Permit CITY OF TIGARD MECHANICAL PERMIT
s : COMMUNITY DEVELOPMENT Permit #: MEC2012 -00684
T F G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/27/2012
Parcel: 2S110DD06100
Jurisdiction: Tigard
Site address: 10635 SW HIGHLAND DR
Project: Tucker Subdivision: SUMMERFIELD NO.4 Lot: 161
Project Description: (1) gas furnace push, pull installation
Contractor: ANCTIL HEATING & COOLING Owner: TUCKER, FRANK L
4320 N WILLIAMS AVE 10635 SW HIGHLAND DR
PORTLAND, OR 97217 TIGARD, OR 97224
PHONE: 503 - 281 -0752 PHONE: 503 - 639 -6974
FAX: 503 - 282 -5722
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/27/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/27/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/27/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: J , ' '4j,,r Permittee Signature ok+ i0PL eil. 0 1.E
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Applica ttEcEIVED
11 vv ,�� I I1R rlE FI(i, [ �l 11\11 City of Tigard Received
: • 13125 SW Hall Blvd., Tigard, OR 97223 Y 0.1 ( a - k -..- Permit No.: �,(�/► �/� _ DOlof
Phone: 503.718.2439 Fax: 503.598.196 L C 27 Q t R
TIC,? RD
Inspection Line: 503.639.4175 /$r• Other Pamtr.
Internet www ttgard - gov Date Ready/By: AM,: l f See Page 2 for
CITY Notified/Method:
1 larerm, non
BUIImgplyts1 N
7 ,,
I , , „ Supplemental
❑ New construction ►�� Addition/alteration/replacement Mechanical permit fees` are based on the value of the work
ID Demolition ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all
- c f f �� � � t mechanical materials, � Val verh P
;;HH,, equipment, labor, overhead, and profit
u
® 1 -and 2-family dwelling „_,... ; . R S 7 .. .:.... . ite.
Y g ❑ Commercial/industrial ❑ Accessory building • For special information use checklist
❑ Multi- family ❑ Master builder
Other:
Qty Ea I Total
&t6 s, tfif - s"#"1ikeai .._; "4"441""'''''""-^''''''",'''''•,•"''''''• � nn cooli : • Job site address: 10635 SW Highland Dr (requires site conditioning pin
e plan showing placement) 46.75
City/ State/ZIP: Tigard, OR 97224 Furnace 100,000 BTU (ducts/vents) 1 46,75
Furnace 100,000+ BTU (ducts/venu) 54.91
Suite/bldg. /apt. no.: I Project name: 40518 / Tucker Heat pump "
Cross street/directions to job site: (requires site plan showing placement) 61.06
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
Tax map /parcel no.: Other: 23.32
Other fuel appliances:
. ,. ..... * .. ,. .. 4 ,`' . a a:. Wafer heater _ 23.32
Push, pull gas furnace installation.
Gas fireplace l 33.39
Flue vent for water heater or gas
fireplace _ 23.32
Log lighter (gas) 23.32
"
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
:*OS 1'Y.' !' > 1•= Chimney/liner /flue/vent
-<;' 23.32
Name: Frank Tucker Other 23.32
Environmental exhaust and ventitaton:
Address: 10635 SW Highland Dr Range hood/other kitchen
equipment 33.39
City/State/ZIP: Tigard, OR 97224 _Clothes dryer exhaust 33.39
Phone: (503)639 -6974 Fax (503) Single duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
:: x - � a st _
. ,. .:..:. .. �..,.... ..t'`d , '.��i,.= ��;,..� _,,.N AttirJcrawispace 23.32
Business name: Anctil Heating and Cooling Other. 23.32
Contact name: Brian P Murphy
Fuel piping:
S14.15 for first four; 54.03 for each additional
Address: 4320 N Williams Ave , Furnace, etc.
City/ State/ZIP: Portland, OR 97217 Gas heat pump _
Wall/suspended/unit heater
Phone: (503) 281 -0752 1 Fax: : (503) 282 -5722 Water heater
E -mail: brian@anctilhvac.com _Fireplace
ai
pp Range
��, ......- '`. ., ,: ,.. .l.ro,.. a �i.,...' Barbecue
Business name: Same as Above Clothes dryer (gas)
Address: Other:
.
City/ State/ZIP: S
I ,
f -
_ i ;#j* . :::: . "W
Subtotal
Phone: ( ) F es: ( ) Minimum permit fee ($90.00)
CCB lie.: 8897
Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: tiP�� This TOTAL PERMIT FEE 100.80
permit application expires if a permit is obtaiethin 180
days after it has bees a ccepted as not complented within .
Print name: Brian P Murphy I Date: 12 - - 2012 I ' Fee methodology set by Tri- County Building Industry Service Board
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