Permit CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: MEC201300555
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/25/2013
Parcel: 2S 104AA02900
Jurisdiction: Tigard
Site address: 12205 SW 126TH AVE
Project: SAUNDERS Subdivision: BELLWOOD Lot: 37
Project Description: Install range hood
Contractor: ANCTIL HEATING&COOLING Owner: SAUNDERS, DAVID D
4320 N WILLIAMS AVE MARY E
PORTLAND, OR 97217 12205 SW 126TH
TIGARD, OR 97223
PHONE: 503-281-0752 PHONE:
FAX: 503-282-5722
FEES
Specifics: Description Date Amount
Range Hood/Other Kitchen 09/25/2013 $33.39
Type of Use: SF 12%State Surcharge-Mechanical 09/25/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 09/25/2013 $56.61
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: � � Permittee Signa 1
/ ,fir'•
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.
Anctil Heating & Cooling
1j0001/0001
09/24/2013 15:30 FAX 5032825722
Mechanical Permit Appli b-1. . ., FOR OFFICE USE ONLY
City of Tigard Received C. 2 IF e,/1,x,/3 Sz,-5�
g ;'f'.4 i vED Date/By: /�5/ /J i permit No.: OL/s
II 4 13125 SW Hall Blvd.,Tigard,0- '
Plan Review Other Permit:
• Phone: 503.718.2439 Fax: 503.598.}9t(ID Date/By:
TIGARD Inspection Line: 503.639.4175 Jtr 2013 DateReadyfBy: JWs Supplemental Information
Internet: www.tigard-or.gov NotifiedMtcthod:
CITY OF TIGARD
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' Mechanical permit fees"are based on the value of the work
❑New construction ®Addit ion/alteration/replacement performed,Indicate the value(rounded to the nearest dollar)of all
❑ Demolition ❑Other: mechanical materials,equipment.labor,overhead,and profit.
Value:5
G.�TEGORY OF CONSTRUCTION." ;: •!.RESIDEM'fALEQUIPMENT/;SYSTEMS FEES"
® I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family ❑Master builder ❑Other: Description Qty. i Ea. i Total
' JOB SITE'INFORMATION AND,:LOCATION. ' • Heating/cooling: ,
12 2 0 5 SW 12 6TH AVENUE Air conditioning 46.75 I
Job site address: Furnace 100,000 BTU(ductsivcnts) _ 46.75
City/State/ZIP: TIGARD OR 97223 Furnace 100,000+BTU(ducts/vents) _ 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: #41008 r
_ Duct work 23.32_
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Other: 23.32
Subdivision: rLot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater t 23.32•
DESCRIPTION rOF N ORK ..` fireplace/insert for
33.39
Gas hnsert
Flue vent for water heater or gas
VENT HOOD fireplace 23.32
-Log lighter(gas) , 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32 ,
Other: 23.32
[ PROPERTY•OWNER Q TENANT Environmental exhaust and ventilation:
Name: DAVID SAUNDERS Range hood/other kitchen
equipment 1 33 39
Address: 12205 SW 126TH AVENUE Clothes dryer exhaust 33.39
City/State/ZIP: TIGARD OR 97223 Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:( )503-590-3532 Fax:( ) Attic/crawlspace fans 23 32
23.
. .. ...- Other: ,
�.APEL3GA3r"T.;.," -�>:......:'.:` . . ::.'; ' Q:,COI�ITAC'i"';EERSOI�; . ..: Fuel el piping:
Business name: ANCT I L HEATING & COOLING 514.15 for first four;54.03 for each additional
Contact name: CHRISTINE BARTON Furnace,etc.
Address: 4320 N WILLIAMS AVENUE Gas heat pump
- Wall/suspended/unit heater _
City/State/ZIP: PORTLAND OR 97217 Water heater
Fax::( ) 5 0 3-2 8 2-5 7 2 2 Fireplace -Phone:( ) 503-281-0752 Range
E-mail: INSTALL@ANCTILHVAC.COM _ Barbecue
'
'CONTCTOR,` :.•._ : ,7t C lothes dryer ryer(gas)R
Business name: ANCTIL HEATING & COOLING Other:
-yam _ MECHAS'I AL:PERMLT'FEESw.. _•-
Address: SA E AS ABOVE V Subtotal
City/State/ZIP: (/�: Minimum permit fee(590.00) 9.d
V Plan review(25%of permit fee)
Phone:( ) Fax:( ) t ,', State surcharge(12%of permit fee) to.jr0
,. TOTAL PERMIT FEE .5(0
CCB lie.: Q
8 8 g 7 ^�, J. This permit application expires if a permit is not obtained 180
days after it has been accepted as complete.
Authorized signature. t •�- • Fee methodology set byTri-County Building Industry Service Board
Print name: CHRISTINE BARTON I ' Date: 9/2 4/13 j
I.\Building\PcrmitsiMEC_PcrmitApp_040113.doc 440.46177(11/02/COM/WEB)
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