Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00151
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/08/2011
Parcel: 25111 DB05300
Jurisdiction: Tigard
Site address: 15293 SW ALDERBROOK PL
Project: JONES Subdivision: SUMMERFIELD NO.7 Lot: 407
Project Description: Furnace and NC installation. NC unit must meet minimum 3 ft. rear and side yard setbacks.
Contractor: ADVANCED HEATING & AIR CONDITIONING Owner: JONES, JOSEPH LYNN TRUSTEE
5825 SE FOSTER RD 15293 SW ALDERBROOK PL
PORTLAND, OR 97206 TIGARD, OR 97224
PHONE: 503 - 774 -0161 PHONE:
FAX: 503 - 774 -4391
FEES
Specifics: Description Date Amount
Air Conditioning 04/08/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 04/08/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 04/08/2011 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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: - • Signature: i /
— rd — -
Call 503.639. • 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.
Mechanical Permit Application FOR OFFICE Fs1: OyI.A
•
City f Tigard Received
7 131 SW Hal Blvd., Tigard, OR 97223 Date /B . A / r1= EIMIIMMEMNI
g Plan Review Other Permit
Phone: 503.639.4171 Fax: 503.598.1960 Date /By:
T I C n R D Inspection Line: 503.639.4175 Date Ready /By: liffl Ed See Page 2 for
Internet: www.tigard - or.gov Notified/Method Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ New construction [fv Addition/alteration/replacement 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, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value. $
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES*
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
Air conditioning
Job site address. l 5Z93 SW p� $Q PL • (requires site plan showing placement) 1 46.75 i{p;15
City/State /ZIP: 1 ` 5-1 1 Furnace 100,000 BTU (ducts /vents) t 46.75 1 5
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Project name:
Heat pump 61.06
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
DESCRIPTION OF WORK Water heater 23.32
—
f 1 U .t \ 0 �1 C_, Gas fireplace for 33.39
/ `x 'V ` Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
L`WPROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: \INN �'� Environmental exhaust and ventilation
Address: c L..• q J✓ 3 s V � "' l
` %� Ar (� `� Range hood /other kitchen
� � �l J C 1 Pc equipment 33.39
City /State /ZIP: Ttc,... ^ .Q0 —) Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (5 - vzo ._, Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON' Attic /crawlspace fans 23.32
Other: 23.32
Business name: Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( )
Water heater
Fireplace
E -mail: Range
/ e= 12
CONTRACTOR Barbecue
) �/I Clothes dryer (gas)
Business name: a ,: ��� f ��Q ed /✓Q /jIl/i�/G� Other:
Address: 53 5 f/9$ /� // t� 7 tt E ANICAL PERMIT FI ES*
City / State /ZIP: �/7 / � /%f --J� Subtotal S3. SC
f V _ Minimum permit fee
Phone: (131 T7// � O,i / ✓ / Fa u x: 77y y7 ($90.00)
r Plan review (25% of permit mit fee
fee)
CCB lie.: *573 _ State surcharge (12% of permit fee) `1. 22..
t � .,--- TOTAL PERMIT FEE 104.,
i / /�� —9- This permit application expires if a permit is not obtained within 180
Authorized signature: f
�/ days after it has been accepted as complete.
Print name: fi t✓ pGl6� Date: 313 it • Fee methodology set by Tri- County Building Industry Service Board
I \Building \Permits \MEC- PermitApp. doc 10/01/09 440 -4617T (1 I /02/COM/WEB)
A C -HEAT Pt:MP - - -T SIT SITE R »AN
FEET TO BACK OF PROPERTY LINE
FEET TO SIDE PROPERTY LINE
3 s'
FEET TO FRONT PROPERTY LINE
ADDRESS:
PLEASE REF AX APPLIC Al ON WITH SITE PLAN
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