Permit , CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00168
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/03/2012
. Parcel: 1 S136CB07000
Jurisdiction: Tigard
Site address: 11207 SW 81ST AVE
Project: Ford Subdivision: HERB AND PEGGIE'S PLACE Lot: 13
Project Description: Replace furnace and revise vent to water heater.
Contractor: ANCTIL HEATING & COOLING Owner: FORD, MIKE & STACY
4320 N WILLIAMS AVE 11207 SW 81ST AVE
PORTLAND, OR 97217 PORTLAND, OR 97223
PHONE: 503 - 281 -0752 PHONE: 503 - 780 -8319
FAX: 503 - 282 -5722
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/03/2012 $46.75
Type of Use: SF Chimney /Liner /FlueNent - 04/03/2012 $23.32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 04/03/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 04/03/2012 $19.93
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: �� , / Permittee Signature: .°A.) ( l�
/ e,y SON
111��� 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.
•
04/02/2012 14:40 FAX 5032825722 Anctil Heating & Cooling (N001/0002
Mechanical Permit Appli ,.: U . � FOR OFFICE USE ONLY
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City of Tigard :� � ,. Re eB y: ceived 2.A69 ,:� it No.* i/a DD .I
13125 SW Hall Blvd Tigard, OR 97223
: _ :. Plan Review
Phone: 503.718.2439 Fax: 503.598. R 3 2012 Date�Oy: Other Permit:
TIGARD Inspection Line: 503.639 Date Ready/By: El See Page 2 for
Internet: www.tigard- or.gov CITY OF TIC) n A . p Notified/Method: Supplemental Information
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Mechanical permit fees are based on the value of the work
❑ New construction ® Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: S
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® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building Forspeeiol information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
-- ,,:: ,, i:::a;:,.r::;:ry" Heahng/cooling:
:I`i� I :.14, I :.':. .,.Y Nil` k' 'r f'i
_ .�.J17✓a : ".o ►i �'_ O�� r. �Vl `.�+?kr1.7 :�� ?1' 11 �, :�1... r A!'d'nl!i�; :F :, ,:
.... .... :. '',. ... r -... ,— ...... � � ._. : :�. :., -... _..r..l� -. . r... :r :I. i, �. -.. .r r . . ,. I.l l.rr r I, rr �D
• : : :...r. :. I',,;..,'h,ii,:;, ::.,.: Atrcondttton
Job site address: 11207 SW 81 AVENUE (requires site plan e showing placement) 46.75
City /State/ZIP: TIGARD OR 97223
Furnace 100,000 BTU (ducts/vents) 1 46.75 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: #40036 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
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
..... ..........* . _ON `' .. .:, ... .i :. .: iM.;: :,';= - Water heater
PUSH/PULL GAS FURNACE Gas fireplace 33.39
Flue vent for water heater or gas
REVISE VENT TO WATER HEATER fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
_ - �x'� ; _ �:: aka :ru - -- -- � : :. _ _ himney/Imer /tludvent 1 23.32
>.:�] �. 'RE��R2;S'' :9Wk�1El(L .-
_ °= �=i•`�. _ tit : :, " =�='.' - -
Other 23.32
Name: MIKE AND STACY FORD Environmental exhaust and ventilation:
Address: 11207 SW 81 AVENUE Range hood/other kitchen
equipment 33.39
City / State/ZIP: TIGARD OR 97223 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)780 -8319 Fax: ( ) toilet compartments, utility rooms) 23.32
'':.:: - - - - 4�$SQhT - w p fans
.� '. APl?i;,I£.a1z'�i� : • , I , _ - � ��U . Attic%ra is ace 23.32
Business name: ANCTI L HEATING AN D COOLING Other 23.32
Fuel piping:
Contact name: CHRISTINE BARTON S14.1S 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
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Barbecue
Business name: ANCTIL HEATING AND COOLING Clothes dryer (gas)
Other:
Address: SAME AS ABOVE j :'r;;-• -•l"r, f.=
City/ State/ZIP: Subtotal
Phone: ( )
Fax: ( ) Minimum permit fee (590.00) e9, ,0-0
Plan review (25% of permit fee)
CCB lic.: 8897 State surcharge (12 °/D of permit fee) /Q .
TOTAL PERMIT FEE /40 . J' � too re l
• r ��\ � � This permit application expires Signature: � � xpires if a permit is not obtained within 180
days after it has been accepted as completer
Print name: CHRISTINE BARTON Date: 4/2/12 • Fee methodology set by Tri- County Building Industry Service Board
Ino,.;l.1;.MD✓,- :,.1\ICP_D.w - :,a ,A:... fCff IIA Ann A <, tri,f Im N•AfJNICDS