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Permit : CITY OF TIGARD MECHANICAL PERMIT °- � .. :` COMMUNITY DEVELOPMENT Permit #: MEC2010 -00326 TIGAAD,, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2010 Parcel: 2S103DA06800 Jurisdiction: Tigard Site address: 10935 SW MIRA CT Subdivision: MIRA PARK Lot: 6 Project: Muntz Project Description: Replace gas furnace and A/C. Unit must meet 3' minimum rear and side yard setbacks. Owner: FEES MUNTZ, JUANITA R Description Date Amount PO BOX 25 TUALATIN, OR 97062 Air Conditioning 07/14/2010 $46.75 Fumaces < 100K BTU 07/14/2010 $46.75 PHONE: 503 - 620 -3914 12% State Surcharge - Mechanical 07/14/2010 $11.22 Contractor: BEN'S HEATING & AIR CONDITIONING LLC PO BOX 80607 . PORTLAND, OR 97280 PHONE: 503 - 233 -1779 FAX: 503 - 651 -3345 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressue: Total $104.72 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: ZI U —�_ Permittee Signature: OA/ 3c / C �/ /e/v/ 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 Apnlicatipn' a „ ,r 1It c)ITI r 4)t I ITS CINIA City of Tigard 4 " nJJ a:rJi � / ,,. /d ", ar,ni,No�y 1 1114 " 131 25 SW Ha Blvd., Tigard, OR 41223 y ' / y ' 1 � � �Q ��`?'2�p Plan Review Other Permit: Phone: 503.639.4171 Fax 503.598,196 _ 1 3 2010 Date/By; t ' A R I >' Inspection Line: 503.639.4175 Dale Ready/Fly, )w' See Page 2 for __ ".�.," - -_- Internet: www.ligard•or.gov O _ 1 � Notified/Method: ! e Supplemental Information l CITY OF 1 aARD _..._ __ •r:lrt q•.rm�n r . �: :: v�•.n. . TYPE 0i)8s, '.QC.,' t') v c'''lay 4 , COMMERCIAL FEE* SCHEDULE •- USE CHECKLIST t�' © New construction Addition/alteration/replaeement Mechanical permit fees are based on the value of the work performed. Indicate the value (rounded to the nearest dullar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead and profit. CATEGORY OF CONSTRUCTION • •: ';.;`.': Value; T 7,517 EG RESIDENTIAL EQUIPMENT / SYSTEMS FEES* yi 1 - and 2 - family dwelling ❑ Commercial /.industrial ❑ Accessory building -- _ For special informoion use checklist. 2 Multi- fumily ❑ Master builder 0 Other Description_ Qry. Ea. )butt JOB SITE INFORMATION AND LOCATION ' !, : Heating/cooling ,... Air conditioning J lob site address: 40 $ Li) ! r A i "fet c ( requires site plan showing placement) / 46 75 C'it y /State /ZIP: e r j k 91 a ,3 Fumace 100.000 ETUJducu/venta) f 46.75 Furnace 100 000+ BTU Nom/vents) 54,91 Suitc/bldg-/apt. no.: Project name;; ' - -- - .. Heat pump �,• 61.06 __ Cross street/directions to job site: Duct work 23.32 ------ Hydronic hot water system 23.32 Residential boiler (radiator or h :ronic) 23.32 Unit heaters (fuel -type, not ele in - wall, in -duct, suspended, etc. 46.75 Subdivision: j , ^t no : Flue /vent for any of above 23 32 (r: Other: 23 32 Tax map /parcel no.: Other fuel appliances DESCRiPTION'Olr WORK .. .. .. Water heater 23. GM fireplace lace • 23 3y ......_, .,,.,; R ;< ' ' T !� . A Flue vent for water heater or gas c p—... _. _ Log lighter (gas) w 23.32 • f Wood/pellet stove 33.39 Wood fireplace /insert • 23.32 t PROPERTY OWNER (� TENANT ; Chimney /liner /flue /vent 23,32 Other: I 23 32 - Name: L a y� ' Environmental exhaust and ventilation Address: h +J �� �`� Range hood/other kitchen Address: f �q -,s- S t t equipment — 33 39 City /State /ZIP: 1 • ! ; • 3 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (sa3 ) 6 r II " 1 Fax: ( ) toilet compartments, utility rooms) 23.32 — A APPLICANT • , .t7. CONTACT: PERSON, • ' Attie /crawlspace fans 23.32 _ _.._ Other: _i 23.322 . _L__ .-... t3usiness name: , " Fuel piping I Contact name: > T14.15 for first four; S4,03 for each additional _ Address: Fumace, etc. Gas heat pump — City /State /Z � _ Wall/suspended/unit heater (� 9 Water heater .. _.,_....._.- ....__.._....... Phone i 3.3 C Y v FAX:: ( ) - F GGG]]]] VVVV Fireplace I _ _ 1i -mail: Range CONTRA'OR Barbecue Business name: > d , , Clothes dryer (gas) .____ I V ■ am Other; Address: ~' P O I y i it r MECHANICAL PERMIT FEES* City /State /7,1P: Pp- NI- & , p(,_ q7 a, gic7 _ - Subtotal phone: (�3) ca 3 x -1-7-77 I Fax; ( .�3 ) bs/ - 3 3 / -' Minimum permit fee ($90.00) /11A� _ .. 1 Plan review (25% of permit f ee) /7 V � -C B TIC.: b I q 7 State surcharge (12% of permit fee) / /, p• _. `� TOTAL PERM FEK y f a y, 7z / //1 Thia perm application aapirea if a permit is nor obtained within 100 Authorized Sibnaturt: 1 days after it has been accepted as complete, Print name / - Date: j3, ) ( • Fee methodology set by Tri.County Building Industry Se■ ice Board 1 vy„ dmng1PermilWEC•PermisAp due 10/01/09 4404617Y (t I/OLCOMIwfia) TOO I] 2IItr'8'.ONIINaH - SNaa SbCCT29COS XFrd CO : LO OTOZ /ZT /L0 4- 6 6 ZOOS JUL 13 2010 CITY OF i"IGARD BUILD NC DIVISION i HIV'BDNI,LV3H - SN3a SbCCTS9CO5 XV1 CO :LO OTOZ /ZT /L0