Permit C ITY OF TIGARD MECHANICAL PERMIT
DEVELOPMENT SERVICES la
I v�sPA PERMIT #: MEC2006 -00497
Wi ° �I II 13125 SW H ll Blvd. Ti and OR 97223 503 - 639 -417 DATE ISSUED: 10/17/2006
a g PARCEL: 2S102BC -00112
SITE ADDRESS: 12550 SW BROOKSIDE AVE ZONING: R -4.5
SUBDIVISION: WALNUT ACRES LOT: 011 JURISDICTION: TIG
Project Description: AC add.
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN:
ELE 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: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
OLSON, KERMIT E /MARILYN J Description Date Amount
12550 SW BROOKSIDE
TIGARD, OR 97223 [MECH] Permit Fee 10/17/20( $72.50
[TAX] 8% State Surcha 10/17/20( $5.80
Total $78.30
Phone: 503- 639 -7278
Contractor:
CHASE HEATING CO
2236 NE 82ND AVENUE
PORTLAND, OR 97220 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 254 -1274
FAX 503- 254 -1816
Reg #: LIC 153390
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: 3 LL Permittee Signature: (7)-- Y_• e
Call 503 - 639 -4175 by 7:00 a.m. for inspections that business day.
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.
4t3ise 0 ': •
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Mechanical Penult Application. - . : 1.9 OFFI( 1. 1 "F (YNIA
Cit.' of Tigard r........... ,"
Date/13y: / '-' / ‘ 10 Peoria-go rf . "TO zegy
• 13125 sW Halt Blvd., Tigard, OR 97223 Flan Review
Phwie: 503.639.4171 Fax' 503.598.1960 other Permit
,,4 '.
Inspection Line: 503.639.4175 iont.-- 10 see rase 2 tar
Internet: www.citigard.orms -/ J'i,...,' - .7 t... ....y: od , i
soppisossatai Information
•
' , .':'.•; 7 7 : 00* - 000.00.020•UjOk., - . ,....... ,-,, -.4j-,':
. ' ' ''''' " ' ' ••••• * ' -"' '' '':''.
1
0 NeW construction Addition/aiterationfreplacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition. 0 Other: mechanical materials, equipment, labor, overhead, toad profn.
Value: S
N 1- and 2-family dwelling 0 Cotmnercial/badustrial 0 Accessory building
For special nifiontation use checklist.
0 Multi-family 0 Master builder 0 Other Description I Qty j Ea_ f Total
4i4i31W45 • ;;;;;1:.:4;:!;:.:41;!..,,.,,M meatirowoug
Aix conditiOning Or heal PoulP
Job site adrb \ 5b 6 u 3 R■ )p,-.6e IA U.C (requiter site plan showing placement) I 14.00 1
City/State/2TP: -- \ --. 30, , i- t ..k ag R1 ap.3 Furnace 100,000 BTU ducts/vents 14.00 - „.
1 Furnace 100,0004- BTU (duets/yeas) 17.90
_ Suite/bldg./apt. uo.: Project mum: 3 I. i5 D._ CiaS heal 'urn' 14.00
Crass street/directions to job site: ' Duet work 14.00
Ilydronie hot water system 14.00
Rzsiclert dial boiler (radiator or
*drank) 14,00
Unit heaters (fucl not electric),
in-wall, in-duct, suspended, etc. 10.00
Flue/rear for an of above 10.00
Subdivision: I Lot no.: ...., „ - --
Other 10.00
Tax map/pareel rto_: Other fuel a . . Lames
450ojimott** Water heater la(K)
Gas Rrepiace 10,00
4 \ C tL. °i•Ce/ Flue vent (Or water heater or gas
fire . lace 10.00
Log lightet (gas) 10.00
Wood/pellet stove 10.00
Wood fireplaca/insert 10.00
, ,, ,,,, ,,„. ,,,,, ,, , , „,,,, ,, ,e. , ,v; „,i..::z , ... i;. .,-, ‘r • • I .,.- - , - ' ,1 r , A.' ,`, chher 10.00
Name: \\X 13...v jov i ( . \ 1 \ ,
Environmental exhaust and ventilation -I
Range ood/other Idtclien
Addicas \3 I 6._ e l - Y1Y\ ‘;- S 81) PNetr\kle equiPment 10.00 1
' .
City/State/Ur , -.,,, • • 4 ' - 1 'X', Clothes dryer exhaust 10.00
Single exhaust (bathrooms,
Phone: (51:1N to = - - I D_ Si Fax: ( ) toilet compartments, utility rooms) 6.80
.A Attickrawispace fans 10.00
10.00
Business name: Other _
..._ Fuel piping
Contact name: $5.40 for first four; S1.00 for each additional
Furnace, etc. ,
Address: .
Gas heat pump ,
City/State/al': Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
il Fireplace
E-ma:
Range
. - ;'' "2.' .....-„ ;• . 4.: -c:);,,tipis ikekkoi Barbecue
C.r Clothes dryer (gas)
Business name: 0„.. v a ..,_i ok . 9 as \A l
Address: Z:; 1,..._r 2_,,,,a..... vt.) ery IQ ,
P:gl:',..3 ,.,.. -r.p.t. • - - - -, . 4`f. ,...- • • : 2
City/State/ZIT: R L C - , ocz 9 a-Z Subtotal
- ..,
Phone: 6 --
0,1A_ ‘... Lk I Fax: ( )1 asi--1- 1'3 I to Minimum permit fee ($72,50) . 1 0 L5t0 _
Plan review (25% of permit fee)
1 CCB tics; 15 33 c7 sum surcharge (8% of pcmiit fee) - 9 )
Autze sigatur e. Skli(LrX/r TOTAL PERMIT FEE' / y. )
horid n_
at permit sPfdiczaine =Oren Zit permit is 'sot obtsbied within 180
days after it has been setepted as symptom
Print name: Or .- Dale: 0 b.- , b • Fee methodology set by Tri-00unty Building Industry S.TVIGe Board
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FEET TO FRONT PROPERTY LINE
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PLEASE WAX APPLICA.TIpN TTITH SIM PLAN - .
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