Permit CITY OF TIGARD MECHANICAL PERMIT
1 4
2 ' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00158
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/13/2011
Parcel: 2S110AD90061
Jurisdiction: Tigard
Site address: 14960 SW 109TH AVE
Project: DEVRIES Subdivision:ANTERBURY WOODS CONDOMINIUA Lot: 61
Project Description: Heat pump installation. Unit must meet minimum 3 ft. rear and side yard setbacks.
Contractor: ABLE HEATING & COOLING Owner: DEVRIES, LINDA J
8900 SW BURNHAM F -5 14960 SW 109TH AVE
TIGARD, OR 97223 TIGARD, OR 97224
PHONE: 503 - 579 -2250 PHONE:
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Heat Pump 04/13/2011 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 04 /13/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/13/2011 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 • 800
1
Issued By: _ "` _: • Permittee Signature: •��. G, / - s `+ .�
Call 503.• • .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.
Mechanical Permit Application VO FOR OFFICE USE ONLY
City of Tigard `� R """°d
13125 SW Hall Blvd., Tigard, OR 9 �te/By i %1 ' V i1 �.
Plan Review
Phone: 503.7182439 Fax: 503. r 6 \\ ma Other Permit:
Inspection Line: 503.639
T I R o ��� Date Ready/By: d ; lurk See Page 2 For
Internet: www.tigard- or.gov A A �� O� Notitied/Method: i -�" I SupptemeulalInformation I
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TYPE OF W OR>li,�'� O \O S COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
�� Mechanical permit fees* are based on the value of the work
{]New construction lvt
® Ad dition!altctatio ment performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition ❑ Other: mechanical materials, equipment, labor, overhead. and profit
Value: S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1 -and 2- family dwelling 0 Commercial/industrial ❑ Accessory building Farspedal information rese cheddist
❑ Multi -family ❑ Master builder ❑ Other. Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Aeatinp/cuoling:
Air conditioning '
Job site address: 14960 SW 1119" Ave. (requires site plan showing placement) 46.75
City /State/ZIP: Tigard, OR. 97224
Furnace 100,000 BTU (duets/vents) 46.75
Furnace 100,000 BTU (ducts/sears) 54.91
Suite/bldg. /apt. no.: I Project name: deVries Heat pump
(requires site plan show ingplacement) 1 61.06 61.06
Cross street/directions to job site: Duct work 23,32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydmnic) 23.32
Unit heaters (fuel -type, not ekctric).
in -wall, in-duct, suspended, etc. 46.75
r Lot no.: 8ubdiviaion: I Flue/vent for any of above 23.32
ll ! Other. _ 23.32
Tax map /pal no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace New Dactless Heat Pump System repla 3339
Flue vent for r water heater or gas
fireplace 23.32
Log tighter (gas) . 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER 1 ❑ TENANT I Chimney /liner /flue/vent 23.32
Other. 23.32 _
Name: Linda deVrles Environmental exhaust and ventilation:
Address: 14960 SW 109 Ave. Range hood /other kitchen
equipment 33.39
City/State/ZIP: Tigard, OR. 97224 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)598-1173 Fax ( ) i toilet compartments, utility rooms) , 23.32
❑APPLICANT ❑ CONTACT PERSON Attictcrawispace Pans 23.32
Other. 23.32
Business name: Fuel piping:
Contact name: $14.15 for first four 54.03 for each additional
Address: I Furnace, etc. I
! Gas heat Dump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) _ Water heater .
E-mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: Able Healing & Cooling, LLC. Clothes dryer (gas)
Other. L
Address: 16285 SW 85" Ave. #105 MECHANICAL PERMIT FEES*
City/State/ZIP: Tigard, OR. 97224 Subtotal 61.06 _
Phone: (503) 579 -2250 I Fax: (503) 620 -3980 Minimum permit fee ($90.00) 90.00
Plan review (2551? of permit fee)
CCB lic.: 184392 State surcharge (12% of permit fee) i 10.80
TOTAL PERMIT FEE 100.80
Authorized si atttce ' i nits p ermit ep expires If a permit a not Weer led within 1ST
, C ,j t ■ days after it has been accepted as complete.
Print name: Kelly With Date: 04-12-2011 ' Fee methodology set by Tri- County Building Industry Service Hoard
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7 ,1 i - 8900 SW Burnham St Suite F5 Air Conditioning Site Plan
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(.'- - j € � ` — (503} 443 -2058 Fax (503) 620-3980
i34 ." = Email: ablehvac2 @aOIcorn
CCB 4184392
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