Permit ti
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Pe
COMMUNITY MEC2012 -00359
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2012
Parcel: 1 S125DC06300
Jurisdiction: Tigard
Site address: 7261 SW SHADY PL
Project: Phillips Subdivision: ASH CREEK GATES Lot: 5
Project Description: (1) Heat Pump
Contractor: HYBRID HEATING & AIR CONDITIONING CO. Owner: PHILLIPS, VAL
PO BOX 329 7261 SW SHADY PL
CORNELIUS, OR 97113 TIGARD, OR 97223
PHONE: 503 - 357 -5663 PHONE: 503 -693 -8690
FAX: 503 - 357 -0668
FEES
Specifics: Description Date Amount
Heat Pump 07/12/2012 $61.06
Type of Use: SF 12% State Surcharge - Mechanical 07/12/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 07/12/2012 $28.94
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
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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: "aotAkiti C J Permittee Signature: Md p10/e4 7
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.
Mechanical Permit Appllca R
EC; IVE FOR OFFICE USE ON'L.1'
IN-- City of Tigard JUL 1 1 2012 Received ? / Z Permit N • C, J 0
11 13125 SW Hall Blvd.. Tigard, OR 977 Plan Review
Phone: 503.639.4171 Fax: 503.59 0' ; r o f 1IGARD pue/gy; Other Permit:
ii,.; is i i Inspection Line: 503.639.4175 D ' ��, n' � � �� f �� � Date Ready/By! ti! see Page 2 for .
Internet; www.tigard or.gov g! 4IV Notified/Method: lEal Supplemental Information
TYPE OF WORK COMMFRCMAL; FEE : SCHEDULE - USE C,IIECKLIST
- ❑New construction Addition /alie ration /replacement Mechanical permit fees• are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, eq ipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value_ •
,.� RESIDENTIAL / SYSTEMS FEES*
YJ I - and 2- family dwelling Q m
Comercial/induStrial ❑ Accessory building for special information use checklist.
❑ Multi - family ❑ Master builder 0 Other: Description I Qty. I Ea. T Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 9 / . Air conditioning
_ ��/ (requires site plan showing placement 46.75
City/State/ZIP: ---7 Furnace 100,000 BTU (ducts/vents) 46.75
' Qp i �� / p� 7°2 Furnace 100,000+ BTU (duets/vanes) , 54.91
Suite/bldgJapt. no.: Project name: Pm; 1 9 Heat um P / 61.06 , 41-0c
D
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
•DESCRIDTION OF WORK Water heater _ 23.32 ,
�� Gas fleo 33.39 .
Flue veent t for water heater en vas
fireplace 23.32
- Log lighter (gas) 23.32
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Wood/pellet stove 33.39
Wood fireplace/insert 23.32 , '
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� PROTERTY OWNER I,] IENANTOWNER �] T Chimney/liner /flue/vent i 23.32 •
Other 2
Name: Y AL 7A 7 ]//- o 6 Environmental exhaust and ventilation
Address; 724/ ) ..had 0 Range hood/other kitchen
equipment 33.39
City/State/ZIP: --F 4'rek _ A2 g 'aa„3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: () 4 4 j — g' ( QQ 1 Fax ( ) toilet compartments, utility rooms) 23.32 " '
❑ APPLICANT -a CONTACT PERSON Attic/crawispace fans 23.32
Business name: Other. , 23.2
Fuel piping
Contact name: S14.15 for first four 54.03 for each additional
Address: Furnace, etc.
Gas heat pump_
City/State/ZIP: Wall /suspended/unit heater
Phone: ( ) J Fax: : ( )
Water heater •
Fireplace ,
E -mail: Range
CONTRACTOR Barbecue •
ry
J // d ` Clothes dryer (gas)
Beeriness name: ,� � y / fj Other,
Address: tJ 3 9 MECHANICAL PERMrf FE •
City /State/ZIP: Pty /76 u 5 €0 ! 7 //3 Subtotal ^ 4, 0 4
Minimum permit fee (590.00) fd- -
Phone: 3) 35 7— 66 3 I Fax: (a3) B5rr Q d,6 Plan review (25% of permit fee)
✓L�CB lic.: /1 7 State surcharge (1 of permit fee) � /0.. tO • TOTAL PERMIT FEE /00. g p
'Ibis p ermit 2ppliotioo expires if a permit is not obtained within 180
Authorized signature: days after it bas been accepted as complete.
Print name: C rl� A.,,,,, ` Date: 1/2 • fee methodology set by Tri .County Building Industry Service Board
1: 113uildinglPermitstMEC •PermitApp.doc 10/01/09 440.4617T(II /02/COMIWEB)
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Hybrid Heating & Air Conditioning
McClenny / RIX
• Refrigeration / Heating / Cooling
P. 0. Bois 329 -230 Baseline - Cornelius, Oregon 97113 Office 503- 357 -5663 Fax 503 357 -0668
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SOTS -- Please show the following on the site plan;
Location of Indoor Unit and Outdoor Unit
Indicate how the iiue will be run (thru the root -- out the sidewail — etc)
!rd ca:e with do lire i,cw the lineset will be run and ap distance
Indicate how the condensate will be run •
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Hybrid Heating & Air Conditioning
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McClenny RHC
P. O. Box 329
Cornelius, Or 97113
Phone: 503- 357 -5663
Fax: 503 - 357 -0668
Fax Ngeidev14-
J t rr i �.f " •¢(2T Franc Hybrid Heating & NC may" eenkrt
Date to
Pages incl. Cover.
Fax: 5 0 3 - $�9 � -) 9 6 • CC:
Urgent For Review Please Comment Please Reply Please Recycle
•Comments: G haS B ietts2. JK � (14:c4 (14:c4 G`C . 4 •
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