Permit CITY OF TIGARD MECHANICAL PERMIT
o COMMUNITY DEVELOPMENT Permit #: MEC2010 00564
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/05/2010
Parcel: 2S114BB14200
Jurisdiction: Tigard
Site address: 10432 SW KENT ST
Subdivision: SWANSONS GLEN NO. 2 Lot: 83
Project: Fisher
Project Description: Furnace replacement.
Owner: FEES
FISHER, PAULA K Description Date Amount
10432 SW KENT ST Furnaces < 100K BTU 11/05/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 11/05/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 11/05/2010 $43.25
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 $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: / ..ermittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
01/03/2007 17:44 FAX 5036513345 BENS - HEATING&AIR 2 002
Mechanical Permit Applicati0 mit Orrli:l': i si; t),Ni,i'
City of Tigard `ECE i
3125 SW Hall Blvd., Tigard, OR 97223 �, � , � t?
' Phone: 503.639.4171 Fax: 503.598.1960 rf 01 0 �y °W Other Permit:
-• r i i n l: 1, Inspection Line: 503.639.4175 P1 Y 4 L
Internet: www. tigard or.gov Date Ready/By! 55 Sc e Page 2 for
CITY OF TIGARD Notitied/Melhad EN Supplemental Information
•
T`YPT ;oT +•, wo • „ i P. 1.r i .t 7. co MERCi i=t t. Sc> DUr. - v$ CH ciarsT.
Mechanical permit fees* are based on the value of the work
❑ New construction TEI Addition/aiteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: materials,
OB COIV RUCTION " , mechanical r p fit
als equipment labor, overhea� and o
profit.
Values 4/940
-, . i RESIDENTIAL' E U IPMENT /. SYS'T'EMS FEE$•;
-1• and 2 family dwelling 0 Commercial/industrial ❑ Accessory building ,- Q •
For special lnforn:anon use checklist.
❑ Multi-family 0 Master builder ❑ Other:
Description ' 1 Qty. 1 F.a. } Total
Jon: iOR JNPORMATTON C.00AT40N
. �'. Heating/coolin
Job site address: 0 7 J 2 ¢ S � - _ Air conditioning
— - (re site plwn rhowinR placement) 46.75
City /State/ZIP: - w Furnace 100,000 BTU duets /vents 46.75 , c '
•
Suite/bldg./apt, no.: / Protect name: Furnace 100,000+ BTU (ducts/vents) ` 54.91
F. 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
lax map /parcel no.: Other fuel appliances
Water heater
' ' FS
• . DCRIP7TON ;OF WORk ;: :, 23.32 • . Gas fireplace 33.39
i • .
,. / ^. • I .. _ Flue vent for water healer or gas
fireplace _ 23.32
.— LoR lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNE Chimney/liner /flue /vent 23.32 •. 1. r. • :0 TENANT: ; .`: , Other: 23.32
Name; A .L - f TL e r" Environmental exhaust and ventilation
Address: JO y3 . � A ,h Range hood/other kitchen
f equipment 33.39
City /State/ZIP: T 4 n 9 72../ _ Clothes dryer exhaust - 33.39
Singlc -duct exhaust (bathrooms,
Phone: (tJ'p3) • - vg 9 Fax: ( ) toilet compartments, utility rooms) 23.32
, • ' :li . '.•,,.'.r3.0NTAarPERSON;i;' Attic/crawlsn cefans 23.32
Business name. , , iC 4 t-G Other; 23.32
Contact name: 1 ` -ra.. Fuel piping
514.15 for first four• S4.03 for each additional
Address: K _Furnace, ore.
• Gas heat pump
City / State/LIP: Wall/suspended/unit heater
Phone, ( - xi 3- z 4 go I Fax :: 613 ) LT) 13M
3 y. Water heater ~
E-mail: I Fireplace •
Range
.. , , .1, ' CONTRAC'rOR. , •••••:.:: ..': 4r+: Barbecue
Business name: iU. �,-- - )� hh'' ' JG Clothes dryer (gas)
Other:
Address: D . • : • . MECHANICAL PERMIT FEES'
City/Stalc/ZIP: FDr 11-N 02,- 7a. EV, subtotal
^'root, (. .?) Z 33 -) •. 9t Fax: (an) 61..S/ 3 3 , � Minimum permit o fee ($96.00) '10
_ Flan review (25% of permit fee)
..CB lic.: 6 4/S-17 State surcharge (12% of permit fee) v
_ TOTAL PERMIT FEE 1 M()
Authorized signatur : This permit application expires If a permit is not obtained within 180
days after It has been accepted as complete.
Print name: Date: t,57(0 _, • Pee methodology set by Tri- County Building Industry Service Board
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