Permit •
CITY OF TIGARD MECHANICAL PERMIT
- 2 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00036
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/18/2012
Parcel: 1 S134AD02800
Jurisdiction: Tigard
Site address: 10840 SW BLACK DIAMOND WAY
Project: PERRIN Subdivision: BLACK BULL PARK Lot: 18
Project Description: Furnace replacement.
Contractor: ANCTIL HEATING & COOLING Owner: PERRIN, SUSANNA & JON
4320 N WILLIAMS AVE 10840 SW BLACK DIAMOND WAY
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE: 503 - 281 -0752 PHONE:
FAX: 503 - 282 -5722
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/18/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/18/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/18/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 1.800.332.2344.
/
Issued By: - ermittee Signature:
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.
01/17/2012 10:42 FAX 5032825722 Anctil Heating & Cooling U0001/0002
Mechanical Permit Application
FOR OFFICE USE ONLY
City of Tigard 11 OIF
ii Received ;
Permit No.: "?
EE I r? 12 ,g macaoick--0
II, : " 13125 SW Hall Blvd., Tigard, OR 1 C
p 5
, Plan Review
' - 2 Phone: 503.718.2439 Fax: 503.5•8.i 6 '
Other Permit:
Date/By:
nspection Line: 503.639.4175
TIGARD Inspection JAN 17 2012 Date Ready/By: /uris: 0 See Page 2 for
Internet: www.tigard
Notified/Method: c Supplemental Information
, .. • . .. . CITY OF TV3P.,FID .. .. „, . . ,. ..... . . ..
9 ro : • . ,:,. ,, •::: ,c0NOOK14 FEE- •
Mechanical permit fees* are based on the value of the work
0 New construction E Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition 0 Other: _mechanical materials, equipment, labor, overhead, and profit.
•
Value: $
• • .• , • . . • • - ' .... • CA .', ..0 NsW0 ,,,,,: :.•,,, ■ ., • 1 .:••■,,' • ' ,': ■•' .'•,:•',:. gismtNTIAL.:g0thpmeirIsksTtigst*Es:
El I- and 2-family dwelling 0 Commercial/industrial El Accessory building For special informed/on use checklist.
E Multi-family E Master builder ID Other: Description I Qty. 1 Ea. I Total
'' ':::-: " . .' - :..:- • ''' ' JCO3.‘Skii:INFORMATION A.ND.LOG,AiI6 ,' .' • . • ,'. • ' - Heating/cooling:
Air conditioning
Job site address: 10840 SW BLACK DIAMOND WAY (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) I 46.75 46.75
City/State/ZIP: TIGARD OR 97223
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg/apt, no.: I Project name: #29898 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:
1 Lot no.:
Other: 23.32
.
Tax map/parcel no.:
Other fuel appliances:
• : ' : ':' - i-
DESCRIPTION ;:", !,' .'.' :' .'.';',::... :.:'. : " .'":' ' Water heater 23.32
' • • • . . .. ... ,
Gas fireplace 33.39
PUSI FURNACE
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
•
_Wood/pellet -
Wood/pellet stove 33.39
- , .
Wood fireplace/insert 23 32
..• ' .: •-:.::':''• Ig::PROPERTY :OW 'I' ;:. ' :: 4 :1. : ; "-,'' : '''...'. 2:•-'''' Chimney/liner/flue/vent 23.32
Other: 23.32
Name: JON PERRIN
_
_Environmental exhaust and ventilation:
Address: 10840 SW BLACK DIAMOND WAY Range hood/other kitchen
. equipment _ , 33.39
City/State/ZIP: TIGARD OR 97223
Clothes dryer exhaust 3,3
Single-duct exhaust (bathrooms,
Phone: (503)997-0806 Fax: ( )
toilet compartments, utility rooms) 23.32
• • ' - ' t . ' . 0
APPLICANT ': ' F '''.1:' ::•.,''...: i-•; ' :,- :„ 'ID 'CO1NtA.CT .: '.. . Attic/crawlspace fans 23.32
Business name: ANCTIL HEATING & COOLING Other:
Fuel pipi 23.32
ping:
Contact name: CHRISTINE BARTON
$14.15 for first four; $4.03 for each additional
Address: 4320 N WILLIAMS AVENUE Furnace, etc.
Gas heat pump
City/State/ZIP: PORTLAND OR 97217
Wall/suspended/unit heater
Phone: (503) 281-0752 Fax: : (503) 282-5722 Water heater
— Fireplace
E-mail: INSTALL®ANCTILHVAC.COM
-
Range
CONTRACTOR Barbecue
Business name: ANCTIL HEATING & COOLING Clothes dryer (gas)
Other:
Address: SAME AS ABOVE
,,1 F EES .-:'•: ,:...:.:''.:::. 1. ' .
City/State/ZIP:
Subtotal '((,,"1"
Minimum permit fee ($90.00) 1,0 ..C.10
Phone: ( ) ! Fax: ( )
Plan review (25% of permit fee)
CCB lic.:
State surcharge (12% of permit fee) 1 1
TOTAL PERMIT FEE 1, .) .
Authorized
. .
application expires if a permit is not obtained within 180
signafure:UMP This permit days after it has been accepted as complete.
Print name: CHRISTINE BARTON I Date: 1/17/12 I • Fee methodology set by Tri-County Building Industry Service Board
1:1.Bui !ding \PermitsWEEC-PerrnitApp.doc 09/09/10 440-4617T (I I /02/COM/WEB)