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Permit , "` 4u CITY OF TIGARD MECHANICAL PERMIT Y t , 11 Permit #: MEC2010 -00301 y COMMUNITY DEVELOPMENT 13125. SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/02/2010 I 1G ` AF> [} g Parcel: 1S136DB01100 r Jurisdiction: Tigard Site address: 11005 SW 74TH AVE Subdivision: Lot: 0 Project: Simonson Project Description: Replace gas furnace. • Owner: FEES SIMONSON, KATHRYN A Description Date Amount 11005 SW 74TH Furnaces < 100K BTU 07/02/2010 $46.75 TIGARD, OR 97223 12% State Surcharge - Mechanical 07/02/2010 $10.80 PHONE: Minimum Fee Adjustment - Mechanical 07/02/2010 $43.25 Contractor: S & J HEATING & A/C INC 1004 NE 4TH AVE CANBY, OR 97013 PHONE: 503 -651 -2702 FAX: 503 - 266 -2452 ' 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 to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: QA/ /5 1- AP . / C1- j /0"\,/ Call 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. Mechanical Permit Application x ,, sy� m� z �. , , r a 1 ; , ` ' . :� Y f "t142ah l v c I ' fv�� P . ." # • } =n t 'City of Tigard R I/ , 7 ex /0 :' 4 Pprran No..rf 1 70/0 - DO 30 r', 13125 SW Hall Blvd., Tigard, OR 97221 I..:, ! if ' Pltm lt w u u - • la. Phone: 503.6394171 Fax: 503.594.1960 Other Permit; ' JUL resent t 1 � j [7 , Inspection Line: 503.639.4175 L - 1 2010 rr, dt ,d la See Page tar a'hi Internet; www.tigard -0Ggov Notified/method: Suppleweatal Information CIT DF TEA BD • TYPE IFF1 ? !N - nI1 /iRJ N COMMERCIAL FEE* SCIVEDh11 - uste airvocusT . Mechanlcal permit fees* are based on the value of the work, New construction ❑ ❑ A ddition /altered i , rreplikement ❑ Demolition ❑ Other: performed. Indicate the value (rounded to etc nearest dollar) of all mechanical materials, equipment, labor, overhead, and profit. • CATEGORY OF CONSTRUCTION �a1t Va S _ , .__ ... RESIDENTIAL EQ OIVI T' / flt PEES* l and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building p speclaC Jgformatlon use checklist __ ❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qry-I Fa_ I Total JOB SITE INFORMATION AND LOCATION iltntittp(twoli t�� ^ Air conditioning t F /h Job site address: l �- - • �. , y � t� (requires site plan showing placement) 46.75 City /State/ZIP: l 1 l i zt O 7 _'2.) Pomace 100.000 BTU (ducts/vents) ` 46.75 Suite/ bldg. /apt, no.: Project name: ,it''1�Q� 7 - it) C Hate 100.00(1 BTU (doccNvcnts) 61.06 µ � 11 h-v T pump Cross sheet/directions to job site: Duct work 23.32 liydronic llot water system 23.32 Residential boiler (radiator or I_ drone), 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended. ctc. 46.75 Subdivision: I Flue/vent for any of above ( 23.32 Other: 23.32 Tax Map/parcel no.: Other fuel appliances DESCRIPTION (111» WORK ' Water heater 23.32 Gas fireplace 33.39 - - -- ( J Flue vent for water heater or gas a---) is 11� )`.��,��!�` -- Lam, - .................... 4� __...... dace 23.32 ()vU1 FA tj i'\) 0 \c �t ( A 1D `� L. l o Lo lid (Ass) 23.32 Se ..,:› 1----- Wood/pellet stove 33.39 11 (!� 'Wood fireplacc/insest 23.32 - - �•�.■ t 1( � L '` 14-� " J). A g Chimncy/lincr /tlnchent 23.32 `133 iftorEi 1 `e • ©w 1 . ".. ❑ TENANT ,_,,,�.,,,.,. -- Other 23.32 . Name: Y8f1.(rk tes i.hLt P , Environmental exhaust and ventilation Address: equipment . lwodlotiter kitchen . - (U + �c a equipment 33.39 City/State/ZIP= "Ti " L R 1 f Cam" -C, ant q,. 2 7. Clothes dryer minus! 33.39 Single-duct 'exhaust (bat rooms, Phone: ( ) Fax: ( ) toilet compartinents. utility rooms) 23.32 ❑ A1FLICANT NTACT WILSON Atticicrowlspace funs tt 23.32 Other 1 23 Busine9$ name: 5 4 - c 1 teat -1 ■ YS ` A l '2- C -:., „,_- t crikl:: -1 A›•-A. ►J C- Pn,..r. .'.1?' -r5e. -,--r-. Contact name: ti r - � 5 for first PAM 54.03 for each Additional Address: Furnace, dc. Gas', heat pump City /State/ZlP: / Y .y Wall/suspended/unit beater Phone;,.() '�.(,2 T11 I Felt:: (' ) - 6(0 ` Lt t"a F1rep l aCE wat cr E-mail: �JF1,t. i r , 4 h4bic 1 p. , C ArJ ,C lN�.. _ Ran .,,.. _._:_- Barbe _ `- t ` l Clothes dryer (gas) Busirir name: Y F`�C t 1�1 `C v \ � / " `lit is t a Otlzc - Address: A W _ I. A,vi Ad, elEi ip d . City/Stattc/ZTP: .. • Subtotal .0 Minimum pennit fee ($90.00) 90 , ot) nee: ( ) Fax: ( ) Plan "rt Vi4w {25° of permit fee) CCil lie_: q (0 q i ✓ - State surcharge (12% of permit fcc) /0 • ?c) TOTAL PERMIT FEE /00 • Ch!) /, This permit ■pp1rcaiioa cabins it w m permit nor obro:ned within 150 1I i ' Authorized si', . t days after it 1121 been accepted at Wmplet Print name: JIM . A t ' � � . +n Date: a ' Fee methodology sct by Tri.County Building Industry Service Board • • 1:1EuildinglPetmitt • . • 10/01/09 440.461Tr 0 vo2JC II4JWEB)