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Permit a CITY OF TIGARD MECHANICAL PERMIT 1,11 s COMMUNITY DEVELOPMENT Permit #: MEC2010 00390 T r G.�R 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2010 Parcel: 1 S135DB04500 Jurisdiction: Tigard Site address: 11345 SW 92ND AVE Subdivision: DOGWOOD RIDGE Lot: 4 Project: Paulson Project Description: Furnace replacement. Owner: FEES PAULSON, KEVIN J & ANDREA M Description Date Amount 11345 SW 92ND AVE Furnaces < 100K BTU 08/04/2010 $46.75 PORTLAND, OR 97223 12% State Surcharge - Mechanical 08/04/2010 $10.80 PHONE: Minimum Fee Adjustment - Mechanical 08/04/2010 $43.25 Contractor: TRI COUNTY TEMP CONTROL INC 13150 S CLACKAMAS RIVER DR OREGON CITY, OR 97045 PHONE: 503 - 557 -2220 FAX: 503- 557 -0919 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel . Fuel Types: 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 • UNC by calling 503.24. • • • • . .800 ; i's C Issued By. ' .. e % ��_�� Permittee Signature: _; j 1 .. 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. AUG -3 -2010 08:13A FROM: TO: 50359819E0 P.1 Mechanical Permit A licatio col . . 0 , , ,, 12,1'1 1 City of Tigard Raav d , ` 13125 SW Hall Blvd., Tigard, OR 97223 AUG 3 201° daffy' • �/ its .n� .. _ ,,.y Phone: 503.639.4171 Fax: 503.598.1960 PlaaRavio . 4, Inspection Line: 503.639.415 , -1 , �, dam' �e �Permit r ' Internet: www.tigard-0r.gov CI O F' i I A•H Oe1e rtady/By: 0 See Page 2 for �' & � i � i �� O a llotlfled/Method: Supplemental Information TYPE OF WORK t- i COMMERCIAL FEE* SCHEDULE -•USE CHECKLIST ❑ New construction ® Addition /alteration/replacement Mechanical permit fees* are based on the value ofehe work perforated. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ purer; mechanical trlataials, equipment, labor, overhead, and profit. CATEGORY OF CONSITRUCTION Value: $ ® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory budding RESIDENTIAL EQUIPMENT! SYSTEMS FEES* 111 Multi - family ❑Master builder ❑ Other: - For spectal tlJonaa11o4 use check/iat. Description I Qty. I Ea. 1 Total • JOB 917E INFORMATION AND LOCATION Ileattatticooka Job site address: 1 046 em 0, fwe)() Air conditioning ? � �e plan showing (ucts/v em) 46.75 City / State/ZIP: Pomace 100,000 RT ce 100,000 BT eacte/wme) 1 46.75 K(p7 ,5 . SuitelbldgJapt no.: Furnace 100,000+i3TU(ductaheots) 54.91 I Project name: �"v� - Heat pump 61.06 Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fttel -type, not electric), in -wall, in -dues suspended, etc. 46.75 Subdivision: I Lot Flue/vent for any of above - 23.32 Other 23.32 Tax map/parcel no.: Other fuel appliances DESCRIP'T'ION OF WORK Water heater 23.32 Gas fireplace 33.39 Flue vein for water heater or gas e RePtalXjUrria.CO fireplace 23.32 Log ladder (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 PROPERTY OWNER I 0 TENANT Chimney/liner/flue/vent j � ,� inn Other. 23.32 Name: 721 , IdJ Ct1. paws© 11 Enviroomeutai exhaust and ventilation Address: Ranee hood/other kitchen equipment 33.39 City /SlatefZlP: Clothes dryer exhaust 33.39 - 4-167 Single-duct exhaust Phone: ( ) - G G ,( Fax: ( ) m comp iler compartments, utility rooms) , 23,32 ® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32 Business name: Same as contractor 32 Fuel plpinE • Contact name: blame Mason 514.15 for Ant four, 54.03 for each addldonal Address: Furnace, de. Gas heat pump , City /State/ZIP: Well/soapended/unit heater Phone: ( ) Fax:: ( ) Waxer healer Fireplace ce Range CONTRACTOR Barbecue . Business name: Tri County Temp Control Clothes dryer (gas) Other: Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES* City / State/ZIP: Oregon City, OR 97045 Subtotal Minimum permit fee ($90.00) Via:YO Phone: (503) 557.2220 Fax: (503) 557.0919 Plan review (25% of permit fee) � JU LJ CCB Tic.: 72623 State surcharge (12% of permit fee) I / a `. t1, 'I\) TOTAL PERMIT FEE. Authorized signature: 414 Gr ,� " _ W t6h pemtt days aftter It h been acceptd ae c Male tsar I Pri n t name: D (l', j Melton 1 D ale: $ i t 1 • Fee methodology sat by Tri -County Building lodumy Service Board a 1:1 uIldina\Permle\MEC 10/01/M 440.4617TT(11M2COM/WEa) 16vv S i✓'e Z