Permit q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Pe COMMUNITY MEC2012 -00309
T WA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
Parcel: 2S 104AA05800
Jurisdiction: Tigard
Site address: 12750 SW WILLS PL
Project: Harstad Subdivision: BELLWOOD NO.2 Lot: 79
Project Description: Install (1) NC, (1) furnace Must meet minimum 5' side yard setback and approved rear yard setback
Contractor: SUNSET HEATING & COOLING Owner: HARSTAD, CHERYL L
0607 SW IDAHO ST 12750 SW WILLS PL
PORTLAND, OR 97239 TIGARD, OR 97223
PHONE: 503 - 234 -0611 PHONE:
FAX: 503 - 234 -0439
FEES
Specifics: Description Date Amount
Air Conditioning 06/11/2012 $46.75
Type of Use: SF Furnaces < 100K BTU 06/11/2012 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 06/11/2012 $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: / , / Permittee Signature: o A'PPq v /f t c � i
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.
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Mech Permit licati ECtivtt FOR OFFICE USE ONLY ea-
City of Tigard . Indirect Pamir No. - - '''oo II
JUN 0 7 2012 Datc/By: • 1 2,...-
IN 13125 SW Hall • Blvd., Tigard, OR 97223 Pkm Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TR;ARD inspection Line; 503.639.4175. CITY OF TIGARD Dsto Ready/@y Sec Page 2 far
Internet. svww.tigar4.9r.gcm ' BUILDING DIVISION Notified/Method: . cer $npplemental Information
• '
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El New construction gAtiditionialtoration/replacement performed. Indicate dm value (rounded to the nearest dollar) of all
Ei Demolition 0 Other: mechanical materials. equipment, labor, overhead, and profit
. . :' • • • '' ; " ..* '; • : : :'' .....tIttobit.V.42)VigODIS'ElitletiON• • ."•••. ' '
-, ' '• ••:' . . ' • ' • Value: $
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p 1- and 2-family dwelling 0 Commercial/indUstrial 0 Accessory building F N odal information use checklist.
0 Multi-family 0 Master builder 0 Other: Descr iiion En. I Total
::......' : -` . ::::.: •',;‘,': lie tff,/1 cooling
Job site address: / .3.-750 514) 10 j a,
UirCA Si 10 tan Amin Incoment 46.75
City/State/ZIP: " Ar . @-/g-2-3 Furnace 100,000 BTU (ducts/writs) 46.75
- Furnace 100,0001- BTU (dactvivants) 54,91
Suite/bIdgJapt. no.: Project name: 61,06
Heat pump
Cross street/directions to job site: Duet work 23.32
klydronie hot water sYstem 23,32
_ Residential.boiler (radiator or
hydronic) • 23.32
- Unit heaters (fuel-type, not electric),
• 7- in-wall, in-duct, suspended. etc. 46.75
Flue/vent for any of above 23.32 .
Subdivision: Lot no.:
. Other: 23.32
— , —
Tax map/parcel no.: . Other fad appliances
• " • iii44 Water heater
-Kr .'••••!••... ; • -:v s.::...- .:..i:
,..........::;,,. i.-: ..:•7i•Y.,;::•...:••IiirsejittiNqOr7,Vit KM' "• • '-' ! • ','•' ' ' ' ;:'•• 1 . . - ' ' !' .' • . • ' 3339
23,32
•
q_e_ateX___I-- Ale--' , Flue vent for water heater ot gas
fireplace . 23.32 .
Log lighter (gas)
Wood/pellet stove 33.39
. Wood fisAace/insert 23.32
Chimney/liner/flue/vent 23.32
,'. '• . .':'•:' : : a ::••: Other. 23.32
—
Name: Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 33.39
City/State/ZIP: Clothes km exhaust 33.39
, Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility moms) 23.32
';' ..1..'-`1.4;i 0-S'..=.: '?..'?2•44'c.: 2332 Other: I 23.32
Business name: . • , Peel .1.1n•
Contact name: • _ $14.15 for first four; $4.03 for each additional
Furnaceat._
Address: (ilui heat pump
•
City/State/Z1P: Wall/sus_yendcd/unit heater
Phone: ( ) . Fax: : ( ) Water heater
Fireplace
E-mail: . , , . ItLzu et •
: ' .. • • • : . . ' ''':',...!..,. ' •.' • Barbecue
::"'w"-:..0tbiOlikijtijiC'::':: '‘: ' :':: :". :....;.::::
Clothc__
Business name: S'I.s.trl Set l y Cr.D Ill Otter;
Address : CAC 01 5 klt.) 1 44.4t0 ,Sirek.:1 . 7.? ' • :.rl'.V:'.....:•e;'Natf .•4 4 1 . ':. ::: :'...•.'' ' : '. :: .
CitY/StattarP: p 044.1 VIZ 07 '1 31 Subtotal 3 . CO
Minimum permit fee ($90.00)
Phone: (ct.$:)) 234-tip i I Fax: (503 ) l 34 - 0_9:-1 Plan review (25% of vomit fee)
/CCM lie.: IV! C/5 .. . . State surcharge (12% of permit fee) j i.
', - • • . —
TOTAL PERMIT FEE 1,1 .1 7 - ol
Authorized signature. Gt;41(41?
Thk permit application expires if a permit it not obtained within 150
days a ft er It b b een incepted tet complete.
Print namc: C4vt441 Rejet.• J Date: 1.4/1112., • Fee methodology oet by Tri-Connty Budding Industry Service Board
1 . 440.4617 (i lievcomiwrin
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DIRECTION
Name & Address: • •
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