Permit CITY TIGARD RD MECHANICAL PERMIT
41 DEVELOPMENT SERVICES PERMIT #: MEC2005 -00295
' I I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/6/2005
PARCEL: 2S110BD -04400
SITE ADDRESS: 11938 SW ELEMAR CT ZONING: R -4.5
SUBDIVISION: ASPEN RIDGE LOT: 009 JURISDICTION: TIG
Project Description: Install a/c unit.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 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:
Owner: FEES
OSBORNE, DONALD L + Description Date Amount
11938 SW ELEMAR CT [MECH] Permit Fee 6/6/2005 $72.50
TIGARD, OR 97224 [TAX] 8% State Surchar€ 6/6/2005 $5.80
Phone: 503 639 - 4234 Total $78.30
Contractor:
OREGON HEATING + A/C INC
PO BOX 397 REQUIRED ITEMS AND REPORTS
DUNDEE, OR 97115
Phone: 503 - 538 - 2953
Reg #: LIC 125815
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 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699
or 1- 0- 332 -2344.
Is ued By: ' � L / ��fL / Permittee Sig, ature: 407
Call 503 - 639 -4175 by 7:00 a.m. for inspections tha ines • ay.
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.
Jun 02 05 01 :47p 503- 537 -2172 p. 3
r.
Mechanical Permit • I E" ::..f. t` :I : � D c FOR OFFICE USE ONLY
_ ��. 3
City of Tigard Received HAREM PermitNo.: 4-
Date/By: i i��'v iO DOi�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ��
Phone: 503.639.4]71 Fax: 503.598.1960 tUIV O � i �� , ,Rk Date/By: Other Permit:
Inspection Line: 503.639.4175 JV 1 ; . 't �
Internet: www.ci.tigard-orus �� : W Date Ready /By: 3 s: H See Page 2 for
�I ! Notified Method: / / Supplemental Information
T' COMMERCIAL FEE *: SCE EDULE -.. USE CHECKLIST
Mechanical permit fees* are based on the value of the work
ID New construction " ddition /alteration/replact:ment
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials,
equipment, labor, overhead, and profit.
$
CATEGORY OF CONSTRUCTION • • .: • ` Value:
1- and 2-family dwelling RESIDENTIAL EQUIPMENT/ SY ' FEES* "
y C ❑ Commercial /industrial ❑ Accessory building
1=1 Other:
For special information use checklist.
❑ Multi- family ❑ Master builder
Description I Qty. Ea. Total
•,, : JOB SITE INFORMATION, AhD LOCATION • .. Heating/cooling
Air conditioning or heat pump
Job site address: ad li ' r `� /r ! ,
1 f! l y t, l!C ma (requires site plan showing placement) J! 14.00 „ t
City/State /ZIP: t? tom, /� -1 •( 0l 7 I- Lt Furnace 100,000 BTU (duets/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt, no.: V Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
} lydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.:
Flue /vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DE iON ORK Water heater 10.00
.Si • .. ,.. S OF W `
n ,- \ fireplace 10.00
�� J (.,- - t� Gas � - -( c '.
/: /� � 11 f mot_(„ . / i �� % i; ; i i (! I �i �t Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
y Iner /fluelvent
10.00
l PROPERTY OWNER r :::. . L : TENANT
5 / ) .. .'`.. . .. .. .. . Other. 10.00
Name: ; -rn ( ' (n/ t/ �t Environmental exhaust and ventilation
■ Jr
i . \ �1 Range hood/other kitchen
Address: I 1 L � --:,; - ? r „ - (. in 4 ,,y r equipment 10.00
City /State /ZIP: :' ( ; . Gt .-7 z•-(7,--(-1 Clothes dryer exhaust 10.00
Single-duct h ust (bathrooms
Phone - 7 7 - ' .' ' L. L.--/ Fax: ( ) toilet compartments, utility moms) 6.80
- ' APPLICANT. ..: • ' ❑ CONTACT: PERSON Attic,crawispace fans 10.00
Business nameDir� oj_ �� Other.
� Fuel
pipin p'P g 10.00
Contact name: I ' f' �s� $5.40 for first four; $1.00 for each additional
� Furnace, etc.
l .
Address: 6 � f ,
b (In 11 s- Gas heat pump
Cit y/S tate/ ZIP: Wall, /suspendedrunit heater
Phoner( )3) 6r3g � 3 Fax: 613) 537 Z/ ' Water heater
�/ Fireplace
E - mail: Range
CONTRACTOR :: Barbecue
Business name: • Ilk' i / •"y, N_-cli \ ( t i �,/yi , ' Clothes dryer (
" �) l� r w Other.
Address: j ✓ . . .. .. . , .... . .
. ` �e4 : 'MECHANICAL PERMIT FEES:, :.. ` :: : `-'.:.
City/State /ZIP: ri 0V— C, i I C Subtotal I r I-� r
Phone: 6123 112 abi FaxY�! )i9 , Sa7 '] l 7 2- Minimum permit fee (572.50)
�:.� �1 1 v Plan review (25% of permit fee)
CCB he.: l S tate surcharge (8% of permit fee) 0 , �6
TOTAL PERMIT FEE
Authorized s ature: f ~ r q-19. ki,,t. I b q /� , 1 r ' This permit application e s within 10
1v r ica1 Print name: "y 1 I �(> hnlsj/ 1 . i� Date: Fee methodology set by Tri- Conty Building Industry Service Boa : \Building\Pcrmits2 EC•PrmitApp.doc 12/03 IJ ( U 440.4617T (I i /02 /COMRVEB)
Jun 02 05 01:48p 503 - 537 -2172 p.2
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Site plan for : 190.2 -l E_
back 3 7
pon) 1 /3 t - 7
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