Permit CITY TIGARD MECHANICAL PERMIT
i DEVELOPMENT SERVICES PERMIT #: MEC2005 -00118
' 114-11#7.:-°-1: " I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/18/2005
PARCEL: 1S136AD-00400
SITE ADDRESS: 10460 SW 66TH AVE ZONING: R -4.5
SUBDIVISION: VILLA RIDGE NO. 2 LOT: 002 JURISDICTION: TIG
Project Description: Installation of gas furnace and gas piping.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
LPG 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS: 1
Owner: FEES
MAXINE STRINGER Description Date Amount
10460 SW 66TH AVE [MECH] Permit Fee 3/18/200f. $72.50
PORTLAND, OR 97223 [TAX] 8% State Surchaq 3/18/200f. $5.80
Phone: 503 244 - 5245 Total $78.30
Contractor: -
THERMAL FLO
14865 SW 74TH AVE. #190 REQUIRED ITEMS AND REPORTS
TIGARD, OR 97224
Phone: 503 670 - 8383
Reg #: LIC 151847
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 -001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1 -800 -3 -23 -
Issued ( 32--
_ F_ � _ t 4 yA . 4 f! __ . Permittee Signature _ � y /f�irt� ,
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
This permit can 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 App lirilbb, t 1 V A.. U FOR 0! USE ONI,l'
City-gif Tigard imiiii.
' "" Pennit No " •
Date/By: ...- linfjp, / _ e. , 0, _ •-• liti :
11 5 SW Hallt!,.,igard, OR 97223
Phone: 50r63911 Date/By: 71 Fax: 503.598.1960 MAR 17 /AAA, Plan Review t"Til
i Other Permit.
, }1i
Inspection Line: 503.639.4175 a ,, Date Ready/By: Ell See Page 2 for
Internet: www.ci.tigard.or.us CITY OF • "IF Notified/Method: MC, Supplemental Information
P 1 e , .
*TYPE 1 - "AP -, ' - , ,,, ' - , , - '. -, COMMERCIAL FEE* SCHEDULE -=, USE CHECKLIST
New construction gAddition/alteration/replacement Mechanical pennit fees* are based on the value of the work
D
performed. Indicate the value (rounded to the nearest dollar) of all
Ej Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
CATEdORY , OF CONSTRUCTION:; : , :' , , Value: $ .
a&tiis
ntai„EQuNT/ itgtEms FEES,
IFj 1 - and 2 dwelling 0 Commercial/industrial 0 Accessory building ..,--. - ,. "
For special information use checklist.
0 Multi-family 0 Master builder 0 Other:
Description Qty. Ea. Total
JOB :st4.INF(141141161■1: AND LOCATION : : 1 - - : Heating/cooling
Job site address: 1e) Li (... 0 so / -Li LA. 1/ Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: 'Pc.)R.12o4-41 t) CIR 9 -2 Fumace 100,000 BTU (ducts/vents) . 1 14.00 A/
Fumace 100,000+ BTU (ducts/vents) _ 17.90
Suite/bldg./apt. no.: Project name: 5 .2-3 g....,5-
Gas heat pump 14.00
Cross street/directions to job site: . 5 u) p 4. ..5 Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
- - hydronic) - 14:00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION oi , '',,- 2, -ri, =,.,- Water heater 10.00
Gas fireplace 10.00
tYldfrka Q Ito FiCrOa / I2 6 Z. tiite, Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
' E
. , Chimney/liner/flue/vent 10.00
:i ':: ' ± - ''., ':: ':!'f '.0 ' - Other: 10.00
Name: Ad* x 1 p c s_ r _ R 1 pici c e ..... Environmental exhaust and ventilation
Range hood/other kitchen
Address: t Ir L . , ifr
6 F 0 69 IP _4- V equipment 10.00
City/State/ZIP: 0-1,,b(4.41 (/ ,,,, q7 0._ ..2..... sz Clothes dryer exhaust 10.00
/ .°. Single-duct exhaust (bathrooms,
Phone:4563, ,..4- _7, V,5 Fax: ( ) toilet compartments, utility rooms) 6.80
D401:10yoil, ',,-,, :;., 7 ,1 , ! ,:; -i,, taON :,,,(:.,:' r Attic/crawlspace fans 10.00
Other 10.00
Business name: r ii/e4444., Flo I Pi C , Fuel piping
Contact name: 4,ake e41-itlit/
„-. $5.40 for first four; $1.00 for each additional
- -
Address: / ---i
tr - - iv -- (t a " .,-.. v - a - -- - Furnace, etc. - -/ -
Gas heat pump
City/State/ZIP: 77 al c( o 1 c / 7 1- .2. 4 / Wall/suspended/unit heater
Phone: (403) 4: 140 - K3 (13 Fax: : .(5 3) 1 ce - yzk 4 Water heater
Fireplace
E-mail:
• Range
; ;:, ' 1 • ' c ':, : ,: '-': ,, ', .-.„
CONTRACTOR -,':; , .,:,,:iY ', .,:-,:: , rL7' Barbecue
Business name:
Clothes dryer (gas)
--- / - 41 . 2,4 1 „E i h c •
Other:
_ i _ a _.
Address: i LI s<( s t4/ pi kV •91 qo 1/ECHANICALPERMETFEESt: ,',;,.
City/State/ZIP: t t ci 4.1 4 .ot‘ q1 .2-.2-i-t Subtotal
Minimum permit fee ($72.50) zg
Phone: (50 3) 6) 70 - 3 f 3 Fax: (6 12' 03) 10 - qoQg
Plan review (25% of permit fee) ,50
CCB lic.: 1 5 1 b-L1 7 State surcharge (8% of permit fee) 5
., -
TOTAL PERMIT FEE 7 re, ,..3 0
Authorized signature: .--' ,/2 . ,14Z,(1,3/1 Ae1.01/4/1.1.4.," This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 7 ---t f- C / <e&/5Ce I/We ifiZ Date: 3 n 0 0 * Fee methodology set by Td-County Building Industry Service Board
i: \ BuildingTermits \MEC-PermitApp.doc 12/03 440.4617T (11/02/COM/WEB)