Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit: MEC2012 -00394
T [GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/26/2012
Parcel: 2S114BC00200
Jurisdiction: Tigard
Site address: 10065 SW RIVERWOOD LN
Project: Harrison Subdivision: PICK'S LANDING NO.1 Lot: 57
Project Description: (1) NC Push/Pull NC system from R22 to R410A Must be placed within the 5' side yard setback and approved
rear yard setback
Contractor: AAA HEATING & COOLING INC Owner: HARRISON, DORALIENE
5017 NE GRAND AVE 10065 SW RIVERWOOD LN
PORTLAND, OR 97211 TIGARD, OR 97224
PHONE: 503 - 284 -2173 PHONE: 503 - 684 -6129
FAX: 503 - 284 -1552
FEES
Specifics: Description Date Amount
Air Conditioning 07/26/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/26/2012 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 07/26/2012 $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: 4�j i r Permittee Signature: p� A POLE C�OAj
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.
From: 07/26/2012 07:38 #203 P.002/003
Mechanical Permit Application 6 i HA u r r i (T us' r ()NI
I . City of Tigard Received 1 ra-{o (z Cr Permit i�ot:�,0O ,r /qn ���' C�trTY
/-
A C 13125 SW Hall Blvd-, Tigard, OR 97223 J U Z 6 2012 P>eo [ieview ,'�
Phone: 503.718.2439 Fax: 503398.1960 Date/py. Other Permit
i i n ii n inspection line: 503.639.4175 -
Internet www.tigard�r.gov CITY OFTI ° i /B Y' la See Pam: for
BUILDING DIVISI� `�°d �(�'(o s apphme>nal Informant
Ei- ._.,.. - , . M.;.,;.,..1::, ,:t VTYPBypF: WiORK_s „•:, ,r >; _ :; .:;� ODI - ". ,086 rc
Mechanical permit fees* am based on the value of the work
❑ New construction ® Addition /alteration/replaceattertt
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other. mechanical materials, equipment, labor, overhead, and profit.
^'4 Yci '' it`.. _ )i; .r °::g,.> Value:
g . ,;....�.-.-..,:.,. SCAT11101 lh:'OF COPTBI'B><ACIYON' . ;'"�' i-'i'+-�': . M
._ -w: ::.�..,r .,,.,7 %i.z: cs�..., J^i ::................ s � ���.Jr,^r =tier +4 i":�e�x ^i w4�,�u2,:; � - - -- - -e
- .0 m 111011PEN Ai: ppQ �IllAdtT1417118MB'FB�a.'` x :' 4.,x'
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For spedal Information we a ec*I&
❑ Multi family ❑ Master builder ❑ Other
Description I Qty. I Fa. I Total
jT+`.r /i "p,i:'• :.'.i t'i ?A ;�c7i. °` d t - .. _i s 3 ar_ -, ..
,.; : ii ,+ a' i:'vi ?_J� rOH BPI'F, O R1VIA7YQNtiI�11 I:O(1►TI --- _ i `€', ?' „ "- -'"I i A ir c n conditioning
c
ing
•.. ,. . � ' . Air conditioning
Job site address: 10065 SW RIVERWOOD LANE (reaaties aim plan showing placement) 1 46.75 46.75
City/State/ZIP: TIGARD, OREGON. 97224 Furnace 100,000 BTU (ducts/vans) 46.75
Furnace 100,000+ BTU (ducts/ma) _ 54.91
Suite/bldg. /apt no.: l Project name: HARRISON Heat pump
Cross street/directions ctions to job site: NEAR GRRENLAND DRIVE AND RIVERWOOD Duct site plan showing placement) 61.06
LANE Duct work 2332
Hydronic hot water system 23.32
Residential boiler (radiator or
hydmnic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
[ l Flue/vent for any of above 23.32
Lot Lot no.: Other 23.32
Tax rnap/parcel no.: % Other fuel appliances:
,�� ^::n :fF;;rr'}' "g;; � �c'a �EGfi - �. asa!z-•q
S. .R ''F_1°,ii l I - ^m-sa •rte' Water h
.
