Permit CITY OF TIGARD MECHANICAL PERMIT
31 11 COMMUNITY DEVELOPMENT Permit #: MEC2013 -00400
Date Issued: 07/17/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S133DD04600
Jurisdiction: Tigard
Site address: 11555 SW SHOREVIEW PL
Project: Provancher Subdivlsion:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 85
Project Description: Install fumace.
Contractor: OREGON HEATING & AIR CONDITIONING Owner: PROVANCHER, RICHARD
19300 SW 118TH AVE 11555 SW SHOREVIEW PL
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 691 -9699
PHONE: 503 - 863 -0741
FAX: 503 - 691 -8556
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 07/17/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/17/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/17/2013 $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: 4
Permittee Signature: AV
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.
Jul. 15. 2013 12:59PM No. 0162 P. 1
Mechanical Permit App Y' 'eEIVED FOR OFFICE list: ONLY
C Received
4 13125
Dale/By: 7 S /-3 I . Permit DIo.: / AO /0 L 0
1 25 of Tigard
. SW Hall Blvd., Tigard, OR 97p 5 2013 Plan Review
Phone: 503.718.2439 Fax: 503.59t1960 p ele/BY: Other Permit:
TI e A I. D Inspection Line: 503.639 Dale Ready/By: lin >a See Page b for
Internet: www.tigard- or.gov CITYOFTI Noiieed/Method: Supplemental Information
BUILDING DIVISION
C .
Ti(P OF,.*ORRC : ~, • ,. . b RCIAL I zt>EA SC IEDTJ{E,._ ti ErtIagcial6 •
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
Value: $ •
CAT :OF ' 11,UCTIOPI:, ( , y : !• . .. . •;Ii;ES1AniAXIEQUIpMFIVT%S'YST MSFAS'; ,; • • 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special Information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty- I Ea. I Total
.IOlf Sf 'E %1'NFOROXTI0Is1.,A�NWLOCAlIt }t, Heating/cooling: _
r. Air conditioning 46.75
Job site address: 'Ss-s- ,s . (' ' >� • e._ ♦ . Furnace 100,000 BTU (ducts/vents) ) 46.75 CJJ 7.
I City/State/ZIP: I �� • Furnace 100,000+ BTU (ducts /vents) — 54
o Heat pump 61.06
Suite/bldg. /apt. no.: Project name: ,D a , c., Duct work 23.32
Cross strect/direetions to job site: Hydronic hotwater 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
Other fuel appliances:
Tax map/parcel no.: Water healer 23.32
• DESCRIPTION; OF woiu° Gas fireplace /insert 3339
• Flue vent for water healer or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33 -39
Wood fireplace/insert 23.32
Chimney/liner /flue /vent 23.32
• Other: 23.32
el • ROPERTf GONER: 0;.T 4 OT':: Environmental exhaust and ventilation:
Range hood /other kitchen
1 equipment 33.39
/s
Address: y <l-r -_ . r Clothes Myer exhaust 33.39
City/State/ZIP: /or / 4 p" r .2_ Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) . 23.32
Phone: b ) 8.. - ... 0 Fax: ( ) Attie/crawlspaco fans l 23.32
®- APPR,ICAN`P,„ CI CONTC' A .T. • Other 2332
Fuel piping: —
Business name: p ,
$14.15 for first four; $4.03 for each addiltonnl
Contact name: , c
---, I r. , Furnace, etc. -
Gas heat pump
Address: //700 St i, ` . Wall/suspended/unit heater
City /State /ZIP: T a , , l7 CC, Water heater
Fax: Fireplace
Phone: (cog ) _ ( ) Range
E -mail: Barbecue
0.41,4•14,001 i Clothes dryer as) • •Other;
Business name: Or „ .
r , . " �` Ivi) t IIANICAI)G11lIT k T>S'
Address: 11:100 S`W ., , r 4 ve Subtotal y 6 _ Is.
1 City/State/ZIP: cog 9 Minimum permit fee ($90.00) 4 D.-
4 a ° f Plan review (25% of permit fee) ,..--
Phone: (o3) M • '6 Fax: ( ) State surcharge (12% of pennit fcc) , /0. cep
• TOTAL PERMIT FEE /00 . V
This permit application expires if a permit is eel obtained wIthln 180
days after it hoe been A ccepted au complete.
Authorized signature: . - • Fee melluodology set by Th-County Building Industry Service Board
•
Date: ,r ZS' ao