Permit CITY OF TIGARD MECHANICAL PERMIT
-" COMMUNITY DEVELOPMENT Permit #: MEC2011 -00570
T 1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/13/2011
Parcel: 2S103BA00132
Jurisdiction: Tigard
Site address: 12195 SW 116TH AVE
Project: MORRISON Subdivision: LERON HEIGHTS NO.2 Lot: 22
Project Description: Gas furnace replacement.
Contractor: ANCTIL HEATING & COOLING Owner: MORRISON, TERRY A SANDRA
4320 N WILLIAMS AVE 12195 SW 116TH
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE: 503 - 281 -0752 PHONE:
FAX: 503 - 282 -5722
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/13/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/13/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/13/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 or 1.800.3
Issued By: - ermittee Signature: Le`I / -L1141111-y
./a
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.
12/12/2011 16:45 FAX 5032825722 Anctil Heating & Cooling fj0001 /0002
Mechanical Permit ApplicatioiRECEIVED FOR OFFICE USE ONLY
! ew ��� Permt No.: • y ig 131SW Hall BlvdTigard, OR 97223 ts C ' ili C 2 2 �, Other Permit:
Phone: 503.718.2439 Fax: 503,598.1960 Date/By:
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Ions: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: o Supplemental Information
BUILDING DIVISION .
.- •:: . ., :;t ",:: ";:.::: ;: r,' CQ1�' 1ERC[ A,' L= 1? Ei�'+ SC�EDII J?lF ':•..` = ' T- :jSE.:Cff�GICT:I
:: . ;: IE U3 WORK:. .
; :.;;:....,.:• * of work
: - =•.. " • " �- ' " °_" -- � �' Mechanical permit fees are based on the value o the
❑ New construction E Addition /alteration /replacement performed. Indicate the value (rounded to the; nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
..;, ' CA'fEGOBY ; UE; :CON " : '..;.•... , ," •.:., ...• .. ,; ';. '.;:: , N*[': IpT ,E,QUI#'10NT;jSYS;y:MSEEES"- .•
E 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist
❑ y Other: Description Qty.. Ea. Total
Mule -family .• ❑ Master OteR3AAT..AhID'G4GAO0" ".1!':';':::;" ;:
.,.'': :.; 70II, srIE 1N'F'. - " N : .. Air conditio i ing .
Job site address: 12195 SW 116 AVENUE
(requires site plan showing placement) 46.75
Furnace 100,000 BTU ( ducts/vents) I 46.75 46.75
City /State /ZlP: TIGARD OR 97223 Furnace 100,000+ BTU (ducts/vents) , 54.91 _
Suite/bldg. /apt. no.: Project name 45' /y� ��5 on-) Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: ! Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) : 23.32
Unit heaters (fuel -type, not electric), -
in -wall, in -duct, suspended, etc. : 46.75 •
Flue /vent for any of above 23.32
Subdivision: Lot no.: 23.32
Other: •
Tax map /parcel no.: _ Other fuel appliances:
AS
EC -. � ..., :.:: ..:.:: s:::; , ;i,;:r:' Water heater .Ri,QT1ON;;O`F:fl'OItK�: ~:;i,�;:: `:`.".•`; <�::; "",:•<....,�,:..
,.." :. " -. .:.:. ._....,. . • Gas fireplace 33.39
PUSH/PULL GAS FURNACE Flue vent for water heater or gas
fireplace 23.32 _
Log lighter (gas) 23.32
Wood/pellet stove • 33.39
Wood fireplace/insert 23.32 ,
,", ; - •,: :;r,;; , Chimney /liner /flue /vent 23.32
;,.... - -•, � ::... -., -_::. ,. ...:,_:.- .•:.._:.:...- ...*:,.- ... .....::.,..• - 23.32
..
.. ;�.PRO�'ER'I?Y::UV.VNER.,:: _�_,�: :,:: ': �'.:.'; i . .. :::
"•...::. Q;: 1; E1�ANT ;.;;`.;..:•;;- :::;::;.:: "`.:: Other:
Name: TERRY MORRISON Environmental exhaust and ventilation:
Range hood/other kitchen
Address: 12195 SW 116 AVENUE equipment 33
City /State /ZIP: TIGARD OR 97223 _ Clothes dryer exhaust 33.39 .
Single -duct exhaust (bathrooms,
Phone: (503)544 -9807 Fax: ( ) _ toilet compartments, utility rooms) 23.32 _
_... �YL.1(G1NT: ;':;_ . >s.:'�;;!: :ii< <'.;a:.';•>:{�;aCON'�'AT 'EERSON:`•:
craw p c
:_.:;;;:.•.... , . -. -.- 23.32
- Other:
Business name: ANCTIL HEATING AND COOLING Fuel piping:
Contact name: CHRISTINE BARTON $14.15 for first four; $4.03 for each additional
Furnace, etc. _
Address: 4320 N WILLIAMS AVENUE Gas heat pump _
City /State/ZIP: PORTLAND OR 97217 Wall /suspended/unit heater
Phone: (503) 281 -0752 I Fax: : (503) 282 -5722 Water heater _ _
Fireplace
E -mail: INSTALL@ANCTILHVAC.COM : ,
Range _
.:.. ......:.....,.' *4<11VTRr14 TOR ". >:::` ::, :,;`::::: ":. " -'' _ -._ •. •.
B arbecue •
Business name: ANCTIL HEATING AND COOLING Clothes dryer (gas)
Other:
Address: SAME AS ABOVE . ..
:. >: -. `•:: _., •; • MECHAI�; I,CA1:k.ERNIITI''EES *. -" ,_ ".:
_ Subtotal
City /State /ZIP:
Minimum permit fee ($90.00) qd, { }0
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
CCB lie.: 8897 State surcharge (12% of permit fee) / ). 7)
TOTAL PERMIT FEE (G) .BZ)
r This permit application expires if a permit is not obtained within 180
Authorized signature: '� ■ . ,_. t("_.Q._ days after it has been accepted as complete
Print name: CHRISTINE BARTON Date: 12/12/11 ' Fee methodology set by Tri- County Building Industry Service Board
. . _ .. - .. - 440.4517T (1 I /02 /COM/WEB)