Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00436
Date Issued: 10/04/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 1S134 DB04100
Jurisdiction: Tigard
Site address: 11125 SW 109TH AVE
Project: FRY Subdivision:4HAN'S ADDITION TO THE CITY OF TI Lot: 3
Project Description: Furnace replacement
Contractor: A TEMP HEATING & COOLING INC Owner: FRY, JEANNETTE A
16000 SE EVELYN ST 11125 SW 109TH AVE
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97223
PHONE: 503 - 650 -5014 PHONE
FAX 503 - 557 -2990
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/04/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/04/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/04/2011 $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: ' .G^ Permittee Signature:
Call 03.639.4175 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 ApplicatiO ECEI�
1111 City Of Tigard Received � 0 /l I'ernE U o /AI=
T - • 13125 S W Hall Lilvd „'1 igard. OR 97223 OCT ®3 2 01 Platt Review ® P hone' 503 7182439 Fax: 503. 98,1960 Date /13� , Oilier pm•ma
!impel: lion Line 503 63).4175 Dare Ready/13y ru ® See Pa
"` {(' Inter ww%) ,tigard -or3ov CITY OF TIGARD Natified/MaiI d Sup plrmantullnrortnatlau
BUILDING DIVISION °' °'” _ 7-1-6 '
TYPE OF WORK w CONIMERCIAL FEE` SCHEDULE - USE CHLCKLIST
El New construction 4A ddit i unlulterauon /replacentt nt Mechanical permit fees* are based on the value of the work
performed. Lndtcatc the value (rounded to the nearest Jailer) ol'all
0 Demolition ❑ Other mechanical materials, a ui mmcnt, labor iverhead_ and prntit,
Value' $
CATEGORY OF CONSTRUCTION -
RESIDENTIAL EQUIPMENT ) SYSTEMS FEES"
101- and 2- family dwelling 0 Commercial /industrial 0 Accessory building _ Forspe information use chccJi/&,
0 MuIti- firmly E] Master builder 0 Other: Descr iption - Y Qty. 13'i Total
JOB SITE INFORMATION AND LOCATION Hearin_ /etlulin :
.. Air condilruntng
Job site adrlres$: # I t 2- S to i +14 `P - . lie titres site 21:11 St,uwiii pIaceinelir) ' 6.75
r k D n v Furnace I00,0UO 2 It ideas /venlsl — ,�, 46.75 T 4
City/State/21Y: 21Y: - r1 1 2 43 _Purritioe 100,009+ BTI.1(dvcts veers) 51191
Suite /Milo. /apt no.: Project name; r. Heal pump
jecluires ytre plan ehowinU&cern ant) bl.06
Cross street /directions to)job sire: Duct work - _ 23.32 -
hlydmnic hot watei system _ 23 32
Residential boiled (radiator or
hydronic) 23,32
• — Unit heaters (fed -type. not electric),
in -wall, induct, suspended. etc - _ 46.75
Subdivision: Lot no.:
Flue /vent for arty of above 23,32 1
, _ .. Other 23.32
'fax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater �. 23 32
' 1 Gas fireplace 33
rSA - CiA •! 1 1 r f . ii- C n a. J O Flue vent for ware[' heater or gas ^�
't[replece 23,32
Lo& Iighler (gas) ,^ 23 32
^s Wood /pellet Stove 33 39
- ' Wood fireplace/insert 23,32
PROPERTY OWNER El TENANT
Chimnex /line[' /flue /vent 23 32
ISt _ Other: _ 23 32 _
Name; (11, I — Environmental exhaust and vent &ration!
Address; a i jj i ^ t .9-, Range hood/other kitchen
{ I ( _ equipment .r-. 33 39 _.. , __
City /State /ZIP' : p t (7 11-2- 2 Clothes dryer exhaust 33,39
J Single -duct exhaust (bathrooms,
Phone: ( ) Fax: - . toilet compartments. utility ooms) 23 32
APPLICANT D CONTACT PERSON Attic /crawlspace tans - 23 _
- - Other, 23 32
13u;,iness name
_ ,, ,� Fuel piping; ^ „
Contact name: l t'.Ml' HEATING - AND COMING, YNC S14.l for first tour: 54.03 for aeeh additional
460DYSEYil Si. Furnace. etc
Address: Ciao mar OR 9701$
-- Gas heat pump .—
City /Stale /ZIP $�''� 5014 } Wali /suyperdedJunit heater _
- - m .�
phone: ( 1 Fax. x , , ( 5 S 5 zit it i i• 0 - Wale, heat,
Fireplace
E.-mail: Range _ — ,--
CONTRACI'OR - Barbecue -. --
Business name. - Clothes dryer (ias) - �,
..
•-k- LING n c - Other. ... ..
Addles,. + MECHANICAL PERMIT FEES
—1,6000-SE-Evelyn FJn_SE n� � -' Subtotal L "
C't ly /S'tatc /ZIP Cla ?Uis, OR 97015 ' Miniinunt permit lee ($90,00) di , p 0
1110111:" ( ) Fax: t 1 Plan review (25% of perm fee)
CCB tic.' , Q - State suieharge (12% o penult tee/ t I •
V TO'L'.0.i i ERNII'f' FEE ri . :MI
Aulhori red signature. gW Print name: 'I'iiia ?rrIsiL �ippllCU rzplt•eb if a permit. is sal uUtaiuetI within 180
days after it has bran eerepred us eomplete,
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