Permit q CITY OF TIGARD MECHANICAL PERMIT
III t: COMMUNITY DEVELOPMENT Permit #: MEC2013 -00439
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/01/2013
Parcel: 25111 DA11200
Jurisdiction: Tigard
Site address: 15365 SW REGENT TER
Project: Draper Subdivision: APPLEWOOD PARK NO.3 Lot: 105
Project Description: Installation of A/C. Placement of A/C or heat pump units must comply with the manufacturer's clearance
requirements.
Contractor: SKY HEATING & AIR CONDITIONING, INC Owner: DRAPER, MICHAEL
1637 SE NEHALEM ST 15365 SW REGENT TER
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 - 235 -9083 PHONE: 503 - 853 -6717
FAX: 503 - 235 -0454
FEES
Specifics: Description Date Amount
Air Conditioning 08/01/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 08/01/2013 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 08/01/2013 $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: r dfi i ?/ ( ..77(2--jc_ . Permittee Signature: QN / 97 0 / 0 /..../ e ef-77vA./
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.
From:5032350454 07/31/2013 14:14 #697 P.002/003
Mechanical Permit A lica EIVED FOR OFFICE USE ONLY
City of Tigard 1 V Recei I u AsN
° 13125 SW Hall Blvd., Tigard, OR 97223 DatrJBy. s7 �rl PelmitN �C ��,3�oO 3
Plan
' . Phone: 503.7182439 Fax: 503.598.196 Date/By:
• Inspection Line: 503,639.4175 l_ 3 1 2013 ��Y t>therP" ,. TicA :l) Date R B
Internet: www.tigard or CITY OFTIGARD Notified/Method: �� S pplemental Information
., TYPE, , . _ tottc. I F>� c.gotiLIe:- .,USE -e C
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
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, aid profit.
.
CATEGORY OF''CONSTRUCTION ' E Value:
N„ 1? !\1%EQUIPM6NT. /S]B1'EMSFEES' i-
Z 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For apeciol information use checklist.
❑ Muhi- family 0 Master builder ❑ Other: Description I Qty. ] Ea 1 Total
. ;OW SITE INF?
=ORMATION AND ' LOCATION_ .. Ail:ler 611iti
81ml !fig:
1 ` 3( / ,5 �(� / F { Y ra. ..C.Q condoning r 46.75 (A .75
lob site address: J w?,,p Furnace 100,000 BTU (ducts/vents) 46.75
�j
City/State/ZIP: , Q a ✓� (7 � (1 � sa3 . ( Furnace 100,000+ BTU (ductshxnts) 54.91
Suite/bldg. /apt. no.: V l Project name: '.A P& / uc
Dt t work work 61.06
/ Duc
23.32
Cross street/directions to job site: Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (feet -type, not electric), '
in-wall, in-duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: L no,: Other 23.32
Other fuel appliances:
Tax map /parcel no.: Water beater
23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
ail-- vent for water heater or gas
l rz s' / c e S /3K a.i Y rondth,�
ali ', fireplace 2332
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney/liner/flue/vent 23.32
*PROPERTY ;OWNER • ❑ TENANT Other: 23.32
M n / Environmental exhaust and ventilation:
t Name: 1 l_Jl to r Range hood /other kitchen
/ / �f equipment 33.39
Address: /536S 2(A I a.te
Clothes dryer exhaust 33.39
City /State/ZTP: Q � r
Singlo-duct exhaust (bathrooms,
(93) d' 1' / Fax: ( ) A e fans utility rooms) 23.32
Phone: ttidcrawis rawlspa ce fens 23.32
-APPLICANT ` CONTACT, PERSON , Other. 23.32
Business name:
� y� . 4- l 1 c Ire , Fuel piping:
l/
` ! / $14.15 for first four, $4.03 for each additional
� Contact name: / a � � ; Furnace, etc.
Address: /6 3 S r /) Y1 Gas heat pump
Wall/suspended/unit heater
T or City/State/ZIP: go I Og. q?'� a , Water heater Phone: (SD3) a — a 2 f I Fax:: (Jt/3) d3S" V Y' Fireplace
• Range
E -mail: Glnt2` f( Barbecue
TRACU)B ' . ; , VU j Clothes dryer (gas)
/1 A r Othe
Business name: .. w ! ./ r a :... ....... .... .._,.....
MECHANICAL 1PERMIT;FEES�Y .
Address: , `1rinffi • Subtotal
■
7O �S—
City /State/ZIP: / f (LA G 0 A , �� Minimum permit fee ($90.00) C 0 .
Phone: ( ) ) ?S .-'' a F3 i I Fax: ( ) X35 v / Plan review ( of permit fee)
^ State surcharge (12% of permit fee) /O , g0
CCB lie.: 5 d /
This permit e TOTAL PERMIT FEE 9
application /CIO, 6
pp expires if permit is not obtained within 180
Authorized signature: M 1Cfs/kitl (j ,4� • days after it has been accepted as complete.
Fee methodology set by Tri- County Building Industry Service Board
Print name: Tao A A ( 4 Date: ']- 3
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