Permit CITY OF TIGARD MECHANICAL PERMIT
• - COMMUNITY DEVELOPMENT Permit #: MEC2012 -00416
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/07/2012
Parcel: 1 S133DB12300
Jurisdiction: Tigard
Site address: 11381 SW PALM PL
Project: Ford Subdivlsion:3CHOLLS FERRY ROAD TOWNHOME; Lot: 49
Project Description: (1) push/pull gas furnace installation
Contractor: A TEMP HEATING & COOLING INC Owner: FORD, BYRON E
16000 SE EVELYN ST FORD, PATRICK N
CLACKAMAS, OR 97015 -9519 11381 SW PALM PL
PORTLAND, OR 97223
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 08/07/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 08/07/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 08/07/2012 $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: G�I Permittee Signature: D � APP�i 64 77 0/1L
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.
Application RECEWED
Mechanical Permit A ( ) <, t
UD i i, i i i t. t ..t. t,nl.\
City of Tigard AUG 0 7 201Z nos Permit Nom : G 13125 SW p P hasic 03. 2 Fax: pan eW
03 598 960 O�LerPnrmic:
_ Ti C Bey: Dae - Inspection
,. Lino; , 75 BUILDING DIVISIO Na lUatlY/BY IM S + Z fur �PPtat tarormattoo
rlir�!laa iq�o8lEt c :? s 7 t?4...1 : 407
' .:. -• .... .. 3
El New construction �A dtliliodalteratiion !replacement Mechanical permit fees' arc based °a the value ((the work
performed Indicate the value (rounded to the nearest dollar) of all
Demolition ❑ Other. , mechanical materials. equipment labor. overhead. and profit ,
... . Value: Sy
CRY 9F .ON
$j 1- and 2- family dwelling ❑ Coinme cial/indusir ial ❑ Accessory building For rpeckalJDAlrmdlae sae chadrlox
❑ Multi- family ❑ Master builder 0 Other: Description 1 qty. I Ea. 1 Total
athuskoanae:
H
- e
JOB 917 A mAR ( 1 � 1 f h n A 1l TY9 AND . !I co ditioning
Job site address: 1 1 3 5 N
/ 1 `i P '1 M `r V 1 A.Cr/ ,,.........i.. 6
475
z>P: T ►� i dl � 2 Furnace 100,000 BTU (duets/vears) ! 46.75 , w
City/State/ZIP;
� , - Furnace 100,000+ fl'ru (dncd/..nma) 54.91
Suite/bldgJapt. no.: I Project name: re C elk Heat lip
(tcq.atm site plan abowie plucct) - 61.06
Cross street/directions to job site: Duct work _ 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydroaic) 23.32
. Unit beaters (fuel -type, not electric).
in -wall, in -duct. saepended eta. 46.75
Subdivision no.: flue/veut for any of above 2332
Other 23.32
Tax map/parcel no.: Other t appliancesappliances: 23 32
-
_ (147- .. . . : ..: Vi+ater boat
p li r h i e 11 6 V`S +.J rA � n . � 1 t Fht vept fo water hea ter or sae 33.34
fireplace 23.32
Log lighter (pus) - 23.32
Wood/pedlar nova 33_39
Wood fireplace /desert 23.32.
:...:<. ••• Chi�ey 8ur/vem 2332
Other
Name: g Con y j A � exhaust and ve on
Address: 3 v V ' &1 AN , ` t , Range hood/other kitchen
equipment 33.39
City /State&ZIP: 1"I Bk 04 : 1 pa 4 7:2 Clothes dryer cld3auet 33.39
J v • Single-duct eshauat(buthrooms,
Phone: ( )) • I Fax: ( ) rooms) aomparttuents,
"" : APP14:0Arr : : sir PERSON �awdspace fens
:�� .. , p j ,� ' •. , � Add ict/ 23.32
Busin name: Otba: . 23.32
' 4ZSRP LiCA�thw T/1 Alin ,+r em ie ,Iiosd
Contact name: 16000 5E a . St. $14.15 for first Cour $4.03 fin each additional
Addriner
11172 r ..,, ; el • • I Furnace, etc -
503.650.5014 Gas heat pump
City /State/ZIP: waves intent heaps ,
Phone: ( ) ileA Fax : 9 ) 554.- 2','t 0 Water heat t „ p,
Fireplace
NT AS.T . flatboat°
Business name: ATEMP AND COOT TNfi, Other: drier Z
m�:
Address: 16000 SE Evelyn St. . : D 3 ) g+ .. ... a A [e14rnuT -.... .
City/SteralZIP Cdsh, •011-97015 t�abtatr,t Ts(1). � Phone: ( ) Pax: 6 2 L Ct 0 M; r e view permit fee ($90.00) _o v
Flu review (2596 of?°r°°it foe)
CCB lid.: 1., Q �� State surcharge (12% of permit fee) j 0 . $
UU TOTAL PERMIT FEE , f 0-
Authorized /*:.. : � _� Thi permit application =pines if. permit is out abtslaed wiit ein 150
days alter it has been accepted a complete.
Print name: ^U 1 / Date: .. e Foe mothodolow sot by Td- County Building industry Se vice Booed
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