sr•. ONl.V
City of Tigard Received JUN 2 6 201 pateB to 0. 7 /3 - PernmitIW ;?4/-412
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
l h
Phone: 503318.2439 Fax 503.598,1960 c Other Permit
T 1 GA i D Inspection Line: 503.639.4175 CITY OF TIGAR:: U RI See Page 2 for
Internet: www.tigard•nr.gov BUILDING DI VISIi11ao5ed/Method: SupetqJ Info don
TYPE OF WORK. COMMERCIAL. FEE' SCUD
CITEDU� – USE CHECKLIST,,
Mechanical permit fees* arc based on the value of the work
0 New eoasduction EfAddlta0tl /9ltetat]OD/feplaCelll11e11t
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit:
G P CONSR Value: $
45.8 'IAL` 1; Q1lI$11»rrr'/�`v BETS "'
$'l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special Information use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. 1 Ea. 1 Total
JOB 'OY 1 OR1 �A'T)7 '.` ' f,0`C�i" 4 1° d11� " / 'l 1H(eatin2/coolin :: _ '
, ?" '' dra.,`' ° ' ..,
y ' Air condi j 46.75 L /C.- 7-C site address: l6 I S IJ:`r It Furnace 100,000 BTU (ducts/vents) 46.75
City / State/ZIP: /"0 r 4cy� ciR 722 7 Fmnace 100,000+ BTU (dueta/vcmts) 54.91
T heat pump 61.06
Suite/bldg./apt. no.: Project name: iv n Duct work 23,32
Cross street/directions to job site: Hydronic hot water system 23.32
—"' Residential boiler (radiator or - -
hydronic) 2332
iJnit hcatert (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
Other fuel appliances:
Tax map /parcel no_: _ Water heater 23.32
DESCRIPTION OF WORK Gas fireplaca'insert 33.39
s��! [ Flue vent for water heater or gas
•--L. �s #a 1/ ' t )- - nkoopi r fireplace 23.32
Loglighter (gas) 23 32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/ttue/vent 23.32
Other: 23.32
ROPER'rY', 014eNET2 1 ❑i Environmental exhaust and ventilation:
Name: D ais / l �1�o Range hood/other kitchen
equipment 33.39
Address: q j el 5.,w- Hill Sr Clothes dryer exhaust 33.39
City / State/ZIP: ,_ / ray Single•duct exhaust (bathrooms,
��') �Q "mss `• •> x toilet compartments, utility rooms) 23 32
Phone: ( 3') 0,7q _ q,768. Fax: ( ) Attic/crawlspace fans 23.32
APPLIc,�NT, . , E1 CQN I<ACt, P,tSON _ Other: I 23.32
Business Hattie: Fuel piping:
� '' H ,< $1415 for first four; $4.03 for each additional
Contact name: c r y . rq It-, Furnace etc.
Address: Gas heat pump
I fl O s i; !,r Ave heater
City/State/ZIP: n o2 1 7o? Water healer
Phone; (5 ) G , 9!- 76 99 } I F ( ) Fireplace
E-mail: Range
Barbecue
- C 9 �;', , - Clothes dryer (gas)
Business name: 401,..)r, . � //e Other
NITCRANICAL• PnivaT F EES"
Address: /930 s/,, /184. � l,e Subtotal E /I5
City/State/ZIP: 7, 0/2 q 1 o Minimum permit fee ($90.00) 9o. •'
ri Plan review (25% of permit fee)
Phone: (S3) 6g4i• ?CV?' Fax: ( ) State surcharge (12% of permit fee)
CCB lie : / 72 2 6 TOTAL PERMIT FEE j pp_, :a
This permit applicatia;pir if a rmit is ined within
days after on it e has bean accept as not comple
Authorized signature: , . , • Fee medtodo set by Tri C oan Buildmg Industry Service Board 180
1'7tint namc: a � G7.4 / /. >age�. boy
Date: �f2ry�iv[� _—.