Permit a'' CITY OF TIGARD
MECHANICAL PERMIT
,, COMMUNITY DEVELOPMENT PERMIT #: MEC2008 - 00495
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/3/2008
PARCEL: 2 S 102AD - 01900
SITE ADDRESS: 08935 SW BURNHAM ST ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TVF &R
Project Description: Replace existing unit with same Valuation $5100
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: 1 BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
OTHER UNITS:
FURN > =100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Owner: FEES
TUALATIN VALLEY FIRE + RESCUE Description Date Amount
20665 BLANTON ST
ALOHA, OR 97007 [MECH] Permit Fee 10/3/200E $143.30
[MECPLN] Plan Rev 10/3/200E $35.83
[TAX] 12% State Surch 10/3/200E $17.20
Phone:
Total $196.33
Contractor:
ANCTIL HEATING & COOLING
4320 N WILLIAMS AVE
PORTLAND, OR 97217 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -281 -0752
FAX 503- 282 -5722
Reg #: LIC 8897
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.
Issued B ,,``� 4 ,-- - 1 00 0.1 %"" Permittee Signature:
Call 1 .• 39.4175 by 7:00 a.m. for inspections tha u ' ess dr1y.
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.
�
3 . �
M chanical �
IN 1 Per m>It p ratio � �� - FOR OFFICE USE ONLY
4 City IVED Received g
•
y o Ti gar d Date/By: U P N 0 � fib 2e_
13125 SW Hall Blvd., Tiga OR 9 2 i w C/
Date/Bevi " , r /� Other Permit:
Phone: 503.639.4171 Fax 503.598.1960 y lJ
C1.G n [i D Ins Line: 503.639.4175 O C T 0 3 2008 Date ReadyBy: r 0 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: / V`� " PIMSupplemental Information
=MEDIA ,,e. gyp ��
TYPE O
T atittlMG'D1YISION . . . , ".. .. COMMERCIAL; `.FEE*'.gc i= USE
❑ New construction ® 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. •
- .- '' .* ,CA OF +CONSTRUCTION'° 7;1,1- Value: $ , - /(fZJ c
'RESIDNT
EIAL�EQUIPMENT 1 SYSTEMS FEES"..
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty I Ea. I Total
" °'' ".-v - JOB- SFRMA TION ANDm'tO_ CATI'ON .a '" . ` , mg
ITE -INO
, . . . " Heating/cool'
Job site address: 1 �� 1 � Air conditioning or heat pump
( ou ` 7V l+AP/ S _ (requires site plan showing placement) 14.00
City/State /ZIP: r f 1 o-o t m_ 9- 3 Furnace 100,000 BTU (ducts/vents) 14.00
` Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: 1 Project name: T ( F _ C TAT-I lk 2 ) 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
hydronic) 14.00
Unit heaters (fuel -type, not electric),
' in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.:
Flue/vent for any of above 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances
r. ,: ' t +: - A.." . ee,'^ - Water heater 10.00
�r -1 ; WORK1' , t .. � .. �A
Gas fireplace 10.00
Ykot es, q,1(', f'S'Pki () IiA1 i a) S Aulf , Flue vent for water heater or gas
fireplace 10.00
VP (/t1r1 Er- a .5- Log lighter (gas) 10.00
Cn 3D S j !1 ii yli0:7 4' I1JIJ( ft t LE.C. , Wood/pellet stove 10.00
Wood fireplace/insert 10.00
'. ..<..„ . ikpli P.ERTY� OWNER ,. : I - : 'C ,,:;..
Chimney/liner /flue/vent 10.00
Other: 10.00
Name: y%( F Environmental exhaust and ventilation
Range hood/other kitchen
Address: li s i 1 Cr \ MORAL (210. equipment 10.00
City/State /ZIP: .v 4 .j . , A, ry 6 Clothes • er exhaust 10.00
, Single -duct exhaust (bathrooms,
Phone: ( 5 n ) - I tD pI _ 4 0V Fax: ( ) toilet compartments, utility rooms) 6.80
;. -. ,� " APPLICANT: "' ® C O N TACT ., Attic /crawlspace fans 10.00
Other: 10.00
Business name: A Ai (,rl L IA E,A,._, , i t coo I. , xi . Fuel piping
Contact name: V A L j /OC,Ili' ` $5.40 for first four; $1.00 for each additional
2 q Furnace, etc.
Address:
3r.0 Al Lai i.(�1 A7 a S /3/42) Gas heat pump
City / State/ZIP: '/f�� it � Q / Fax: ( ��� 2? i 7 Wall /suspended/unit heater
kl Phone: ( ) ail ? s� ) ,2 _57 9,), Water heater ,
Fireplace
E - mail: Val G 110.4-,s f (4,v6 e. C 1' n Range
- .�CONTRACTOR ,� :t Barbecue
Business name: '34/142 Ad �ct621l£
Clothes dryer (gas)
r tU /� �' Other:
Address: ''-z - - s' N E C H A N ICA L PER FEES* ° f •
City/State/ZIP: Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lic.: 7 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: f This permit application expires if a permit is not obtained within 180
/ f days after it has been accepted as complete.
Print name: I f � ` a 6 Date: * Fee methodology set by Tri -County Building Industry Service Board
I: Building \Pem \titsM C- PemutApp 01 /19/07 440.46177 (11 /02/COM/WEB)