Permit (27) CITY OF TIGARD MECHANICAL PERMIT
IN. .,. ..,kCOMMUNITY DEVELOPMENT tt16 4
Permit#: MEC2017-00255
i
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 11, T`- Date Issued: 04/12/2017
TIGARDParcel: 2S104BD02200
�' Jurisdiction: Tigard
Site address: 13640 SW FERN ST
Project: Nathman Subdivision: HANDY ACRES Lot: PT 28&
Project Description: NC,furnace,and water heater installation. Placement of NC unit must comply with manufacturer's installation
requirements.
Contractor: ADVANCED HEATING&AIR CONDITIONING INC Owner: NATHMAN, CHRISTINE P&
5825 SE FOSTER RD PARISI, BERARDINO
PORTLAND, OR 97206 13640 SW FERN ST
PORTLAND, OR 97223
PHONE: 503-774-0161 PHONE:
FAX: 503-774-4391
FEES
Specifics: Description Date Amount
Air Conditioning 04/12/2017 $46.75
Type of Use: SF Furnaces< 100K BTU 04/12/2017 $46.75
Class of Work: ALT Type of Const: Water Heater 04/12/2017 $23.32
Occupancy Grp: Fuel Piping 04/12/2017 $14.15
Stories: 12%State Surcharge-Mechanical 04/12/2017 $15.72
Fuel
Fuel Types:
Gas Pressure:
Total $146.69
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: .. -- (./".....y"... -"------- Permittee Signature: C% ��
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.
CITY OF TIGARD MECHANICAL PERMIT
t 11.. . COMMUNITY DEVELOPMENT
Permit#: MEC2017-00255
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2017
TE 'A ' Parcel: 2S104BD02200
Jurisdiction: Tigard
Site address: 13640 SW FERN ST
Project: Nathman Subdivision: HANDY ACRES Lot: PT 28&
Project Description: Replace 200 amp service and(1)branch circuit.
Contractor: ADVANCED HEATING&AIR CONDITIONING INC Owner: NATHMAN, CHRISTINE P&
5825 SE FOSTER RD PARISI, BERARDINO
PORTLAND, OR 97206 13640 SW FERN ST
PORTLAND, OR 97223
PHONE: 503-774-0161 PHONE:
FAX: 503-774-4391
FEES
Specifics: Description Date Amount
Air Conditioning 04/12/2017 $46.75
Type of Use: SF Furnaces< 100K BTU 04/12/2017 $46.75
Class of Work: ALT Type of Const: Water Heater 04/12/2017 $23.32
Occupancy Grp: Fuel Piping 04/12/2017 $14.15
Stories: 12%State Surcharge-Mechanical 04/12/2017 $15.72
Fuel
Fuel Types:
Gas Pressure:
Total $146.69
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: , Permittee Signature: f
t.f,. ' _moi
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard `� Received
�"� y � Permit No.: G,
" 13125 SW Hall Blvd..Tigard,OR 97223 ���yyy � Date/B �1�� it /, 'f 7- /
II Phone: 503.718.2439 Fax: 503.598.I ®� � ® Plan Review
Date/By:
TIGARD Inspection Line: 503.639.4175 ��� � �� Date Ready/By: El See Page 2 for
Internet: www.tigard-or.gov ��%6 Notified/Method: Supplemental Information
TYPE OF WORK�� esCOMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees*are based on the value of the work
CINew construction Addition/alteraSRc t performed. Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
[rI-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist.
❑ Multi-family ❑ Master builder ❑Other: Description Qty. Ea. Total
JOI3 SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning ( \-1.k„';15.
°c
Job site address: t1.514041.0 Ste) j �.�!���) Furnace 100,000 BTU(ducts/vents) ( 46.75 Lfc.x TIS
Tt e aux), �rZ.. g1t3
City/State/ZIP: Furnace 100,000+BTU(ducts/vents) 54.91
-�j
Heat pump 61.06
Suite/bldg./apt.no.: Project name: citA ��.,IetN) Duct work 23.32
Cross street/directions to job site: Hydronic hot water 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 heater % 23.32 'Z..-F�Z
DESCRIPTION OF WORK Gas fireplace/insert 33.39
11 Flue vent for water heater or gas
.,S`rN�,���{� //��.r�t�� =.r fireplace 23.32
Log lighter(gas) 23.32
• Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
0 PROPERTY OWNER 1:1TENANT •
Other: 23.32
Environmental exhaust and ventilation:
Name: Cel!r,i; ,
> - ja`L,�,I,�ty Range hood/other kitchen
i` equipment 33.39
Address:
Clothes dryer exhaust 33.39
City/State/ZIP: Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT "CONTACT PERSON Other: 23.32
Business name: Se Fuel piping:
S14.15 for first four;S4.03 for each additional
Contact name:
'Ce4ST�tti.- Furnace,etc. i \'4 i5
Address: ` ,....4 Gas heat pump
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( . - Fax: :( -- Fireplace
I Range
Email:i4i S (E,God C'� . v��s�+ i . Barbecue
-
CONTRACTOR
' �"V� Clothes dryer(gas)
�` Other.
Business name: vv MECHANICAL PERMIT FEES*
Address: szzs SG �S1e[� Subtotal , t(?�.�
City/State/ZIP: �aJr� kip/IVO fa P •/d • (CO Minimum permit fee($90.00)
`� � '�+ Plan review(25%of permit fee)
Phone:(u _'� ...Otb i Fax:��' t —1/4-'1/43eN 1 State surcharge(12%of permit fee) ( S.1 t,
CCB lie.: O%..1� TOTAL PERMIT FEE ,ii-+G.(c
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature: r * Fee methodology set by Tri-County Building Industry Service Board
Print name: Z1'�'t A,.: .. 'Y) Date:
I:ABuildingAPei nits\MEC_PermitApp_040113.doe 440-46171(11/02/COM/WEB)