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Permit CITY TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT PERMIT #: MEC2008 -00387 TIGARD DATE ISSUED: 7/24/2008 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S135D6 -06800 SITE ADDRESS: 11265 SW 94TH AVE ZONING: R -4.5 SUBDIVISION: O'NEEL ACRES LOT: 008 JURISDICTION: TIG PROJECT: LACY Project Description: Install furnace and heat pump. CLASS OF WORK: ALT 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: 1 DOMES. INCIN: 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: Owner: FEES JON & JAN LACY Description Date Amount 11265 SW 94TH TIGARD, OR 97223 [MECH] Permit Fee 7/24/200E $72.50 [TAX] 12% State Surchai 7/24/200E $8.70 Total $81.20 Phone: 503- 639 -9680 Contractor: OREGON HEATING & A/C PO BOX 397 DUNDEE, OR 97115 REQUIRED ITEMS AND REPORTS Contact #: PRI 503 -538 -2953 FAX 503- 691 -8556 Reg #: LIC 172126 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issu By: / / ),(L Permittee Sig ture: � Call 503.639.4175 by 7:00 a.m. for inspectionstha day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application ® FOR OFFIc:l utii; {aN� I..p ' Received I n p z *• ' City of Tigard C EtV DateV: / /1LI ° 4 PrmitNo 13125 SW Hall Blvd., Tigard, OR 7 Plan Review -- __._.... t phone: 503.639.4171 Fax: 503.598.1960 nn Ot her Permit; T IGARD Inspection Line: 503,639.4175 JAL 2 4 ZUU$ Date R.oady /By: 7uris H See Page 1 for Internet: www,trgard- or,lzov D Notitiod/Method; e Supplemental Information • Y OF TIGA t ii 3 ( q 'ii! 1' 1_` 11 } i , t M,,,, t . w! 1� , ,,, „1 `} 1 ! , I tt; i s at yryn'n ' f p fit y k 8(0 ' 8 , iD ( �� , I, l ; , , e ; . . fili 'i { 9 �.: r a t i � ( g r i P�i rla 1 e r E '>F - i ' war R rt.hlia, . I1 „!wx .. 4 0 ■ • ;� g . s Mt r ,ri a . , #1119 7, - 1 ; �,.,,; ❑ New construction Addition /alteration/replacemcnt Mechanical permit feesx' are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition [,] Other: mechanical materials, equipment, labor, overhead, and profit. r,rs,t ;t +dal J f t `1 i ++' w r;, ra °a tlfrflli! oe+ a d Value. iE 41�?lEl iii E1: piskl is�' 1 t 4 : � 4} I ! ! l :► $ ,t iet P? � " Itiri° 4- •nnr'te ri: klitlaW r 11 = ;!t i &11u116$! ii 1�'rig t!1 {ll r I ' a �t ,a • q t { z { q 03 i -trod 2 -famil dwellin z >CC l et s � a l t, i f` ' ! ; i y g ❑ C ommercial /industrial ❑ Acc essory building ❑ Multi-family CI Master builder ❑ Other: For special infonnahon use checklist. li l'{{” Ill ' - n Ip U G li } tt} e i R tat n ap> ? #tf 1.111.111 �r :;1 Description QYY, r > �. I Total p a f�dd l i ` } r , .1 I pu , 2112 13111 l F ?[ i 1 ri # V rl¢t ?4 )1., :oiiit1 , it j!i i • Heatin11/coo1ing _ . Job site address: j S ti / 1 Air conditioning or heat pump V e (requires site plan showing nisecuuieut) 1 14.00 r (#- GC City /State /ZfP: T ; 9 A re ' l 0 p a - 7 a ? Y Furnace 100,000 BTU(ductsty nta) ' 14.00 4 � Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bidg, /apt. no.: Project name: C> $ 3 a ? rn Gas heat pump — 14.00 Cross street/directions to job site: Duct work 10.00 Hydronic hot water system 14.00 Residential boiler (radiator or bydronic) .. ,14,00 -.. (Jnit heaters (fuel -type, not electric), in - wall, in - duct, suspended, etc. 14.00 Subdivision: Tot no.: flue/vent M any of above 6,80 Other: 10.00 Tax map/parcel no.: Other fuel appliances • et .1 r' r r t tl 1 3 of Ff. I 1. r i . } 1 a r i fi ,t 9 1 l I i l A ! .1 tH ' ' {11 i l ' . Water heater 10.00 �ss�s�:�;�r � f 1ltl,s„ ' rz� � s k1_r . 