Permit ,, CITY OF TIGARD MECHANICAL PERMIT
` g COMMUNITY DEVELOPMENT Permit #: MEC2010 -00682
T f G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/23/2010
Parcel: 2S104CCO3300
Jurisdiction: Tigard
Site address: 13986 SW HILLSHIRE DR
Project: MOZNETTE Subdivision: HILLSHIRE ESTATES NO. 2 Lot: 139
Project Description: Gas furnace replacement.
Contractor: ABLE HEATING & COOLING Owner: MOZNETTE, JAMES S TR &
8900 SW BURNHAM F -5 MOZNETTE, SHARIN TR
TIGARD, OR 97223 13986 SW HILLSHIRE DR
TIGARD, OR 97223
PHONE: 503 - 579 -2250 PHONE:
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/23/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/23/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/23/2010 $43.25
Occupancy Grp:
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 UNC by calling 503.232.1987 or 1.80
Issued By: Permittee Signature:
Call 503.6 •.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.
RECEIVE I
Mechanical Permit Application FOR OFFICE I_ SE ONLY
I a City of Tigard DEC 2 3 2010 Received • 13125 SW Hall Blvd., Tigard OR 97223 �± � 0 ��" Perm" No.: V 1= 1 — L4
Phone: 503.639.4171 Fax: 503.598.196 DEC
OF TIGARD Date/B Vow Other Permit:
TrGARn lttspecttonLine: 503.639.4175 BUILDING DIVISION DatcRcadyBy: B See
Internet: www.tigard- or.gov
Notified/Method Supplemental p at e2lnformatien
TYPE OF WORK COMMERCIAL FEE• SCHEDULE - USE CHECKLIST
❑ New construction Addition /alteration/replacement Mechanical permit fees* are based on the value ot'the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1- and 2 -famil • dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
} g ❑Commercial /industrial 0 building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other Description [ Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Jab site address: + t ' • • Air conditioning
K� 1 % (0' n {�
_ ' W ``5 Y lV� Cj (L\ 1 - (requires site plan showing placement) 46.75
- City/State/ZIP: f 1` GZ Furnace 100.000 BTU (ducts/vents) 1 46.75 a �
h � ` Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldg./apt. no.: }project name: l` \D \D , -- 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 (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
S",.t division: I r1nt �0 -
I Flue/vent for any of above ; 23.32
Other: 1 1 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 2332
Gas fireplace 33.39
9 3k-- INC.1'. F Y,, \ \11 As \-- .- V\f=.0:t , Flue vent for water heater or gas
0 fireplace 23 32
Log lighter (gas) 23.32
Wood/'pellet stove I 33.39
Wood fireplace /insert 23.32
PROPERTY OWNER - Chimney/liner /flue/vent 23.32
❑ T ENANT Other.
I 23.32 .
Name ' � S t-- .J , 1 Environmental exhaust and ventilation .
O� {�
r `, Range hood/other kitchen
Address;
lT rli c�lJ r h \`�x ` lZt r We r= equipment 33.39
City /State/ZIP c4j� c `,°> Clothes dryer exhaust 33.39
i, L� Single -duct exhaust (bathrooms,
Phone:l 5 . ; pax ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic %rnwlspace fans 23.32
Business name:
Other. 23.32
Fuel piping
Contact name: S14.15 for first four; S4.03 for each additional
Address:
Furnace, etc.
Gas heat pump
City /State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name:d ' (� 1 r Clothes dryer (gas)
�'tL7LJ'- � k'�C W �i h x ` ' Other.
Address: ��G �� � � \ `- - *J MECHANICAL PERMIT FEES*
City /State/ZIP [ '.�����
\ t '� � Subtotal
Phone: ( J , ( fi e 7 CE'1 Minimum permit fee 1 ax ( � 1 q ^ (590.00) �Q t ` =�5 '- JV `Qr�� t ) V Plan review (25% of permit fee) �
CCB lie.: )
\�c‘ oZ__ State surcharge (12% of permit fee) \ p , 90
TOTAL PERMIT FEE 4 v -c.i.,(
Authorized signature This permit application expires if a permit is not obtained within 120
�� ✓""" days after it has been accepted as complete.
Print name: eA k \ Date: , /,;
' Fee methodology set by Tri- County Building Industry Service Board
I:U3uiiaingTermiatMEC.pe,ri p oc Iorouos 44 ITT (II/C OM/WEB)
L O86£-OZ9-£O9 6uil000 hg 6ugeeH env