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Permit CITY OF TIGARD MECHANICAL PERMIT 1 1 , COMMUNITY DEVELOPMENT Permit #: MEC2010 -00662 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2010 Parcel: 2S114BB11800 Jurisdiction: Tigard Site address: 10429 SW TITAN LN Project: Burton Subdivision: SWANSONS GLEN NO. 2 Lot: 59 Project Description: Gas furnace replacement. Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: BURTON, CLYDE PO BOX 80607 10429 SW TITAN LN PORTLAND, OR 97280 TIGARD, OR 97224 PHONE: 503 - 233 -1779 PHONE: 503 - 313 -3980 FAX: 503 - 651 -3345 FEES Specifics: Description Date Amount Furnaces < 100K BTU 12/21/2010 $46.75 Type of Use: SF Flue/Vent For Any of Above 12/21/2010 $23.32 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/21/2010 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/21/2010 $19.93 Stories: Fuel Fuel Types: Natural Gas 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 1.808 - Issued By: Permittee Signature: �� i��. G � �tLar Call 1 .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 Application V wit oFFicE n:tir: c>,Ni City �+ � R eceived `� of Tigard $ C Datc/By: " r Permit No.: _ _ « / n . >t 13125 5W Nall Blvd., Tigard, OR 9722 j plan Review lr/ r� �� ■ � C10 II Phone: 503,639.4171 Fax: 503,598.1 0 Date/By; ther Permit: Ins ection Line: 503.639.4175 y' (U ` ex'�►C- I I i �1 It 11 G �� Data Ready/By: Jurit: RI See Pa 2 for Internet: www.tigard or.gov OV IN G ' O olifted/Method; Supplemental Information TYPE OF WOR ~ ��G� COMMERCIAL FEE* SCFIEDULE - USE'CHECIC]✓[$T Mechanical permit fees' are based on the value of the work L] New construction Addition/alteratio replacement performed, Indicate the value (rounded to the nearest dollar) of ail ❑ Demolition Other: mechanical materials, equipment, laboryerheiLd, and profit, CATEGORY OF CONSTRUCTION . Value: $ U . 1 -and 2- family dwelling ❑ Commercial /industrial ❑Accessory building • C1 Mufti family Master builder cop special btformailon use checklist. © Other: .,:,RESIDENTIAL EQUIPMENT / SYSTEMS FEES* Description 1 Qty. 1 Ea. 1 Total JOB SITE INFORMATION AND LOCATION. • .. I .., . Heating/coolin 44 Job site address: / C J ,, �� j v. Air conditioning �j r . � (requires alto plan showing placement) 46,75 City /State /ZIP: , )/�.�► Ole e�"1.7 ~f �L/ Furnace 100,000 BTU (ductafvcnta) i 46.75 (- 16)(75 --- �� `Zr Lx �r 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 water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (tbel -type, not electric), in -wall, in -duct, suspended, etc, 46.75 Fluc /vent for any of above / 23,32 Subdivision: Lot no.: Other: 23.32 _ Tax map /parcel no.: Other fuel appliances - DESCRIPTION OF WORK ...•: Water heater 23,32 • ,1 :' r�, `''- , , Gas fireplace 33.39 ee, F I4 &A-_s ruin/ ' ,. Flue vent for water heater or gas fireplace 23.32 • _2.g Ijhter (gas) 23.32 Wood /pellet stove _ 33.39 Wood fireplace /insert 23.32 Chimney/liner/flue/vent . 23.32 • /I PROPERTY OWNER ❑TENANT Other: 23.32 Name: j 4d oet cr--41 Environmental exhaust and ventllat // �� Address: Range hood/other kitchen /d aq co '/ � iivr equipment 33.39 CirylStatelZlP: i dR cri aa.T Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phonc:43) '12- 9163 Fax: ( ) toilet compartments, utility rooms) 23.32 I" APPLICANT © CONTACT PERSON': Attic /crawlspacc fans 23.32 Business name: Other - 23.32 — ,„ - ., w. Fuel piping Contact name: r kk tr d 514.13 for first four; $4.03 for each additional Address: Fumaco, etc. Gas heat pump City/State/ZIP: Wall /suspended/unit heater Phone: 13- q g (� � ! Fax:: ( ) Water heater Fireplace E -mail: Range • CONTRA OR . ' Barbecue Business name: 1 e 4 d 4 - f Clothcs dryer (was) Other: Address; f 0 a x g6 6 7 - MECHANICAL PERMIT FEES! City /State/ZIP: POrtl tI,f p2„ q7 if _ Subtotal Mini permit fee (590,00) �f — Sb2 '+one: (-2..?) a, 33 - 1-77 Cf Fax: (;.?)r) b $I - 33 Plan review (25% of permit fee) ..,CB tic.: State surcharge (12% of permit fee) 1() , TOTAL PERMIT FEE l (fO, 37) Authorized signatu ii This permit application expires if a permit if not obtained within 80 days after it has been accepted as complete, IF Fee methodology se by Tri•Count Budding Print name: � � l3Ate /�, to /0 � 8Y Y Y g Service Board I: I114i1(llne.rermitsmEc.Permitap5.doc !Wel 44Q. • 7T 11MCOM/wen) T00 el HIVVDNIZY3H - SNdH S fi££TS9£05 YVd 60:ZT OTOZ /0Z /ZT