4if � : �: ,� --.. ..-. w...�.,.- I , rII Gas fireplace . 10.00 r S 3t- 4 t I r` tit t" y1 Gt e e q ,� G l 64 f (u hn r nue vent for water heater of gas fireplace 10.00 -- --- Log lighter (gas) _ 10.00 _ Wood/pellet stove 10.00 j { 4 ;( j[� Wood fireplace/insert _ 10,00 _ I .141 8371uklt l i 1 .6 ,`i , �� � i ' , it u' I lk :,, tit Othernne� liner / flue /vent 10.00 Name: �° h � ,� d a 0 LAC' . ( Environmental exhaust and ventilation � Address_ l ^ - ' I A C G S C LI P 1,, V e _ equ equipment 10.0 hood/other cquipmcnt 17 City /State /ZIP: —r--, q e O' 12 ci i a . - 3 Clothes diver exhaust „ 10.00 / Single -duct exhaust (bathrooms, • Phone: (6c .) G 3 I - q �, $ 0 Fax: ( ) toilet compartments, utility rooms) 6.80 i r 1 t 1 S 1 "M1 4 't!` u'i a rr o Attic /crawls ace fans 10.00 BFI : - i i i l. p 11y E; I ; O" .. al it M" P t�'2[;� c t-, Ht�-1 / y J Other: 10.00 Business name: O J t { G�r 1 N� .+r !M 4i A G „ F' uel a in —" _. AP � Contact name: " S' 1 G 4 r c rs 4 _ 55.40 for first four; $1.00 for each additiona Address: r D t5 a ,C 3 q v . Furnace, etc. Gas heat pump City /State /ZIP: 17 V- " c e e i Q /�� —y ' ( C—? I l l S' WalVsuspended/unit heater Phone: (S 3) 6 ? - a q c 3 Fax:: ( 503) 6 `7 rl 3 4-c 4j Water heater -..r Fireplace E -mail: Range i {, 3 t 1 h' nit t a g ` p! 1 1 1, , , , , ,, , } , I g . , I ! i :. 1 , . � ti, ' u t p r l ` ,. 4 1 N ai tR Riau t. i s...., . j� t Y 6 13 i' , F i ` Barbecue — Clo thes dryer ( gas) Susiness name: C G l' e- ... Other, g p _ [ p , i. Address: .._ 1. ; .i , a ,`lilia�w td i 9�I � '`ta.t ,. N3 #` ,1t City/State/ZIP: _ _ Subtotal 2 -7 .5 C Minimum permit fee ($72.50) Phone_ ( ) ~^r Fax: ( ) Plan review (25% of permit fee) CCH lie,: 1 "'7 a I a State surcharge (12 %ofpermit fee) g -1 G • TOTAL PERMIT FEE 3 1 . a 0 Authorized si nature: This permit application e xpires If a permit Is not obirtued within 180 w g days after it has been accepted AS complete. [Print name: - T o S \ I —H r`. 4-e.. pi Date: 7/ j I t/ Gg ,, Fee methodology set by Tai- County Building Industry Service Hoard I:\ BuildingTermit sNIC- PcrmitApp.doc 01119'07 440-4517T (t 1,t2iCOM.W1iB) • 80 /Z9 39 ONIld3H NO9360 9SS8 -T69 -COS 00:0T 8002 /bz /Le m m N Basement 10' + —r 5' • 1 14' + • z H a w _ 0 Basemen[ Gaoge N 1� F SW 94th Avenue Jurisdiction - City of Tigard m � 3 co Job #: Oregon Heating & Air Conditioning, I... Scale; 1:113 CC Performed for: Page John Jan Lacy PO Box 39 71992 Hwy 99W Right -Sae Residential Cig 11265 SW 94th Ave Dundee OR 97115 6.0.119 RSR28.586 • Tigard, OR 97223 2008- Jul -24 08 :59:44 Phone: 503 - 538 - 2953 Fax: 5©3637 - 2172 C.il�l I?ocume�rfslWri hlsoti H1/AG1L... m Craig@Oregonheating.com 503-639-9680 Craig @Oregonheating.com Y 9 I •