Permit CITY OF TIGARD MECHANICAL PERMIT
$ COMMUNITY DEVELOPMENT Permit #: MEC2012 -00265
T [ G A R fl 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012
Parcel: 25111 DC06600
Jurisdiction: Tigard
Site address: 9470 SW BRENTWOOD PL
Project: Adams Subdivision: SUMMERFIELD NO.9 Lot: 498
Project Description: Furnace and NC Must meet minimum 5 side yard setback and approved rear yard setback
Contractor: BULL MOUNTAIN MECHANICAL Owner: ADAMS, ROSALEE A
13580 SW RHETT CT 15685 SW 116TH AVE APT 189
TIGARD, OR 97224 KING CITY, OR 97224
PHONE: 503 - 612 -6677 PHONE: 503 - 684 -9382
FAX: 503 - 692 -3084
FEES
Specifics: Description Date Amount
Air Conditioning 05/22/2012 $46.75
Type of Use: SF Furnaces < 100K BTU 05/22/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/22/2012 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
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: 1 h J ` 1� Permittee Signature: OAJ A- P�C4�Qg
yyy'rr' LLL/// v�,Cv� C
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.
S
From: ' 05/21/2012 10:30 11839 P.001/003
REC
Mechanical Permit Application roc on icy; usl. ( )NI.1
MAY 21 2012 ,
City of Tigard C i� q a Date/By A , 14, se Permit No. �? - DP.- 0644P
.16 i 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGA '
Phone: 503.718.2439 Fax: 503.598.1960 BUILD/" ,.;, • Other Permit
1 c. n r; i� Inspection tine: 503.639.4)75 D :A, MIS I t h •. T . Ready/By: M See Page 2 for
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8� 8o NotifiedlMethod: 62 Supplemeatalloformatkn
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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.
.l �/,�'�Opp��ZOF 7"w 017011: l•! •' ` late Value: $
C - "Ve 6i �afi'.y c4 ka; OVA Ted ...•. A -w ." I� %�
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building T For ,pedal Information use checklist.
❑ Multi- family ❑ Master builder ❑ Other Description I Qty. I F.e. I Total
M §. o s 1 r as i` t; =` "' Heatine/coolinx:
Air conditioning
Job site address: 9470 SW Brentwood Place (rertutas she plan showhut etexmeas) 1 . 46.75 46.75
City/State/ZIP: Tigard, OR 97214 Furnace 100,000 BTU (ducts/vests) 1 46.75 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
SuitelbldgJapt. no.: I Project name: Adams Hi pan 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 I Flue/vmt for any of above 23.32 no.:
Other 23.32
Tax map/parcel no.: Other fad appliances:
��' 00,�';�, ��f P*N-lei 1"if a 177, ' . � � ! pg • .
,�? <�,µ_��!� c = � �,�r Water heater 23.32 �
�... �.,... � a xkri � inw 9e.G
Replace furnace, coil & air conditioner Gas fireplace/inset 33.39
�"
Flue vent for water heater or gas
Ai p nie_ fireplace 23.32
Lox lighter (Etas) 23.32
Wood/pellet stove 33.39
Wood frephxefmsert 23.32
r r - f r r r tom s , 4# a '°I c r /liner/flue/vent 23.32
4a' , `w`'� �.$ = =� -� � � ..zxv ?� ..� ,1 G a ti.r'rvte � i 11 W � c o .:,£�:
Other: 23.32
Name: Rosalee Adams Environmental exhaust and ventilation:
Address: 15685 SW 116 Avenue #189 Range kitchen
equipment 3339
City /State/ZIP: King City, OR 97224 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone (503)6849382 Fax: ( ) toilet compartments, utility rooms) 23.32
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,=� � : s;, Attie%tawlspaceferns 2332 •
Business name: Other - 23.32
Fuel piping:
_ Contact name: S14.15 for first four; S4.03 for each additional
Address:
City /StateJZIP: Gas heat pump '
wall/sut retie mit beater
Phone: ( ) I Fax: : ( ) Water heater
E-mail: Fireplace
Range
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... w.: �. < , ` i ? >... :4- .- !`.��d -[.r !l . ? ,,.', .tar K F' r - 'C. Barbecue
Business name: Bull Mountain Heating Clothes dryer (ms)
Other.
Address: 6520 Rosewood Street f , • •r- 7 ..
r i a y �R m � �, �T. Y__ ,__. I r oYti1 tv � _? ;il.iLl? a 1 e - r m -
City/State/ZIP: Lake Oswego, OR 97035 Subtotal 93.50
•
Phone: (503) 6126677 ` I Fax: (503) 6923084 Minimum p fee permit fee)
ll� \\ Plan review (25% of permit fee)
Cal lic.: 157814 'j\ State surcharge (12% of permit fee)
TOTAL PERMIT FEE 104.72 �!
Authorized signs This pmt ce expires If a permit b co nit obtained within I80
days agar ft hu bees ac cepted ere lapkte.
I Print name: Jack use I Date: 05/14/12 I • Fee methodology set by Tri-County Building industry Service Board
r: 1®0&g'Permi411EC- c 03/07/12 440.46171 (11/02/00Id/WEB) j
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