Permit CITY OF TIGARD MECHANICAL PERMIT
111 * ° COMMUNITY DEVELOPMENT Permit #: MEC2013 -00238
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439
Date Issued: 05/06/2013
Parcel: 1 S136AA02100
Jurisdiction: Tigard
Site address: 10310 SW 69TH AVE
Project: Arnsberg Subdivision: FUR VALLEY Lot: 1
Project Description: (1) gas furnace replacement
Contractor: HYBRID HEATING & AIR CONDITIONING CO. Owner: ARNSBERG, PAUL
PO BOX 329 8818 SW SPRUCE ST
CORNELIUS, OR 97113 TIGARD, OR 97223
PHONE: 503 - 357 -5663 PHONE: 503 - 502 -7437
FAX: 503 - 357 -0668
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/06/2013 $46 75
Type of Use: SF 12% State Surcharge - Mechanical 05/06/2013 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/06/2013 $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 V Perm ittee Signature: Qu #PPLi ,1 �D/
666 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 Application f• OR 4WI I( l: l ()NIA
City of Tigard REQ I ReceBy � �/ 3 sr Permit No.: /tEcavl 3 -��3,
111, 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Other Penal
Phone: 503.639.4171 Fax: 503.598.1960 MAY 06 2013 pate/By:
Inspection Line: 503.639.4175 Date Ready/By: i s la See Page 2 for
Internet: www.agard -0r.gov
I t: A K 7 p CITY OF TIGARD Nottfed/Merbed- '7/ Supplemental Information
TYP>� old. o 91NG DI iON , . - .GO <> soli -,, -r •
Mechanical permit fees* arc based on the value of the work
❑ New construction [ Addition/alteration/replacement performed, Indicate the value (rounded to the nearest dollar) of all
ID Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
_ 'Value: $
CATEGORY - OF CONSTRUCTION ' R T
)2'1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special Information use checklist '
0 Multi- family ❑ Master builder ❑ Other: Description I Qry• > a J Total
SITE IriNFORMATI0N. ANA LOCATION • . Heating/cooling — -
� — Air conditioning
Job site address: /03 f 0 S u.) _ 69 (----- (requires site plan showing placement) 46.75
0 ^ ,_ a � Furnace 100,000 BTU (duets/vents) 46.75 1,r
City/State/ZIP: ': i ' I iC Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat .urn . 61.06
Cross street/directions to job site: Duct work 23.32 1
1 1ydronic hot water system 23.32 . 1
Residential boiler (radiator or
hydronic) 2332
Unitheaters (fuel -type, not electric), .
in-wall, in -duct, suspended, etc. 46.75
Flue/vent for an�of above 23.32
Subdivision: Lot no.: Other ` 23.32
Tax map /parcel no.: Other fuel appliances, _
DESCREPtION OF WOORE. Water heater 23.32
Gas fireplace 33.39 • •
iel P'43 ` F Flue vent fur water heater or gas
fireplace 2332
1 og Iig (gas) 23.32
Wood/pellet stove 3339 _
- Wood fireplace/insert — 2332
Chimny/liner /fluc/vent 23.32
p PROPERLY OWNER , • ' ' [] TENANT Other. 23.32
Name: /f . o f f - Environmental exhaust and ventilation
Address: / 03 / O SGQ
L Range hood/other kitchen
equipment 33.39
•
City /State/ZIP: � z Ae 1 ,2 ., _1 Clothes dryer exhaust 33.39
J r / single -duct exhaust (bathrooms,
Phone: 3') ,5 2 7 Fax: ( ) rnilet compartments, utility rooms) 23.32 ,
APPLICANT CONTA Cr- _PARSON _ Attidcrawlspace thtts 23.32 Other. 23.32
Business name: Fuel piping
Contact name; 514.15 for first four; S4.03 for each additional
Furnace, etc.
Address: Gas heat pump
City/State/ZIP: Wall/suspended/unit heater •
Phone: ( ) 1 Fax: : ( )
Water heater
Fireplace
E -mail: Range .
CO CTOIi Barbecue
MOW Clothes dryerSgas)
Business name: �� ! -. i - e , _ - 4 Other. -
AddreSS: ?, i s"'02 9 biz a9pAI:.PEka# , ,: •,; ' • •
City/State/ZIP: ( C?r/7 e. `u S OE 9774.. Subtotal ' e /6-75
Minimum permit fee (S90.00) 490 — •
Phone: (3 , (y Fax: Cho ) 357-- o 1 6 Plan review (25% of permit fee)
CCB lie.: / t, 7.6 State surcharge (12% of permit fee) / .-'v
TOTAL PERMIT FEE /oo _ Se0
This permit application euplres if a permit is not obtained witbin 180
Authorized signature: ✓„J 1 , , ). . i . days after it has been accepted as complete.
Print name: b Cr- eV /e7/40 rte
/C. t4, Date: 6 3 ./ 5 • Fee methodology set by Tri•County Building lodumy Service Board
t. eernuts\MEC- nutnitApidac 1o/o109 440.4617t(11/02/COM/WEB) .
Hybrid Heating & Air Conditioning
McClenny RHC
P. O. Box 329
Cornelius, Or 97113
Phone: 503 - 357 -5663
Fax: 503 - 357 -0668
Fax
To: City of Tigard From: Hybrid Heating & A/C Barbara
Permit Dept Date: see below
Pages incl. Cover see below
Fax: 503-598-1960 CC:
Urgent For Review Please Comment Please Reply Please Recycle
•Comments; Please call or fax when permit number has been issued.
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Location:
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Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10310 SW 69TH AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
05/17/2013 00:00
MEC2013-00238
PASS - No C of O
Minor label 348530
Violation Summary:
Inspector Contractor