Permit CI TY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES PERMIT #: MEC2006 -00470
DATE ISSUED: 10/3/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S135BD-01200
SITE ADDRESS: 09804 SW SHADY LN ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Replace gas pack like for like.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
NAT 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: 1 <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
FORBES, DONALD CAROLYN Description Date Amount
BURDICK, DONALD LINDA
434 RIDGEWAY RD [MECH] Permit Fee 10/3/200E $118.50
LAKE OSWEGO, OR 97034 [TAX] 8% State Surcha 10/3/200E $9.48
Total $127.98
Phone:
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact #: FAX 503 -691 -1879
PRI 503- 692 -1565
Reg #: LIC 5193
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: 6. Permittee Signature • 1 �'
Call 503- 639 -4175 by 7:00 a.m. for inspections t . day.
This permit card shall be kept in a conspicuous place on the job site until co - ' letion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application . FOR OFFICE USE ONLY
City of Tigard Received if r i Permit No.: t .
Datear 0 #' . ii ... 0 0 ..."‘
°U A
13125 SW Hall Blvd, Tigard, OR 97223
• . Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
Date/By: Other Permit:
Inspection Line: 503.639.4175 „Irv. Date Reactyaly: El See Page 2 ter
Internet www.ci.tigard.or.us
Notified/tvfethod: WM Supplemental Information
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0 New constiuction Addition/alteration/replacement Meehanical permit fees* are based On the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other:
mechanical materials, equipment, labor. overhead, and profit
,
'4-W--45431,-'.R.4-0;:i415,--f,itai:;:ti-4.'; -, " , :t 7 i' i zt'Ff'. -. ."7"i r c . f - S - : =1 5 I- -:Y-i'-' : 'FzF ,.. :' 1 .:''7 ; 5=K"4 - AV'T Value: $ • 3 3 90
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Wli, `..`;5"11a14,111,gral,:',',=1.t.C.:=:-VS,
ID 1- and 2-family dwelling I C ommercialfmdustrial 0 Accessory building
. For special infonnation use checklist.
0 Multi 0 Master builder 0 Other:
Description I Q. I Ea. I Total
,..;4W-te•VM-.Tif1174774-Rni,NIVER7Viii-VritiliietTfiiliFW,57t-ef5=U4T'riN- Reefing/cooling
....15,z,t-2:1-4-',..t,,,...,,...- •-st.r.r.;....-' - - ,a.,...111,7,.. ....
Job site address: ..2:50•E - 9i09 e"
, '-, Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: ..27; , ,, i i- - < 9 -- 1 - :' , 2 3 Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: I Project name:
Gas heat pump 14.00
Cross street/directions to job site:
. Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/vent for any of above 10.00
Subdivision: Lot no.:
Other: 10.00
Tax map/parcel no.:
Other fuel appliances
4: i . V 7 M 4 " .. 174 talWIS,` .6 • " .f•gigp - R . WZW : t I k7.0.,i,'--':4-4 Water heater 10.00
, 0 i , ■
Gas fireplace 10.00
R . .. i, 1 uL_t_. : ,e_6-7,1,„ Li .)e.5..,-As 10,4 c...i< r Flue vent for water heater or gas
.
-
/ •-'
..,
" _ fireplace 10.00
Pe-4;
L/ - /' ,-/` ." Leg lighter 10.00
, f
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(..._ .. e■ :-_, .. 4 7 le?Ai Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Chimney/liner/flue/vent 10.00
ISM....,:a-439"kk.TirdEgst:23-.Mtal..7.---..fjr.---' PAWIrg*Eatta other 10.00
Name:
5 - z.477 I-0: t.. ir:t7%. ../.... A, ) V;, f .-7- Environmental exhaust and ventilation
--,
Range hood/other kitchen
Address: (.../3 :•-.1 Li ;.71(,„„,et",/,„( / R 0
equipment 10.00
City/State/ZIP: /.., ,---‘ :,:e t7: ,....',/ Cf,42 Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( S ) '7 "e„,„ - II A)3 Fax: ( ) toilet compartments, utility rooms) 6.80
i 'W.d:a..,TaWi.WIraraittly,SW,-.:'...24.:g*WWW-gitlAirf:Mti2;t1;44.- ' Attielcrawlspace fans 10.00
;.401,,rr .' , .Mm-,,kY...L".;.,. 4 7Fe.-a..:.. '''.: '."‘ th' . ' Al v.t.:, -,t.... '3..6„..k,„. ' •-z
Other 10.00
Business name: A /.-4 ,, ikii:',' - 3 , --4 4 ,V/CVie..
Fuel piping
---
Contact name: 1 ,,,, f -„,,,, ,r .,,,,,,-.3, $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: i, ••••• 3 '-' , <1 -7 i _ 4 7-; / A I eo
Gas heat pump
I ,..--- -
City/State/ZIP: ••• 4 / 4-7 ., ( i...... - >e ) R 97 C. :2, I
Wall/suspended/unit heater
Fax: : ( ., . ) / . ti i / -- (13 -- 9 Water heater
Fireplace
E-mail:
Range
:•. . tr,:. rsI kri -4- .. 72101. :" " M ") i - F - ii - MV-Wa ,. . 7, -MkiNffi:V. : 2 3 -1...1 .- "ii,z1-7. B ar b ecue
• •.4. Z.M..t.Z.,-Z..... 3 . 31 . - x•-•- -- i - aft&. - •. - -7.--..&, ...... '1-7-ar-,,:V-Y.----:',..3311,41COZa.'"::::4-'a
Business name: it rz /2 ?). L-N/ Clothes dryer (gas)
Other
•
Address:
-- •.' 1
-Cz.r-
City/State/ZIP: ._21. t'.:.• . V L-..=
• Subtotal // • ., r."
4 • Minimum permit fee ($72.50)
Phone: ( ) I Fax ( ) . r
Plan review (25% of permit fee)
CCB lie.: ,
-. -
<--- '`' '
State surcharge (8% of permit fee) 7. til
Authorized :
c / I , 1 .-_ • i TOTAL PERMIT FEE
This permit application expires If a permit Is not obtained within 180
signature
days after ft has been accepted as complete.
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