Permit (31) CITY OF TIGARD MECHANICAL PERMIT
11111 • COMMUNITY DEVELOPMENT Permit#: MEC2016-00290
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/26/2016
T r c;;+ R(� 9 Parcel: 2S104AA04400
Jurisdiction: Tigard
Site address: 12360 SW 127TH AVE
Project: MAYO Subdivision: BELLWOOD Lot: 22
Project Description: Installing(1)furnace and(1)NC unit. NC unit must comply with manufacturer's installation requirements.
Contractor: K S HEATING&AIR CONDITIONING INC Owner: PACHECO,ALEXANDRA M
14925 BAKER CREEK RD MAYO, CHRISTOPHER J
MCMINNVILLE, OR 97128 12360 SW 127TH AVE
TIGARD, OR 97223
PHONE: 503-602-8283 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Air Conditioning 04/26/2016 $46.75
Type of Use: SF Furnaces<100K BTU 04/26/2016 $46.75
Class of Work: ALT Type of Const: FlueNent For Any of Above 04/26/2016 $23.32
Occupancy Grp: 12%State Surcharge-Mechanical 04/26/2016 $14.02
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $130.84
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you i•i follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-149'. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
1
Issued By: Permittee Signature: J%aif
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application I O K 01 I I( I I ',I O\l 1
�i
Ci of Tigard " Permit No.:
1111 13125rSW Hall Blvd.,Tigard,OR 97223 Date/By A. `��� V " +� -_ .1. �fl
II Phone: 503.718.2439 Fax: 503.598 "_I Date/By:Plan Review Other Permit:
i- �`i Inspection Line: 503.639.4175 -, Date Ready/By: INI ® See Page 2 for
Internet: www.tigard-or.gov q9 ° Notified/Method: Supplemental Information
" ` :` ;."4V - ',:'1,0&•-,,,` " ` (I � t Mechanical permit fees*are based on the value of the work
❑New construction Addition/alterati4lace ON performed.Indicate the value(rounded to the nearest dollar)of all
o Demolition Other: t�� mechanical materials,equipment,labor,overhead,and profit.
4 Value:$
E 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
❑Multi-family 0 Master builder 0 Other: Description Qty. Ea. Total
a '#� ', ,i $ i Heating/cooling:
,., ...n, t, .. Air conditioning 1 46.75 ,7s
Job site address: 1 ..•_ 1.L3 O v' Furnace 100,000 BTU(ducts/vents) i 46.75 46,-t
City/State/ZIP: UL-) 1 d--7 A vi--- c).0., Furnace 100,000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg./apt.no.: Project name: 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 C 23.32 2-3
Subdivision: Lot no.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
w� Gas fireplace/insert 33.39
c
Flue vent for water heater or gas
_ fireplace 23.32
RJ ¼I (U e � pU C JL' Log lighb Wood/pellet stove 33.39
kye LAJ ( 1 Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
2332
PERfl?O, Other:
.,
Environmental exhaust and ventilation:
/�1
Name: f \ lA- 0 I- (v k s A—c) CD 'Le_( Range hood/other kitchen
Y � equipment 33.39
S
Address: c E LA.) t 4,,7 F\IJ L' Clothes dryer exhaust 33.39
City/State/ZIP: 'l � `e 0 r Single-duct exhaust(bathrooms,
toilet compartments,utility rooms) 23.32
Phone:(ct7() t 16B0 .IFax:( ) Attic/crawlspace fans 23.32
Q, � � Q?fir P - Other: 2332
Business name: .S t4t f I( N J6) .N/ Fuel piping:
l( C., $14.15 for first four,$4.03 for each additional
Contact name: I� (\. 5 1 1V( L(4 Furnace,etc.
Address: 1, f. i L,/ Gj�` s D� -E� ' Gas heat pump
[ Wall/suspended/unit heater
City/State/ZIP: 1�� 0.,,N l.!( N i-( 1 / 'e... ( e c 7(g 8 Water heater
Phone:(5 C73) 1y./'7/. _S-�^`7 7 Fax::( ) Fireplace
1Range
E-mail: Barbecue
(,`O1W M�'I'blll % Clothes dryer(gas)
Business name: Other:
Address: S�/t/(L'----2
Subtotal /i'( . p_
City/State/ZIP: Minimum permit fee($90.00)
Plan review(25%of permit fee)
Phone:(6-03 ) CO Z 6 2-g3 Fax:(5-03) '1'71 ic7 7 State surcharge(12%of permit fee) Ii.i.o.)--
.
CCB lic.: ltp t 9 b 3 S//S-7c2 TOTAL PERMIT FEE FL(
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signa
* Fee methodology set by Tri-County Building Industry Service Board
Print name: `4 S / Date: S�'/6
I:\Building\Pennits\MEC_PermitApp_040113.doc 440-4617T(11/02/COM/WEB)