Permit CITY OF TIGARD MECHANICAL PERMIT
III COMMUNITY DEVELOPMENT Permit#: MEC2013-00476
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2013
Parcel: 2S 110AD01700
Jurisdiction: Tigard
Site address: 14620 SW 106TH AVE
Project: Caicedo Subdivision: LANG HILL Lot: 14
Project Description: Replace A/C and duct work. Placement of A/C or heat pump units must comply with the manufacturer's clearance
requirements.
Contractor: NW SUNDANCE SERVICES INC Owner: CAICEDO, CARLA SUE
10117 SE SUNNYSIDE RD STE F1201 14620 SW 106TH AVE
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503-750-7442 PHONE:
FAX: 503-655-3347
FEES
Specifics: Description Date Amount
Mechanical Permit-RES 08/19/2013 $90.00
Type of Use: SF 12%State Surcharge-Mechanical 08/19/2013 $10.80
Class of Work: OTR Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,CfrffiVe7e}I...e.______ Permittee Signature: e,v 47--,0,6 L./£ '9--7O„/
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
00/14/2013 10:07 5036553347 NWSUN PAGE 01/02
Mechanical Permit Applicati asii II FOR OI II( E i Sl O\I,1'
__ ' City of Tigard • 1 •, Received Penn"N
+ 13)25'SW Mali olvd.,Tigard,OR 97223 Date/By. �'/9 /3 — M�l'�0/3�0�/7l0
liii
2 Phone: 503.7182439 Fax: 503.598.1960 AUG 14 2013t�Ryew OtherPettnit:
-T1;C-:1-R'Ti' In$ptCtiOn Line; 503.634.4175 Date Repdy/$Y ES See Page 2 for
- . Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method; Suvplemental Information
BUILDING DIVISION
TYPE OF WORK . COMMERCL4d. FEE* SCHEDULE —.USE CH£CICUSr
. Mechanical permit fees*are based on the value of the work •
❑New construction IN Addition/alteration/replacement perforated indicate the value(rounded to the nearest dollar)of all
❑Demolition • ❑Other: mechanical materials,equipment,labor,overhead,and profit
Value:$
CA 1l78GORX OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
514-and 2-family dwelling 0 Commercial/industrial ❑Accessory building For special information use checklist.
0 Multi-family ❑Master builder D Other: Description ,,: Qty. Ea. 1 Total
• JOB SITE INFORMATION AND, LOCATION ' Ueet;np/cooIin
Air conditionitl_ 1 46.75
job site address: /IA Zo 51,1 10 tsrt+ AZ Furnace 100,000 BTU(daetllvenn) 46.73
City'/State/ZIP: rp0� gZZLy Ftr epac 100;000+BTU_(ducts'vents) 54.91 _
Suite/bldg./apt.no.: 7 Project name: pump 23.32
Duct work 23.32
Cross st'.etldirectinns to job site: i{ydronic hot water system 23.32 _
Residential bolter(radiator or -
hydronic) 23.32
Unit heaters(fuel-type,not electric),
in-wail,induct,suspended.etc. 46.75
' Flue/vent for any of above 23.32 ,
Other:Subdivision: Lot no.: _- _ 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater _ _ 2332
DESCRIPTION OF wolt4� Gas fireplecerinsert 33.39
Flue vent for water heater or gas
"RePLA-ce drr 00oo - A-14 — L try ref- 4 4-A d p....7-4/o aft_ fireplace 23.32
Log lighter(gas) 23.32
.../17.1L• ' Wood/pellet stove 33,39
Wood fireplace/insert 2332
- Chirnney/linerfftudvcnt 23.32
Other: 23.32
�'. KP120PEItTX OWNER 0.TENANT Environmental exhaust and ventilation:
Name; L.Or 5t� ' 'fC>c DO Range hood/other latches '
equipment 33.39
Address: /4/(4 r
Sri �D�s7'I/ A� _ Clothes dryer exhaust 33.39
Single-duct (bathroom s,City/State/zp: a p, •4Np q1,7.5-/ tolet co mpartments,utility rooms) 23.32
Phone;( ) Fax:( ) Attic/crawlspace fans 23.32
. [1 APPLICANT 0 CONTACT'PERSON Other: 23.32
Fuel piping:
Business name: '536(.1.*-- ` e { �
�.{ !x $td,rC far that four;$4,03 for each additional
Contact name: . Furnace,etc.
Address: ,Gas heat pun p
wallisuspended/uoit heater_
City/State/ZIP: Water heater
Phone:( ) Fax::( ) Fireplace ,
E-mail;
Barbecue
CONTRACTOR Clothes dryer(gas)
•Business name: . I SU,dx 4 s Other:
_
meCRANiCA 4PERMIT FEES"
Address" I NJ x� Sii&iysioe o t " ( l
Subtotal
City/State/ZIP: Minimum permit fee($90•00) — 4,0•
Plan review(259,i,of permit fee) pljk
hone:( 3 ) g g , $.g M.._.._._ - Fax:(503)_6 es--33�'7 State surchar c i2%of permit fee)
CCI3 lie.: /' 3/q ' TOTAL PERMIT FEE /4'•fD ✓
This permit application expires if a permit is not obtained within 280
dart after it has been accepted as complete
Authorized signature: ! AlF • tee metbodotogy set by rri-County mending industry Service Board
NIF
Print name: .Cr , i
. . .`:` Date: $ /3
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