Permit ,, CITY OF TIGARD MECHANICAL PERMIT
111 - COMMUNITY DEVELOPMENT Permit #: MEC2010 -00660
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2010
Parcel: 1 S 133AD12000
Jurisdiction: Tigard
Site address: 11285 SW SUMMER LAKE DR
Project: DEXHEIMER Subdivision: SUMMER LAKE Lot: 1
Project Description: Replacing gas furnace and adding A/C.
Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: DEXHEIMER, SHERRY E
PO BOX 80607 11285 SW SUMMER LAKE DR
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE: 503 - 233 -1779 PHONE: 503 - 313 -3980
FAX: 503 - 651 -3345
FEES
Specifics: Description Date Amount
Air Conditioning 12/21/2010 $46.75
Type of Use: SF Furnaces < 100K BTU 12/21/2010 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/21/2010 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $104.72
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 1.80P. 2.234 .
Issued By: i Permittee Signature:
CaII 503.639.4 • :10 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.
-1�� O
Mechanical Permit Application
rot( c)p`t I('4; L1tiF.. ONLY
1 City of Tigard Received
:. r w , , � � Datc/By: / M Permit No.
13125 3W Hill Blvd., Tigard, OR a ' � V ,r/ • -- e
il• ` Phone; 503.639.4171 Fax 503.598.1960 o �O 4 Plan Review Other Permit:
Date /By;
Inspection Line: 503.639.4175
Itt;,►ICr P �
QC- lj �` pate Ready/By: Judi: ,: See t'■
Internet: www.tigard- or.gov G C1 ®1� Notilled/Method: Q Supplemental l Information
for
lo V ic�l
COMMERCIAL <FEEk 9CPIEDULE' `USE 'CHECKLIST •
['New construction Addition/alterati6n/repJac meat Mechanical permit fees* arc based on the value of the work
performed, indicate the value (rounded to the nearest dollar) 01 211
❑ Demolition Other: mechanical materials, equipment, laborlead, and profit,
. :'!i- . • CATECORY:OF. CONSTRUC'TION', r' `''' ',' Value: $ C
j RESIDEN'Y'1AL' EQUIPMENT; l SYSTEMS FEE ' .
1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist,
❑ Multi•family ❑ Master builder ❑ Other; .
Description . 1 Qty. Ea. • Total
;: ,' .;;'; • ..: ' JOB. SITE •INFORMATION AND: LOCATION: ; : i -; .'.. ` ..•:; `: Hen tinp./cooll,ng
Job site address: _c UIMr'�')ems.. //e Airconditioni
•. IC (requires site plan allowing placement} / 46.75 �ir�,'l S
City /State /Z1P: s Of e Furnace 100,000 BTU (ducta/venta) / 46.75 ij(
• Furnace 100,000+ BTU (d,wta/vents) 54,91
Suite/bldg./apt. no,: Project name Heat stump 61.06
Cross street/directions to job site: Duct work 21.32
• Hydrunic hot watc5ystcm 23.32
Residential bailer (radiator or
hydronic) _ 23.32
Unit heaters (fbe1 -type, not electric),
in -wall, induct, suspended, etc. 46.75
Subdivision: Flue /vent for any of above 1 23.32
Lot no.: r
Other: 1 23.32
Tux map /parcel no.: _ Other ruci ppllances
DESCRIPTION'OF WQRK: ; ' •.' Water heater 23.32
/ /� ^ Gas fireplace 33.39
f '' c e • (o �4J1./ ri,�� '` A A
6., ' C' Flue vent for water heater or gas
firtp lace 23.32
- - Log lighter (gas — 23.32
Wood/pellet stove 33,39
• Wood fireplace/insert 23.32
Chimney /liner /flue /vent 23,32
r � PROPERTY OWNER ❑ TENANT
Other: 23,32
Name: 1 ° - o A .' r AA ' Environmental exhaust and ventilation
Address: i �� ! , r equ /otherkitchtn 33.39
City /State /ZIP: • t -•L 14-6,.. 0 Ci . ,3 Clothes dryer exhaust 33,39
v I L Single -duct exhaust (bathrooms,
Phone: (01 , , - /5,3'7 Fax: ( ) toilet compartments, utility rooms) 23,32
APPLICANT.: , '. , ;: :D CONTACT'.. PERSON....' Attic /crewlspacefans 23.32
• Business name Other: 23.32
Fuetj,iping
Contact name: I K 7r 514.15 (or first four: 54.03 f or each additional
Address: Furnace, etc. _
City/State/ZIP:
— Gas Ilea pump _-
Wall/suspended/unit heater
Phone: ( Siti 7 i 3_ - 3 7 g /, Fax.. ( ) Water heater
'• ✓ Fireplace
E-mail: --
. . CONTRACTOR .c' :::,,,,',,:,:.4:,:::•....•,!',' a
.becuc
Business name: 12 e Nr �,�� d,-, /9"." liG _Clothes dryer (gas
D / //i Other:
Address: MECIIANICAI, PERMIT FEES*
City /Statc/ZIP: PO r yt d q7, ga _ _ Subtotal ei ,5
'tionc: (-2...?) ' 3S _) -7'7 Fax: (67).? ) tY / --! _ 3 3 7` t / �] r ,� Minimum permit fee ($90,00)
Plan review (25% of permit fcc)
t g llc 7 State surcharge (12 % cif ptrmit fee) , )
Authorized signatur ii TOTAL PEANUT FEE i t)4 , 7)-
This permit application expires Ifs permit Is not obtalmed within l80
�� , 11 days after It has been accepted a, complete.
Print name: ' r Date: g � , • Fee methodology sat by Tri- County Building Industry Service Board
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