Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2019-00672
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/19/2019
T f[;.E I f� 9 Parcel: 2S112BD12600
Jurisdiction: Tigard
Site address: 14833 SW 76TH AVE
Project: Elderberry Ridge,Lot 22 Subdivision: ELDERBERRY RIDGE Lot: 22
Project Description: Installing A/C unit. Placement of NC unit must comply with manufacturers requirements.
Contractor: PRO HEATING AND COOLING INC. Owner: RIVERSIDE HOMES LLC
2095 NW ALOCLEK DR, SUITE 1103 17933 NW EVERGREEN PL STE 370
HILLSBORO, OR 97124 BEAVERTON, OR 97006
PHONE: 503-443-5692 PHONE: 503-645-0986
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 09/19/2019 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 09/19/2019 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/19/2019 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State ,f 0'. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire " wor is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you t. folio the rules adopted by the Oregon
Utility Notification Center. Those rules ar set forth in OAR 952-001-0010 through OAR 952-001-00'0. ou may obt• n a copy of the rules
or direct questions to 0 by calling 503.2 .1987 or 1 0.332.2344.
Issued By: % %I� Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application , i•OR ()Ill( I I 'L O y i 1
City of Tigard Receivedty ��� ri
.111114 r 13125 SW Hall Blvd.,Tigard,OR 97223 c r-r, Plan Review r
Phone: 503.718.2439 Fax: 503.598.1960 ' i , ,` 9 Date/By: Other Permit:
I I\ `p i, Inspection Line: 503.639.4175 Date Ready/By: Juris: rd See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
x .dy s^ r .-" a°4,x)6 - r '� � M �Y.. d F ,.. � ',ti. : - ..,6m,., a P.QA'.''° :4‘,..
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"..1 ' { t ,'m'`''S' '-',+ n . A. , Mechanicalmit fees*are based on the value
of the work
New construction ❑Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
x s * , I �z ;. ,a, Value:$
lat
a� � ����x � �.., >x, '� ; �tltb ;� Vis `1.,'`,. A•,�. 'f ....p ...,°.p ..„.f,
WI I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
r,, f ,. tf, ' t
, 3 pe Heatingeoolng:s� RF7F,,, is iy a s t 24 1 t,€a .a. < r
Air conditioning I 46.75 (i
Job site address: /C tic 33 Furnace 100,000 BTU(ducts/vents) 46.75
City/State/ZIP: �� CCu, j c.)-9,.... Furnace 100,000+BTU(ducts/vents) 54.91
1Heat pump 61.06
Suite/bldg./apt.no.: Project name: 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
/ . 2_1_,_ Other: 23.32
Subdivision: (C( � r 1 1� a Z Lot no: Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
`" Gas fireplace/insert 33.39
`' Flue vent for water heater or gas
1— t 41 C_ fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
,t29,,,,,:,^01°,5?-7;; ,,I.,- `&a -* ;. -x> F1 ;` r c5'!:f;°;'104,,, s °' { i� Other 23.32
Environmental exhaust and ventilation:
Name: \.¢-j J' \�0‘oi-< L LC Range hood/other kitchen
equipment 33.39
Address: )7733 )0 �'o,,�r�, y k �)\ ,) Clothes dryer exhaust 33.39
' i (� "" P� Single-duct exhaust(bathrooms,
�)
City/State/ZIP: 'b i . C)S f `-Cy toilet compartments,utility rooms) 23.32
Phone:(50 ) ('pe `
Fax ( )'r 0 21 y`e Z Attic/crawlspace fans 23.32
rF ` lt '"�� ` F ; f %, , M Other: 23.32
Fuel piping:
Business name:
��'4-5,. t fir-`t r",-�+--5 L L C. $14.15 for first four;$4.03 for each additional
Contact name: A,r,, Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
Phone:(97) ) 2o,Z 3'2.5? I Fax::( ) FireplaceRange
E-mail: Barbecue
+,4 e 2 5r„n a� %,..:,,,,1„,,,,- -tom' %a '" CIOtt1es dryer(gas)
Business name: Pro ax..-k-,,,3 Other 1 7 * t
Address: WIC ,3L/ Pi l- I b G )e K. I 1)0 Y Subtotal
City/State/ZIP: (--Vv. t,�- c '7 7)a t/ Minimum permit fee($90.00)
++ Plan review(25%of permit fee)
Phone:(503) 2,706 Fax:( ) State surcharge(12%of permit fee)
CCB lic.: ZL)9Cb\. //zc .p(sc;1-440,-1-Q n,,.,.-7_Ccs TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
Authorized sign titre: 2 *° Fee methodology set by Tri-County Building industry Service Board
Print name: rvbDate:zz„ ,
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