t�, u r. �J 5,� ?` -� /�} /� p�/y '- '',ir:'�'su /�: " -';•�, s "� _. eats 23.32
u:..'4�. �''4w!k :4:t:::e'.stt�k.F '%.-:l`ioeY.�.ES \'.{/�� nVl'^ {,%i:` 4-
t .:c sem �;�; i';': -` Gas fireplace/insert 3339
PUSH PULL A/C SYSTEM. FROM R22 TO R410A Flue vent for water heater or gas
fireplace 23.32
^ Log lipe ht (gas) 23.32 '
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
w �G,.,�.. ,� / , .: r ..,:.., , <. ... Chimney/liner/flue/vent 23.32 •
i i; : r' {'?cJ7� ®sfP$ o o:f �-y/. '• ?11' �{ia, :-`r ; � 1 . ; � t_l �y �r1� � . ^; •:
$ 7!.^ r, L.p...M:Fi'Jb- _•.��fFlfk:tYL =s. .i .QiTS?;n5fl�. _ _.''•"- +�'...1'hr�''.- _d'�t�t �Q J�., .:1 Other
... :�..g;: =� 2332
Name: DORALINE HARRISON Environmental exhaust and vemtiladon:
Range hood/other kitchen
Address: 10065 SW RIVERWOOD LANE equipment 33.39
City /State/ZIP: TIGARD, OREGON. 97224 Clothes dryer exhaust 33.39
Single -duct admit (bathrooms,
Phone: (503)684-6129 Fax: ( ) toilet compartments, utility moms) 23.32
" w' i ' i' 7 ,: -p ,._ �5-,,-• i. Attichnew a fans
. ,{, z ti6•..�'a;F_. CAM'. :, : g rt -s * ucii r# N h i: ; IBpBC 23.32
Other; 23.32
Business name: AAA HEATING AND COOLING Fad pipfa
Contact name: GEORGE MARTINEZ $14.15 for first four; 64.03 for each additional
Address: 5017 NE GRAND AVE FLloac
- Gas heat pump '
City /StateZIPP: PORTLAND, OREGON. 97211 Wall/suspended/ heater ••
Phoney. (503) 312 -2791 I Fax: : ( ) Water heater I
Fireplace
E -mail: 8aoroNGa 0..a►.et►.■ 4 t. conn Range
,4 fT Tf <F 1, VC�Y ": r <':Yi:.:, Ti:: r ".:.x ;:'i �. i7:: 5,vcr.:,
-'.'fir. 7.•- ; rri ?';',.° - } rx� g sr ',04r�=aS.',u,¢ - :_ BBlbeeae
ti ...:...o-b.. s..oT -z .1. -.. _.. _... :. ,_.. n.i. -,�. i,.,i, . , . .FE;.,."_ G-<a. �, r`'a�:fi i:,'-z?:;- tic ?''rY~;..
Business name: AAA HEATING AND COOLING Clothes dry(gas)
Other
Address: 5017 NE GRAND AVE E- = F HI Vigil_ iFTSSt;.x. ,-•g_aa:Tr:
City/State/ZIP: PORTLAND, OREGON. 97211 Subtotal 46.75 _ -
Minimum permit fee ($90.00) 90.00
Phone: (503) 284 -2173 Fax: ( ) Plan review (25% of permit fee)
.7CCB tic.: 222 State surcharge (12% of permit fee) _ 10.80
TOTAL PERMIT FEE 100.80
Authorized signature: This permit application expires u a permit B not obtained within 180
due after It has been accepted as complete. •
L Print name: GEORGE MART Z I Date: 7 - - 2012 • Fe methodology set by Tai Coaary Building todustry Service Boats
IA BUi1dingTermhe VMffC•Pe'mitApp.doe 03/07/12 4404611r (r l/02/COMIWEB) •
•
From: 07/28/2012 07:38 #203 P.001/003
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
e Payment Authorization Form
13125 SW Hall Blvd. • Tigard, Oregon 97223
T I G A R D Building Division: 503.718.2439 • Planning/Engineering: 503.718.2421
Fax: 503.598.1960 • Internet: Is and-or.. ov
Permit No.:
Job Site Address: 10065 SW RIVERWOOD LANE
Project Name: HARRISON
Credit Card Information: Please pant Beady.
® VISA ❑ MasterCard `/3 56 2.10 S 5639 373 o
Discover (credit card account number)
Expiration date: 05/ y
Cardholder name on card: `Solt S p
Contact phone number: So3- 2.79
Billing address for this card: s i7 Iii 8 rsad. v
Billing ZIP code: 97),..//
c f : For permit fees to be paid bum established trust account
Trust account number:
Contractor /Business name:
Contact phone number:
I
.hereby give the City of Tigard permission to pay for the above referenced
permit with the credit card or trust account provided above.
Authorized Signature:
Name Printed: I/Vlo�r-1 - tz.
Date: 7 /I. 6 /24 t a-
Please FAX this completed and signed form to 503.598.1960.
*** DO NOT EMAIL THIS FORM. ***
For your protection, this form will be destroyed after your payment has been processed.
1: \ Budding \Forma \Payrn ntAuthotizanort_031612doc
From: 07/28/2012 07:38 8203 P.003/003
A it Conditioner /Heat: pu Site Plan
AAA Heating p
eating & Cooling
5017 NE Grand Ave
Portland.,. OR 97211
Jobsite Address: Oohs .L K,v L Ir r‘rei ' 9 zY
Project Name: //
North
West
Ts.rr East
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