Permit CITY OF TIGARD MECHANICAL PERMIT
1
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00529
Date Issued: 10/26/2010
TIG AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103BA00401
Jurisdiction: Tigard
Site address: 11625 SW WALNUT ST
Subdivision: Lot: 0
Project: Urling
Project Description: Replace gas furnace and NC. Unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
URLING, HARRY F & NELL P Description Date Amount
RESTATED TRUST, THE, 11625 SW WALNUT Air Conditioning 10/26/2010 $46.75
ST Furnaces < 100K BTU 10/26/2010 $46.75
PHONE: FlueNent For Any of Above 10/26/2010 $23.32
12% State Surcharge - Mechanical 10/26/2010 $14.02
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 $130.84
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: *" Pen:nittee Signature: ,A/ M / "e-
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 Applicati fiECEIVED 1 Ult OFFIC1: USE; ()N Li'
Received
Dat
City of Tigard V e/B /0 Z6 /0 ,»/ Permit No. f /� .--.0.5ra 9
11 13125 SW Hall Blvd., Tigard, OR 97223 CO T 26 2010 Plen Review
i • Phone: 503.639.4171 Fax: 503.598,1960 _ Other Permit:
Ins ction Line: 503.639,4175 DuelBy
"''t,. D Date Rea4 CI O F TIGAR etho d; ®rice ern 2 for
Internet' www.tigard•or.goV etho i 0 See Page
Supplemental to rormadon
BUILDING DIVISI Notified/method; . , • TYPE 10F WORK: ; ...1)..:...•:','.::. . i
. ; ; . ... COMM>'SRCIAL � FEE,: SCHEDULE' -'' U81E'CHECKI;I3T
Mechanical permit fees* are based on thc value of the work
❑ New construction Addition/alterution/rcplaccmcnt
performed. Indicate thc value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materialseguipment, labor, overhead, and profit.
.
CATEGORY :OF. CONST'RUCT'ION' ' : . `;' :v Value: $ /69
• : RE3IDENTIAt T /SYSTEMS. ,':• .
1. and 2- family dwelling ❑ Commercial/industrial 0 Accessory building For special information use checklist.
] Multi- family Master builder Other:
Description I Qty. 1 Ea. 1 Total
;..:,.:':. r• JOB SITE INFORMATION: ANA:IA.CAiTIONa. t'; r"' , , ;.: • ' Heating/cooling
Job site address: / /d t <( (,tiAtt/t3'r S � - Air conditioning
(requires site plan ahowinep I lacement) 46.75
City/State/ZIP: `l a 3 Fumace 100,000 BTU (ducts/vents) ` 46.75
Furnace 100,000+ BTU /ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot wafer system 23.32
- ... _,_� Residential boiler (radiator or
hydronic) _ 23.32
Unit heaters (ftel -type, not electric).
in -wall, in -duct, suspended, etc, 46.75
Subdivision: Lot no.:
Other; 1 23.32 1
Flue/vent for any of above / 23.32
Tax map /parcel no.: y
Other fuel appliances
..DESCRIPTION'QF' WORK' t'.:' ":1 . ..: :. • :' . • Water heater , 23.32
n Gas fireplace 33.39
12p• /}CL v-4/e- (.(.4/, r Flue vent for water heater or as
fireplace 23.32
.. - Log lighter (gas) 23.32 w
Wood/. Ilet stove 33.39
Wood fireplace/insert 23.32
PROPERTY O' R
Chimney/liner/flue/vent 23.32
PROPERTY ' ❑ TENANT.,."',.; •; : ' ;: ,
�
Other: 23,32
Name: 14`tl�f r /4 / r iaL. Environmental exhaust and ventilation
/ /` S (.1i" N� Range hood/other kitchen
Address: [ v ,/ equipment 33.39
City / State/ZIP: `fl4 0 P 4 7 a a_3 Clothes dryer exhaust 33.39
Phone: ( �3 ) ,r1 SingleAuct exhaust (bathrooms,
e /pi Fax: ( ) toilet cvmyanments, utility rooms) 23.32
• .. ...IX A'PLtCANT :. ° !::' CONTACT p>ERsoN ?l ::c: , Atticfcrawlspace fans , 23.32
Business name: Other, 23.32
�- --� T Fuel piping
(' t ,
Contact name: e , ` 514,15 for first four; S4.03 for each additional
K Furnace, etc.
_-
- Ons heat pump
City / State/ZIP: Wall/suspended/unit heater
Phone; ( 7 / 3- l g 0 Fax: : ( ) Water heater -
E-mail: { Fireplace
•
Range
• . CONTRA OR ' ' ! ':,, i <. :,:r. : ' : ; : .;:::„ •.,- .. Barbecue
1 �t 4., `7
Business name: /� G
Clothes dryer (gas) r
Other:
Address: E Q Q (/J ( `7 — • MECHAMCAL PERMIT FI£ ES!' ;
ty /State/ZIP: pr ��
c ker
]� � y q .r q 7 a, g'c 3 Subtotal 'if‘ "P1.1.- "bone: (-9,3) - 3 - j " Fax; (`�f�) S ` . ? � Minimum permit fee permit fee)
J Plan review (25% of permit fee)
• i . ...CB tic.: 6 I/ s Stale surcharge (12% of permit fee) /v. Q i..
TOTAL PERMIT FEE /30 , kg ✓
Authorized signal I p 'rbis permit eppllealion expires If a permit is not obtained within 180
days after it has been accepted as complete.
I Print name: 11111 ,1b 'Date: ' Fee methodology set by TO County Building Industry Service Beard
11Bu ildinglP rmiu\t C.PermilAp 10/01/09 4404617T (II /obCOM/WUB)
T001 j 2IIV DNLLV3H -SUaH StC£TS9£OS Did Sig :0T OTOZ /SZ /0T
10/25/2010 10:46 FAX 5036513345 BENS - HEATING&AIR Z003
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