Permit , ;' r„ MECHANICAL PERMIT
IN CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: MEC201000121
} Date Issued: 03/31/2010
T A
f CRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135DC01800
Jurisdiction: Tigard
Site address: 11895 SW LINCOLN AVE
Subdivision: WASHINGTON SQUARE ESTATES Lot: 8
Project: Noyes
Project Description: Replace gas furnace.
Owner: FEES
NOYES, BONNIE Description Date Amount
11895 SW LINCOLN ST
TIGARD, OR 97223 Furnaces < 100K BTU 03/30/2010 $46.75
12% State Surcharge - Mechanical 03/30/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 03/30/2010 $43.25
Contractor:
HEAT RELIEF CO
13122 NE DAVID CIR # 800
PORTLAND, OR 97230
PHONE: 503 - 261 -9915
FAX: 503- 261 -9814
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct questions o OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Q , \ r yQ ` 1 - \ t1 /\ Permittee Signature: c�
---- Atic
CaII 503.639.4175 by 7:00 a.m. for an inspection 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.
03/24/2010 WED 12:24 FAX 5032619184 21002 /002
Mechanical Permit Application r � T „ , - ,o F %' Sa ' ��
94 1:40,.. City of Tigard v.• v P s Received permit No.:r
IN, . ° 131 SW Hall Blvd., Tigard t 9.7 € 3 l�a, 'i 1, / I r 1 y Date/By: 1 / ' •'�
� Plan Review
Pi Phone: 503.639.4171 Fax: f- 01698,.1960' , Other Permit:
Date/By:
Tti GA5rR> Inspection Line: 503.639.4175 Date Ready/By: 1 ® See Page 2 for
t.: I Internet: www.tigard or.gov MAR: 2 4 2013 Notified/Method: ‘11 .. Supplemental Information
'',, 4r,t_ $,4,r y , " �r� `a Q E tt6'`d e a 7 g'
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❑ New construction 1, , i diat�AValtBi &tilOn/tielilacettllent r Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
POW q � a w"�"- Value: $
�, z ..,.. �> x �- � �.�.,,, ;�, „ -a > �..� , _ _� '��• • � �. % ., , ��r ; � -, x ,_ �
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building 4 Qi11P_
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
�` Description 1 Qty. Ea. Total
,.: " "y M �76 , A ' 0 : 4TIP h `` : Iiea coo
Job site address: 1 l 945- i �� Air conditioning
(requires site plan showing placement) 46.75
City/State/ZIP: 17-4 (�' (/v! (:11-c9---._3 Furnace 100,000 BTU (ducts /vents) / 46.75
Suite/bldg. /apt. no.: (./ 1 Project name: ! \ /6V _ rq Furnace 100,000+ BTU (ducts/vents) 54.91
lY ( Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronie 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
Subdivision: Lot no.: Flue/vent for any of above 23.32
. Other: 23.32
Tax map /parcel no.: Other fuel appliances
'' V - z ' Nifiel.[O) ,, ,41� ,i a lI. .. a , r ,. ;. Water heater 23.32
� .:t,°4, 4 ' t , z `1n
Gas fireplace 33.39
-` // Flue vent for water heater or gas
.17_:_ �I� r1 47J11I'..�/� •l/ 4" Li I 0 i fireplace 23.32
�/J 1 Log lighter (gas) 23.32
1 Wood/pellet stove 33.39
Wood fireplace/insert 23.32
'. ., , , k . � • C himney /liner / Fue/vent 2332
r
- _ ,' a t -,. t{n. '' t . � ..st;` t. a,.
Other: 23.32
Name: �7 .4/ , i ` 1 0 4 / Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 33.39
City/ State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility moms) 23.32
vr N u,n wv .:w. ti w i �' iS 4 " � , s ax.�m rrr ^ ( E1. A °
� µ ����p�0� PS ry � g ,. (,��' ,, gq��j����fi �� }�� i Attic /crawispace fans 23.32
Other: 23.32 •
Busincss name:
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc. /
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range ,
a . ` t zV,• . s • s - -- A iii a � ' '„ -,'" Barbecue
...v s
Business name: Clothes dryer (gas)
Other:
Address: Heat Relief .i,( � .w' { ".�,ij` - � - v+�� r i , "fn , t �, s i
Y eII f`:'f �.k ;6 ({ �NiW cna9, IS .'Vf L :
City/State/ZIP: 9342 .ME D Mid,Circie Dr #800 Subtotal
Phone: ( ) Portland, 011107200 ) Minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lic.: / p /J , 5113451-101S State surcharge (12% of permit fee)
TOTAL PERMIT FEE Il W • 80 -
Authorized si attire: This permit application expires if a permit is not obtained within 180
1� �� days after it has been accepted as complete.
Print name: Date: : Fee methodology set by Tri -County Building Industry Service Board
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