Permit •
A: • CITY OF TIGARD MECHANICAL PERMIT
fly DEVELOPMENT SERVICES PERMIT #: MEC2005 -00075
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/25/2005
PARCEL: 1 S135BC -00500
SITE ADDRESS: 10770 SW CASCADE AVE
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: SRI VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 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: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Remarks: Installation of exhaust and supply air for a Dyno Test room. Project Value: $5,400
Owner: FEES
MIKE DURBIN Description Date Amount
10770 SW CASCADE BLVD [MECH] Permit Fee 2/25/200f $148.70
TIGARD, OR 97223 [TAX] 8% State Surchar€ 2/25/200f $11.90
Phone: 503- 924 -3700 Total $160.60
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST, STE. 1 REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97202
Phone: 503 239 - 4600
Reg #: LIC 33135
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 obt copse •f the - rules or direct questions to OUNC by calling (5 3)246 -669 .
Issued y: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day
Mechanical Permit Application FOR OFFICE USE ONLY
Received . Mechanical k
Date/B : J / t7 MI!, • ermit No.: I ( _i" ' -eeio
CIt of Ti and Planning Appr3val Building
y g Date/B Permit No.:
13125 SW Hall Blvd. Plan Review Other
• Tigard, Oregon 97223 Date/B : Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
� '
Date/B : Case No.:
Internet: www.ci.ti ard.or.us
l move
g e- Contact Su See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Or Su. 1lemental Information.
": :: , i : : - : TYPE.OZWORK' ; ; ;:." ` °::: 1 • z :: : :< FEE * `- USE .,..
❑ New construction ❑ Demolition Mechanical permit fees* are based on the total value of the work
[ Addition/alteration/replacement ❑ - Other: - per - ormea� -- Indicate the value (rounded to the nearest dollar) of all
_,, ............-. -.., - � - - - -- ; -- - mechanical materials, equipment, labor, overhead and profit.
%;CATEGORY;OF; CONSTRUCTION = < °_`��.`;: = �Y.` P
Y dwellin
❑ 1 & 2-Family C Value: $ 4 00 _ r o See Page 2 for Fee Schedule
dwelling ommercial/Industrial ue: �� .
❑ Accessory Building ❑ Multi- Family < RESIDENTIAL ;EQUIP1HErrctsYsI'>rivtsyi i *iSCH>N:DU E;
Description I Qty I Fee(ea.) I Total
❑ Master Builder ❑ Other: li • .:. _. . eating/ oo ng
. :1:'-.:'''
': a : ::e.: -JOB SITE: INFORMATION and LOCATION ` ' „ < : ` :: -; `, Furnace - add -on air conditioning ** 14.00
Job site address: /07 7 0 5) 0 a A Gas heat pump 14.00
Suite #: I Bldg./Apt.#: Duct work 14.00
Project Name: / �R-I as S d HA ric s®t� Hydronic hot water system 14.00
"°ti Residential boiler
Cross street/Directions to job site: (for radiator or hydronic system) 14.00
Unit heatem(fuel, not electric)
(in wall, in duct, suspended, etc.) 14.00
Flue /vent (for any of above) 10.00
Subdivision: Lot #: Repair units 12.15
• Tax map/parcel #: Other. Fuel Appliances
W ater heater 10.00
._.,,.;. ... _ ..
.. ..... . _
. .......DESCRIPTION.OF =- WOR = 4,; Gas fireplace 10.00
'
17V 3T,.I6C.C. N- b 1Alf t ell- Surf L.:1) ...,i 1 a. Flue vent (water heater /gas fireplace) 10.00
f d g 1 Wi- oclrlho NAT' Log lighter (gas) 10.00 _
Wood/Pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner /flue/vent 10.00
®
PROPERTY OWNER; s: := I: [I�tENANTr„'`` - 0.- ;max- ,. , ,,;: Other: 10.00
Name: P.- ,e,gtei;alca _Q& fivtotSQni -, . ... Enviroe &Ventilation '•
Range hood/other kitchen en equipment 10.00
Address: /0770 Slrr,.l CAif_x or ,",vEr
City /State /Zip: T A Q2 6)711.5 3 Clothes dryer exhaust 10.00
Single duct exhaust
Phone:608 -9�4- 70th Fax/8-613- qty.. 192 I (bathrooms, toilet compartments,
';.
=[ A'1PPLICANT:. %; -
" F ;; :` . ;" [ ONTACTPERSON:'i'.;,= `'r ":' utility rooms) 6.80
Name: RO6OAT -T. ,. Srt It i14 Attic /crawl space fans 10.00 •
Address: Other: • 10.00
/ ate) a 6., � a-opi �'f' Fuel Piping
City /State /Zip: f Q 4 ,j 4 J 0 a. 9 A..Q 2 * *($5.40 for first 4, $1.00 each additional)
Phone: 5 -03..- 230.4 ( Q Fax: 23 9 703 g Furnace, etc. **
Gas heat pump **
E -mail: 5 s r i esr j c ) .4,101 Isnly -A4 J ' s &f,LTfN -A,04-14: Wall/suspended/unit heater **
,,_, : CONTRACTOR'" X:'', Water heater **
Business Name: _".Am - Arc .64 I - I/4c _ Fireplace **
Address: 1339 3 E 1t� ��� Range **
City /State /Zip: Po arf,. .sMj OR. Or7 AoL- Clothes dryer (gas) **
Phone: 6-63 23 4 46 0a Fax: ,, 03 3 Other: **
CCB Lic. #: 33 1 3 5 i Total:
Authorized Mechanical Permit Fees
Subtotal: $
Signature: /. ,/ _,, t, Date:
q —` K�-- Minimum Permit Fee $72.50 $
or 6 hs Q r -I orot r I-t Plan Review Fee (25% of Permit Fee) $
(Please print name) State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within *Fee methodology set by Tri -County Building Industry Service Board.
180 days after it has been accepted as complete. * *Site plan require for exterior A/C.I.nits.
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