Permit n CITY OF TIGARD MECHANICAL PERMIT
''"l '' COMMUNITY DEVELOPMENT Permit #: MEC2010 00583
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2010
Parcel: 2S111 CC21900
Jurisdiction: Tigard
Site address: 10310 SW GREENLEAF TER
Project: KUYLMAN Subdivision: Lot: 0
Project Description: Gas furnace installation.
Contractor: A TEMP HEATING & COOLING INC Owner: KUYLMAN, NELLY
16000 SE EVELYN ST 10310 SW GREENLEAF TER
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97224
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/16/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/16/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/16/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 7 z.-:. Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
11/14/2010 07:56 5035572990 A TEMP HEATING PAGE 02
lvivclnar,lcalt rernl�t A iicatio
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city of Tigard eceived
13 125 $w Hall Blvd., Tigard, OR, 97223 Data/[sy: I p No.:
Phone: 503.639.4171 Fax 503.548.1960
NOV 1 201 DatW view > ;
-
Inspection Line: 503.639.4175
Date/By: Otor Permit;
1' I ( hR I`! p 17ste
Internet: www.tigard•or.gov CITY OF TIGARD ilttifi
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BUILDING DIVISIO
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❑ New Construction Ili Addition/al teratio eplaoetne Mechanical permit fees* are based on the value of the work
[] Deirtotition Oth performed. Indicate the value (rounded to the nearest dollar) of all
t v m "`sr- -:"° tr.s+ ^1tr ': a:;,, echani materi e.ui.ment labor overhead.
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Description For special informatfan use checklist.
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Job site address: 0 • . y , Air conditioning
r ' re. uires site -tan showin iaccment 46.75
City /State /ZIP / • � Furnace 100 000 BTU ducts/vcnts) 5
EN 46.
Suite/bldg, /apt. no.: eject Warne: Furnace 100,000+ 13TU "duets /wore MB 54. 91 MIN
Cross street/directions to job site: ���'��� Hit tit a 61.06 ME
Duct work r. ME 23.32 MI
H conic hot waters , tarn ME 23.32
Residential boiler (radix y.r or
h (Ironic 23.32
Unit heaters (fuel -type, riot electric),
in - wall, in - duct, euspendcd, etc. 46.75
Subdivision:
Lot no.: Flue/vent for any of abo'e 23.32
Other: 23.32
Tax map /parcel no.;
Other fuel
1']hr e�,n, I��'- 155y'',fw r r Atr wy, r a „ lianees
m M1iii"'iA1 n' 4 r "a P7a•a,tf ar r I
) r,L��u ",rv' h�� �',a rl. !G d,,t19; �.L'�x'a� �7nu,lt a `�`itYir��rr�..: a;� ',?ty �q . i M1 r . n t 5 *JR. � _Watet heater 23.2
�r � C) frr •l4c 33.39
I �IMJr Flue as vent for e water heater or gas
flr_e_place 23.32
LoShtor (gull) 23.32
Wood /pellet stove 33.39
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�+ f�M,!'L`a "w5 . ,uA.:Y4^. ? t.,,J w ,.G .r.s11Yt't c "•flfat .n,'f�y , M li. ? n ° h t , r �, 23,3
. f< �wbrrx',s,::,� Other: 1
Name: I V.:. _ +. , ` 9 23.32
�nv[rnnmcntal ezhaust ventilation
Address: al �, Range hood /other kitchen
e ui meat _ 33.39
4, + ..,!_i. Si J
• Clothes dryer exhaust; 33.39
Fhonc: • I Single•duct exhaust (ballrooms,
��ry�y, A?' lQtr r 'S"�'� r !Yrtc r{ - rr rC a %G>ta,� ^,� r I toilet compartments, utility rooms) 23.32
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'`I 1.11 ✓1n:11 Attic /crawlspace fans j
Other: 23.32
Business name: t
_ , Fuel piping
S14.15 for first four. $4.03 for each additional
Address: f l t EC� ,., I . ' ,,� Furnace, etc
City/State/ZIP: ` J 1 r Gas heat u . MIM�
4 • `
ILMIL Wall /suspended /unit heater
m illl
•'r Fax:: ill dr.w . Water heater
• { Fire lace
{ If ► s „ s Range •
6�'�1'� lily Caf +I jP C rr T a` e. c
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a t, . 1,I.,1*,, s,-1 . „4 g , raiecbiS. l
di." Ail , 114 , Clothes dryer (gal
r
r � r a/ � Other
Address:
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City /State/7I1? a i• r + r''' '3'i Ir 4i' 114,1 `� 1 1 .r { :. ��`
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�} Subtotal ' � IP
Phone:
J j Fax: "As) .. G+ 0 Minimum permit fee ($90.00)
CCB lie.: 1 (j, / i 7 Plan rc',ziew (25% of permit fee
1 LI State surd arge (12% of permit fee) ` j a '
TOTAL PERMIT FEE l
Authorized si- •nature: ,t f 1 ,0 r a
_ C � \ 1" (� ' t This permit application efptres if a permit is not obtain, . •• t ga
Print name: k f� A/\ • days after It'hgi been accepted as complete.
u` - ' ur ir • . Fcc methodology sot by Trl- County Building Industry Scrvicc Board
ITulldln clrmmlIN \MEC- PemltApp.80c 10/o1/09
440451 /T ( 1 1/02 /COMittT p)