Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00531
Date Issued: 11/23/2011
T1GAAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S1146607700
Jurisdiction: Tigard
Site address: 16279 SW 104TH AVE
Project: Peterson Subdivision: SWANSON'S GLEN Lot: 18
Project Description: Install furnace and heat pump. Unit must meet 5' minimum rear and side yard setbacks.
Contractor: SANDU INC Owner: PETERSON, BENJAMIN
2101 NE 387TH AVE 16279 SW 104TH AVE
WASHOUGAL, WA 98671 TIGARD, OR 97224
PHONE: 503 - 740 -1333 PHONE: 503 - 574 -9622
FAX: 888 - 340 -6548
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/23/2011 $46.75
Type of Use: SF Heat Pump 11/23/2011 $61.06
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/23/2011 $12.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $120.75
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.
v.�
Issued By: d i , p j . Permittee Signature: ajv s9 / .9-77 ,
Call 503.639.4175 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.
Fm:Sandu Inc, Fax. 888 - 340 -6548 To:City of Tigard (15035981960) 17:32 11/22/11GMT -05 Pg 02 -04
Mechanical Permit Applicati CEIVED FOR OFFICE USE. ONLY .
City of Ti and Received
v g NOV 2 2 2011 Date/By: / / ,� ' Permit NoAfEz g' I f, 5Q
• _ ! 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' Phone: 503.7182439 Fax: 503.598.1960 Date/By: Other Permit:
TIGARD Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: a See Page 2 for
Internet: www.figard BUILDING DIVISION Notified /Method: US Supplemental Information
F'EE'T' SCH
' : . : . CAMbiIrRCIAL. EAULE •='USE CHECKI:LS1'. •
Mechanical permit fees* are based on the value of the work
❑ New construction 0 Addition/alteration/replaccment performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
r CATEGORY 'OF CONSTRUCTION. . .; , ; •RESID ENTIAL ,EQUI.PME1'T /SYSTEMSFEES* : • .
cl 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building For special information use checklist.
I ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
JOB SITE 'INFORMATION AND LOCATION .. Heating/cooling:
Air conditioning
Job site address: i 62,39 ( A (requires site plan showing placement) 46.75 •y
5 r— —r Furnace 100,000 BTU (ducts/vents) 1, 46.75 • Y
Cit /Statel7lP: •
Y ` I 1 tl 2_�� Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Fleat pump
(requires site plan showing placement) 1 61.06 G 1.//yy O,i6
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 2332
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 OT`. WORT{ i ; . Water heater 23.32
�j orrice and pc Gas fireplace vent or 33, 39
�` t%f Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplaceiinsert 23.32 • . PROPERTY -OWNER, . :. ChimneyAinerltiue /vent 23.32
0 TENANT
Other: 23.32
Name: P e-S• OA/ Environmental exhaust and ventilation:
Address: /62-99 ICI ire Range hood/other kitchen
equipment 33.39
City/State /ZIP: #71 ( 4 Ot 9 7 2-2-41 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( S ?4— 9 (zt..... Fax: ( ) toilet compartments, utility rooms) 23.32
C�LAPPI.IC�NT' [] CONTACT PERSON Attic /crawlspace fans 23.32
� "� Other: 1 23.32
Business name: ), u ® Fuel t to
P fi
Contact name: t� �a �1j $14.15 for first four; $4.03 for each additional
Address: a t 0 e Mr Av r Furnace, etc.
d ' �� Gas heat pump
Cit y/State /G {i (f , Wail/suspended/unit heater
Phone: ( ) 71 a / Fax:: W 340,49 Water heater
E -mail: Gl an d() • ;ft q �� , Fireplace
• �3�7 Range
CONTRA .. Barbecue
' Business name: 4404, .Jo A a C m Clothes dryer (gas)
Other:
Address: .. 'MECllANICALPERMITFEES!.,, '' '' • '. . •
City/State/ZIP: Subtotal 10? . gI
one: ( ) Fax: ( ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CB lie.: r ;; ; State surcharge (12% of permit fee) R�,.
a�
TOTAL PERMIT FEE ( c./-
Authorized signature: .` -
This permit application expires if a permit is not obtained within la4
days after it has been accepted as complete.
Print name: 6 kJ �r� >,e...ttl 1
I t Date: (1 iB ' . Fee methodology set by Tri- County Building Industry Service Board
\
t:Build ing\ \ s
Permits hiC- i'ermiiApp. toe 09 /09 /to ••dd � 440-4st7T (I vauCOnvwt;a)
FEET TO SIDE PROPERTY LINE --
Q
o
mt
m
Go
co
N
t --c4.) -n
L, etri 0
eE1
0
O
—4 1; _ m
—4 1W. -<
4 �, 0 r
v, —4
rn ;Q
z N XI
r
m 6 ) i f \I
4 T t< t . 4a
o i .,,,
1 ,i, z....
3101 A.U1JdO Id O1S 011J]
Cn + Z
rn
b0 6 d SO L61ZZ /1. 6 ZE :L6 (0961,869E0SI.) pae 40: 81 'xeJ 'au! npueg:wd