Permit III -. CITY OF TIGARD MECHANICAL PERMIT
is = q '' COMMUNITY DEVELOPMENT Permit #: MEC2010 00614
Date Issued: 11/23/2010
TIG 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S102AA01200
Jurisdiction: Tigard
Site address: 11895 SW GREENBURG RD
Project: Luke -Dorf Subdivision: Lot: 0
Project Description: Gas line repair for furnace.
Contractor: ADVANCED HEATING & AIR CONDITIONING Owner: LUKE -DORF INC
6918 SE 48TH 11895 SW GREENBURG
PORTLAND, OR 97206 PORTLAND, OR 97223
PHONE: 503 - 774 -0161 PHONE: 503 - 570 -9955
FAX: 503 - 774 -4391
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee 11/23/2010 $69.06
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/23/2010 $8.29
Occupancy Grp: Occupancy Load:
Stories:
Project Valuation: $125.00
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressure: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $77.35
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
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 0 I NC by calling 503.232.1987 or 1.800.332.2344. ,� ` /9-79/74/6"---/-701V1
/ / j ,,
Issued By: c � U .2��`—'" Permittee Signature: 0/ V L' /6� /-/ V/erg / V
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.
•
Mechanical Permit Ap ( j I Y ED ' . . FO_J4 t,r1'It 1 OPE ON'I l' .
R eceived ,
1111 . City of Tigard err
3 n y Permit rla
el 13125 SW Hall Blvd Tigard, Of +�YP, r 232 ep 2010
Date/By: `� a� /p��! ® _O��/
I Phone: 503.639 4171 Fax: 503.598,1960 i Plan Review
Date/By: Other Permit
'T 1 (.JA R 1'! Inspection Line: 503,639.417 OF TIGARD Date cad !B
/By. 6
Ready /By. Supplemental 7 S See P Page ee age 2 for
Internet: www.tigard or.g4ry Notified/Method: Information
BUILDING DIVISION
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N ew construction Addition /alteration /replacemen
� »._ �. fir€ s .. t a.wi, -r. - eechanic l pe fees' are based on the value of the �..
❑ [/t
p ork
. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials, ment tit
ab ut rtes and pro
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Value' - label",
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sr d
❑ 1 and 2- family dwelling ommercial /industrial r i s n )..
❑ Acce sory building
Rif -
For special information use checklist.
❑ Multifamily ❑ Master builder
❑ othe
Description 1 Qty. Ea. Tonal
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Y
/ 1 .6: , w .1 . ,r 170 `t6L �j O t „rJ t 'cL fli Heating,/cooling
Job site address: \ %�' 5 Su
Air conditioning
.L „'� /� (requires s ire plan showing placement) 46.75
City /State /ZIP: �\ _ �� I a � Furnace 100,000 BTU rducis/vcnts) 46.75
Furnace 100,000+ BTU (duets/veats) 54.91
Suite/bldg.{apt. no.: Project name: Lak _ � )I Heat pump 61,06
Cross street/directions to job site: Duet work 23.32
Hydronic 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
Tax map /parcel no.: Other fuel appliances
r t „ rr X s _ v ,-i i .
n. b ii ir" 5 R1 7 r{ ts.,. T
�,....:T; ,- r<,us, a fir.:. .. uu =2 - � _.�....._,.„ Water heater 23.32 Gas fireplace 33.39
\ Q --11 Flue vent for water heater or gas
� ' fireplace 23.32
/� ,J - :
nj�� �I Log lighter (gas) 23.32
/"�� F s lf: /5 S - 4 Woodrpellet stove _ 33.39
Q� Wood fireplace/insert 23.32
{.T7 .0404:17:/ �� tP . r(.,r a �.,,. -k, Chimney /linerlfluelvent 23.32
=.s m `. n3iii . ;
L t .a:';f; .. Ia tt, _ t_. 1, tr . " Other: 23.32 _
Name: Environmentat exhaust and ventilation
a
Address: Range hood/other kitchen
equipment ' 33.39
City /State/ZIP: Clothes dryer exhaust t 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
? I .g ' - ` t K x�+ .
' . iC t } r' ` _ ,r - Atticicrawlspace fans 23.32
Other: 23.32
Business name: L� 1Z . Fuel piping
(� `� pp
Contact name: V v'II 'V 1 ! i -\j 514.15 for first four; 54.03 for each additional
Address: `` jS3 SW c QA -
Furnace etc.
(�� (� ` E �� ' } l Gas heat pump
City /State /ZIP: `\ (-T t'�J" Z� rIt e VV n--Y-2 3 _ Wall/suspended/unit heater
Phone: ( `� () t3 c c. 5 � h, '-"l �.r • 1 C) '2 Water heater
( �} Fax: 6 - 1 C' V? �a
Fireplace
E-mail:
Range
nee �. i ,', Il 1 @1 �� i "n s.j i LL,,,, t.'",>t ltd - n T t x' •"'..;_
� y . f l ',15 1[_Sc ,yls 1 is. Lictli aa", },:�a.. Barbecue <..._ ...... a ';? = . ,. .,aa >x�e* sf ,. .� �. .. ... ::«.�3lkhi.. �', z�, . :tn ° t ' AS � tt t', � k
Business name A/ /1/lrp�lg ,Nel / // Clothes dryer (gas)
Address: ,y�'!l CC UL/ r -z , 11r'il o F�(�* l/ !fi ftr ,,
Other:
} g a t •- TI n 7;.
6 . 7, Subtotal
1 1 a : eta:
City /StatelZlP:
`�' �� Minimum permit fee (590.00) ' :
,
Phone: L9 7� O � & , Fax: L J' / /t � 7 �/r Plan review f25 % of permit fee) j3 9
CCB lic.: 77) State surcharge (12 °/n of permit fee) t5S)
l 1 TOTAL PERMIT FEE_
Authorized signature , - , - #°--11 - � This permit application expires if a permit is not obtain with
days after it has been accepted as complet 77,
Print name: /02‘.../.67-A:71„, �Gf Date: ' Fee methodology set by Tri- County Building industry Service Board
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