Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00488
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/06/2010
Parcel: 2S110AD08600
Jurisdiction: Tigard
Site address: 10505 SW CANTERBURY LN
Subdivision: Lot: 0
Project: Stapleton
Project Description: Furnace installation.
Owner: FEES
STAPLETON, ELEANOR A TRUST Description Date Amount
10505 SW CANTERBURY LN
TIGARD, OR 97224 Furnaces < 100K BTU 10/06/2010 $46.75
12% State Surcharge - Mechanical 10/06/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/06/2010 $43.25
Contractor:
SPECIALTY HEATING & COOLING INC
7500 SW TECH CENTER DR #130
TIGARD, OR 97223
PHONE: 503 - 620 -5643
FAX: 503 -681 -0793
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or : % c
Issued By: Permittee Signature:
CaII 50 . • •.4175 by 7:00 a.m. for an inspection that business day.
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.
OCT/04/2010/MON 09:23 AM RECEIVED FAX No. P.002
Mechanical Permit Application FOR OFFICE LISE ONLY
City of Tigard 0 C T ; . , ma � � 6 1=E- - --. t ' r g
Permit No
n 13125 SW Nall Blvd., Tigard, OR 97223 Plan Review �" • l0^ 1,
Phone: 503.639.4171 Fax: 503.598.196 OF TIGARD Date/By: Omer Permit;
1iGARp In terne t : ww w . . 503.639.4175 BUILDING DIVISIO Notified/Method; runs: El S jemcntal to
In rrrmatson
Internet; www.tigard- or.gov pp
........•.— ,..... iIYPE 'Okr. IVORICU CI'A); 0 QFCi:LST
❑ New construction Addition/alteration/replaeement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, lam overhead, and profit.
..tip: a :.,, __ � ri
.ray Value .,�._: •.,: � � ...: •. j .r'...���.,u ..•i'�f*•1��1v.Te: c:.• ='.,, ,:..::': - ' ,p�:: " ...<.. •• .... ,. Y. ... -. .. � ..�.. , r - yt:' It. ;
;. ID 0' 1►1 NT= /S FEES+•:..'..:
1 i 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building "
For speclal information use checklist.
❑ Multi - family Q Master builder ❑ Other: -.
Description 1 Qty, 1 Ea Total
,.,J._.. ...... .._ .(� sXx` Q�!l'� ��1`YQ1�� ......- ,. � .R/cooilnk
-
_ •. .. • -- - `.! „• 7.L Ilea
tin
Job site address ,, ' t :�
, Air conditioning
( (� A . - 0 1 - Ji) C crt r-e c t b k .t�- ( / Ii” -'C..
(requires site plan showing piacement) 46.75
City /State/ZIP: Furnace 100.000 BTU (ducts/vents) 1 46.75 t1t., , '7S
Furnace 100.000+ BTU (duct9/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump _
Cross street/directions to job site: Duct work : 23.32
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
Subdivision: Lot no.: Flue/vent for any of above 23.32 _
Other: 23.32 _
Tax map/parcel no.: • Other fuel appliances
5- :�i4'•• r > ; -_.. 1: ;.. :! .: _ ,.iK �_ r i Water hearer 23.32
.:'.1..:1�.tr': '� . .. . - ' i.:. � " .J:�'. i i��Al•,. : - r:..•- .. :SK1 %'� � ..�:..•�..• i.ILi: ... -- .. _._•._.Y ... .,:.1'.':ii. .u'.:V:...i..
..r'...,�. . �.._ : : .... .... .: .:'i : : .... -'.
Gas fireplace 33.39
Flue vent for water heater or gas i
fireplace 23.32
Log li> titer (Ras) 23.32 1
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
•y � n - ... , a,, I . _, .r Chimney/liner /flue /vent 23.32
...•, _. t: +, T . a 0[her: 1 23.32
Name: l.` 1JL-e '`-01/-
..0 t/ -' '..e - 1-1 --% Environmental exhaust and ventilation _
Address: v `� Range hood/other kitchen
equipment , 33.39
City /State/ZIP: Clothes dryer exhaust - 33.39
3 Single -duct exhaust (bathrooms.
Phone: ( ) 4 S 7 � ..- SS'k .- Fax: ( ) toilet compartments. utility rooms) 23.32
:31-:'g..:.::::•. i : v .::.: - - _ raw cc fans
, �. ' i " _ ` l�' 0 u < i Atticic lspa 23.32
Other: 23.32
Business name: Fuel hill:
4
Contact name: 1 S14.15 for first four 54.03 for each additional
Furnace. ctc.
Address: Gas heat pump
City/State/ZIP: Wall /suspended/unit heater ,
Fax: : Phone: ( ) ( ) Water heater Fireplace ,
E -mail; Range ,
Barbecue
Business name: specialty heating & Cooling, Inc. Clothes dryer (gas) — ,
Other:
Address: 7500 SW Tech Center Drive #130 `;;' -.. -= ..: = -._ 7.',..: .
:.'' -.: :i: IIIT FEES ;:.. •.:
" I
City/State/ZIP: Tigard, Or. 97223 Subtotal
Minimum permit fee ($90.00) 10...-11.3 Phone (503) 620 -5643 Fax; (503) 681 -0793
Plan review (25% of permit fee)
CCB lic.: 66578 State surcharge (12% of permit fee) /d , let
g
" TOTAL PERMIT FEE )60, by
Authorized signature: This permit application expires if a permit Is not obtained within 180
� days after it has been accepted as complete.
Print name; Andrea Dripps Date: I ° / 1, -(f f l., * Fes methodology set by Tri Building industry Service Board
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