Permit CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: MEC2009 -00281
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/11/2009
Parcel: 2S114BB17700
Jurisdiction: Tigard
Site address: 16347 SW 103RD AVE
Subdivision: RIVERVIEW ESTATES Lot: 23
Project: Creitz
Project Description: Reconnect a /c.
Owner: FEES
CREITZ, SUZANNE M Description Date Amount
16347 SW 103RD AVE
TIGARD, OR 97224 Air Conditioning or Heat Pump 06/11/2009 $14.00
12% State Surcharge - Mechanical 06 /11/2009 $8.70
PHONE. Minimum Fee Adjustment - Mechanical 06/11/2009 $58.50
Contractor:
A -TEMP HEATING & COOLING
16000 SE EVELYN ST
CLACKAMAS, OR 97015 -9519
PHONE: 503 - 650 -5014
FAX: 503 - 557 -2990
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance i wor is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility tification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir ct questions to OUNC • ailing 503.246.6699 or 1.800.332.2344.
Issue By: e _, _ 4 �� _ � • � , Permittee Signa re: , _` , u
.4:a/J1ILlj..r
Call 503.639.4175 by 7:00 a.m. for an inspection that busi • -s day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
, .
e ' 06/11/2009 08:30 5035572990 A-TEMP HEATING PAGE 01/02
Mechanical ' , snit OFFICE USE ONLY
City of Tigard Accci, 0 ,
• )c _ tit e ?..._ et ag 1
N . ,,312.5 SW Hall Blvet„ Tigard, OR 97223 Plan 84:view
JUN 1 1 2009 Doto/14: & i 0 Y Permit No
Phone: 503.6394171 Fax: 503.598.1960 Other Perron:
TIGARI)
Inspection L CITY OF TIGARD ine: 503.639.4175 Date l /By;
gieamili
Fffal El see Poge 2 for
Internet: www.tigarcl-or. goV
BUILDING DIVISION Supplemental InlbrinatIon
, ]'...■..': , ; ,,&' ,,,,.: .1' ...;:: ; .::' , 1. ,',.': COMMERCIAL, ME* SCHEWILE -.‘ U$E CHECRIASTL
17 New construction 1 Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of al!
El Demolition 17 Other „ materials, eqi ip m ent, labor, overhertd„ profit,
■•: '''': : :: ". - .. •: : .„ '.,-. ' . , Value: $
• " ------i ' S " i'..:11:010ENTIAL EcitlIPIOTO:itOri*NISPEES' '• ''' ':'•
CI 1- and 2 dwelling 0 Cornmareial/industrial ci Accessory building
For spscral rnformation rise checklist.
0 Multi El Master builder II Other: Description I .QTY' I Ea I Total
:,.','.,:.•:,.,...':.,';,'.:,.. ,i, ,;:.,0k*ir,0,';''Of!*4'00t;iOtl;Si F1/4
■'fq :: ::: . ':6:',:-;;'. ;'; : Henan /corilln
Job :
site address: 1 6 10: )1-t, Air conditioning dr heat pump
....._ 2_i showin 11_8 :Icp_ei 1__aent k 14.00 4 44 1 / 9 - 9"
City/Stotc/Z.TP: ' 09., ctroaf Furnace 100.000 BTU (duciwvent9 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt, no.: Project name: ( -1-
4-f-- I- 14.00 7---
Gas heat pump
-
Cross street/directions to job site: Duct work 14.0D
Hydronic hot water system 14.00 I
Residential boiler (radiator or
1_2ydronle) 14.00 _
//nit heaters (fuel-typo, not electric),
in-wall, inAuct, 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
PA'''' '';'• Pt$ii.;:,"'",,,,,i,',,;,.:,,,; ;., i J,. , , w ater p en 10.00
.,
' , :',,, ,,' , •1'. '3 ' i!'''.''.Y ,' ''' ',,:Li',;II: . 1. , . 1 , h; ''J ' ,..
Crag fireplace 10.00
OW °. .za.,:ii
.. l C -
Flue vent for water heater or gas
fireplace 10.00 .
Le: Utter I. a 10,00
Wood/pellet slove 10.00
- - -
Wood fireplace/insert 10.00
' '' .. -77-77-77- d r rt NT
,' : 4ad tik :,,, r,',.:' ..: . •, •, .. ,, , a. Chimneyliner/n/
uevent
- / J0;00
Other: 10,00
Name: i II ,c ,__Cr-1-11-2- Environmental exhaust and ventilation
Range hood/other kitchen
Address:
A •40 A a A AL At -- equipment 10.00
' IP "1" yr upt . Mir 40 , 'Illi
City/State/ZIP; Clothes dryer exhaust 10.00
- Single-duct exhaust (bathrooms,
Phone: ( a ) ,- r Fax: ( ) toilet comptutments, utility rooms) 6.80
voikitektl1' .!:,,ittkgoifi,; ;..,,: , Attic/aawlapace faits 10.00
Other: 10.00
Business name: . .. -----
-.. Fuel piping. ..
Contact name: A-TEMP HEATING AND COOLING, 11' '• $5.40 for firat four; $1.00 tbr each additional
• 16000-5E-EvtlyrrSi. .
Furnace, etc.
Address; • _ClackamasOR 9"/ 015
• . __ Otis heat pump
City/State/ZIP: 503-650-5014 Wnii/attapcnded/unit (mates
Phone'. ) 4 - Fax; : ( 6 •
- ..---- :7:iii) Watcr heater
- ^'" - Fireplace
E-mail; dui_ i - , arn
Clothes dryer (gas)
Business name: AzgAzugailgunalmugalgL________ Other:
Address: • 16000 SE Evelyn St.
' , "••5: ' ''', MECHANICAL PERMITIFt.g • Y.''• ' ';•
- -----ClackainveR1015
City/State/Z1F: I -5.0114_ Sulitotal
--------- - Minimum permit fee 072,50)
Phone: ( ) Pax: 4 1r 4 i k ) • __ n,qc .. .
plan review (25% of permit fee)
CCS lie.: I 41.r
,)_____ •''l I -
....
State surcharge (12% of permit fee) 1,S,
I10
,. .
- TOTAL PERMIT FEE 1 81,.. 2.0,,1
This permit application expires If n permit is not obtained wilful, t an
' Authorized signet' AO S f..., •aia dori after It hot been accepted II a complete.
Print name ' I - ^ ill.4 IA 'C.A,) ,‘,....,th -erv.ce -can,
li I Date: 11.�---=i-F-691 a Pee methodolegy net by Tri Building 1 ..I NI Scant
1:113niblin5TermitAktEe-PeonitAiip doe 04/06106 140 7T (Itrovcomiwsn)
-. 06/11/2009 08:30 5035572990 A -TEMP HEATING PAGE 02/02
A.,Ter , , 1--Heatin & Cooling, Inc.
. SITE PLAN
Prepared by: /A Cs = k Date: C " ty_2l__. --
Customer Name nne,
Cf• &._ j- • Address: JO '11 S.c.►, /61r: 4.uc,
Customer Phone: 20_5 S ° ���.��
Property Boundary Line J
To r G,,. c L_
El cop,
6 r
f �r�CC� House
J +�
r roi-,* Y 4 4
Street '