Permit CITY OF TIGARD MECHANICAL PERMIT
' . COMMUNITY DEVELOPMENT Permit #: MEC2011 -00031
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2011
Parcel: 1S 134CD07200
Jurisdiction: Tigard
Site address: 11730 SW TIGARD DR
Project: Stevens Subdivision: Lot: 0
Project Description: Replace gas fumace and A/C.
Contractor: HORIZON MECHANICAL LLC Owner: STEVENS, DONNA MARIE
2639 SE 176TH PL 11760 SW TIGARD DR
PORTLAND, OR 97236 TIGARD, OR 97223
PHONE: 503 - 849 -4902 PHONE: 503 - 310 -7952
FAX: 503 - 761 -1048
FEES
Specifics: Description Date Amount
Air Conditioning 01/19/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 01/19/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 01/19/2011 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $104.72
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: (er / Permittee Signature: 0 ,," ,)/: e --�
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.
•
tar .,, j11 t3•; chi otlj57ii!'dbt9 CITY OF TIGARD PAGE 01 /01
Mechini:91 Permit AD DIicA al, I poi; 01 I i, 1 1 , o �?�I ■
El M Rocci�sA
City of Tigard d a , ter, to em : / �;r Permit 210
13025 SW 1-1a31 Blvd., Tigard. OR 972231' nn �u /� ''� �� DU/ 3 /
Phone: 5D3.71E1439 Fax; 503.598.1960`+ I P 2011 0 Other Pasant?
[n Fiction l ine: 50109,4175 Glee eeedynss: Othe I see Pa6a 1(w
(p cmct: www.tigard CITY OF T IGA D xolirrcdTtedma: ��(/ Supplemental Wnrraet on
P1111 rlINIh nit n rI i"it 1
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.. .. • - 1 . tt •t r - !° "-1 i "t :'+�„`i t' :!4+ 6 ,•- i�D.4 Wni ' '.: • 0 NOW eznstatetion PeAdditi911 /alterotimtlreplascmeitt Mechanical permit the we bused d e to the i of the work
pafarmed, McRae the value (rounded m the neatest dollar) of all
❑ Dcmoiition ❑ Other: mechanical materials .• i.m labor. overbec• and .rat
_ t A 4$6d�Y t7F DJCTIUN Value $ •
ig 1- ante 2- fu-nily dwelling ❑ Comtrtercialrndastrial ❑ Accessory building j For adatprJrrmdaa we ehecklisx
❑ Multi -fami y
El builder El Other: Description Qty. [ Ea J Total
J * •9f1t1�'- RMdFTON.�'V117 1LC cATtON H eadrap/co [Ong:
-- -- Air conditioning
lob site attires& / / 7 -70 S v.! , '-T', - d t � tz . (sq.irm,tm plan ekodnxisloccm I . 46.75 _/C .- 7
Ci !State ZIP: I 1 C > / Furnace i00,D00 BTU(daciehrcma) 1 46.75 " 95
I'itraacc 100.000+ BTU (dunsittenet1 34.91. ____
Suite)bldgldapt. no.: Project nomc ,- , meat
/' jG.E'Yl � � SGt:'p!f'S Lri.� •a ( +e4ai eircp},„ i d, owrno plwsxmcnl) 4i.D6
Grave :attar/directions to job site: Duct s 2332
.Hydraric ho waterm ens 2332
Residential boiler (rsdiatpr err
l 1Lrdronr 23.32
Unit heaters (fire! -typq not ekxtrie),
in -wall, in -duct, suspended, ere. _, 46.75
Subdivision: Lot no,; Flue/vent for atIV of above 23.32
Other: 2332
Tax mapfprcel no.:
Other tEl napliaacca:
a1;961't10!'L7OPt 43V WCR>MC Water hearer 23.32
dv'i.L7t/(' C)` ,'C /'ciCe. -' t - 6:1 S Gas vent 33.39
(� q ,7 / u � ) n /�^ � flue verrt fur water heater or gas
t - .� •'t .l+ I ( e '1 A...) � ' T f r7 ` 6 / e,e _i_ L.' /' S fireplace x.3.32
�tf ; L r . 2 P /W.: 4•`(' t, 18 r Log lighter (Go) 33.39
C t �� If wood 33.39
■
_&,,e . , c i ti) S '- .-r-t e ( 4-r -0 4-; e .e,-.' wood fireplace/insert 23.32
R' j .0' 17WPC Ch /liner/nuehrent 23.32
Ater 2332
Name. Ervirontaetital exhaust and vendlatlom:
Address: / / 7 3 S, 1- . .7 /'` ?.2 ,r 0a . Range haod/odrer kitchen
equipment 33.39
City/Stat LP: , 7 4,ad 02 f. Clothes dryer exhaust 33.39
Phone: (• ' 3) -3 . 0 - -7e7.5- Z Fax: ( Single-dod exhaust (bathrooms,
toilet corn . ■ etas Wit' roosts 23.32
e,'AtPr ' . . • .• • . • a coxr vvr 1 . lltt - • • . • Attiderawlnpacc fatut 23.32
Business 1��2 : 2 1 roe C A ..a S.' i f /1 L C Other: I 23.32
Cornet n+ '' - � Fnet piping:
Con
/IA p4 .r1 i
51415 fbr first than 34.03 for ege t additional
Address: `Z 43 e ) 5. f, / .7. -t p ( ; Fur... etc
GitylSta . IP; (�0i2`fiL !^ ,lZ Ons heatpump
r C F . 7 Walllsuspcedctl/unit honer
Pilate: (' . r 0 gt f q (/ of 0 Z Fax: : (5•2' 7‘/- // g Water hearer
E -mail: Fireplace
.. CONTRA014 : t • • - . -
Ran •
.. - 8prbeerc
- Business o. e: H 1,6 AA ec (.l /a A ../ , C , L [ r e C Cicti
Add $ . f ?- �. Other'
er: r
3 / 7 G e 4 • •. ■ ..;.a lvu Btd lnr intral 4 '.
Cty/Stntcl.. '; Piz +L A ,ti Cl ,. C_a ? f . c/7 .2 3 6 f Subtotal 3 . SO
� n / Phone: ( ) g `(cj- Y4t5 -Z I Fax: (5 1) 76. I - (p' i g rvtinm►rum permit Fee (540.00)
/�/ CCF3 tic. Z Plan review (25% of permit fee)
"`JJJ / Stntesutdtor (12% of permtt fry) ��. ,i20.
- TOTAL RtEaI►►OT t /n 61 . --7..2 illrth9rl zed . �trtne: //t/ This permit sppo ndee espirss ira permit ie nit abtaised wieatn 1211 C Z*
days after It has taco uec.pMd ee cesspit*.
Print narna r i C k ;.c1 f L C. (y1/4 L c ; Dula: / . /'' / ( • Fee m dtrodotop• act by Di- County Building Industry Service Bend
i:t slIdii, p,,,. »C rn..:y. mime
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