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Permit II CITY OF TIGARD MECHANICAL PERMIT . COMMUNITY DEVELOPMENT Permit #: MEC2011 -00034 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2011 Parcel: 1 S 133DCO3400 Jurisdiction: Tigard Site address: 13250 SW FALCON RISE DR Project: Bianconi Subdivision: MORNING HILL NO. 1 Lot: 27 Project Description: Replace gas furnace. Contractor: WESTERN HEATING & COOLING INC Owner: BIANCONI, JACQUELINE M & 50618 COLUMBIA RIVER HWY 13250 SW FALCON RISE DR SCAPPOOSE, OR 97056 TIGARD, OR 97223 PHONE: 503 - 543 -5599 PHONE: 503 - 524 -8744 FAX: 503 - 543 -3693 FEES Specifics: Description Date Amount Furnaces < 100K BTU 01/19/2011 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 01/19/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/19/2011 $43.25 Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressure: Total $100.80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utilit• ification Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or erect questions to O . b •: • 503.232.1987 or 1.800.332.2344. ssued By: i , �t ,XZ4 ) Permittee Sig . Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Jan 18 11 03:14p Western Heating i 5 03- 543 -3693 p.1 ; i I Mechanical Permit Application � l �p JAN FOR OFFICE USE ONLY Cit of Tigard Z Da ; E : nr � M _ N. -ax5 A Dat L. " 13125 SW Hall Blvd., Tigard, OR 972 n Plan Review Phone: 503.639.4171 Fax. 503.59$ 3 g ®F �t.3 y �p Date By: Other Permit: C3 ( Jt TIGARD Inspection Line: 503.639 L D6l ' VG D VISitJP� Date Ready/By: funs 1a See Page 2 for Internet: www.tigard or.gov Notified/Molted: Supplemental information TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST El New construction Addition/alteration /replacement Mechanical permit fees* are based on the value of 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: $ l- and 2- family dwelling ❑ Commercial/ industrial ❑ Accessory building Multi - family ❑ Master builder ❑ Other: RESIDENTIAL EQUIPMENT i SYSTEMS FEES* For special information use checklist. Description I Qty. I Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling !✓ ` ` Air conditioning Job site address: _25 5i.„3 Cat Cby) ( (requites site plan showing placements j 46.75 City /State /ZIP: ()� .3... In r of `1aa3 Furnace 100,000 BTU (ducts/vents) ( 46.75 V( Q Furnace 100,000+ BTU ( ducts/vents) 54.91 Suite/bldg. /apt. no.: Project name: G U rl n 1 Heat pump 61.06 Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 23.32 Residential boiler (radiator or hvdronic) 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 DESCRIPTION OF WORK Water heater 23.32 Q Gas fireplace 33.39 p ' �V 1 n,' � n L 1 -9 6 3 C - LI f 1' Flue vent for water heater or gas fireplace 23.32 - -- Log lighter (gas) 23.32 I Wood/pellet stove _ 33.39 Wood fireplace /insert 23.32 �j( Chimney /liner /flue/vent 23.32 Ia PROPERTY OWNER ❑ TENANT Other: 23 Name: G1GKe 6 i Gl ann t Environmental exhaust and ventilation • Address: n ange hood /other kitchen Si � �� Gf 1 /'hr1 i f equipment I 33.39 City/State/ZIP: ( -I- to at-7;2a Clothes dryer exhaust 33.39 G Single -duct exhaust (bathrooms, Phone: (33) 1 4_ O `74'4 Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Atticicrawlspace fans 23.32 Business name: Other: 23.32 Fuel piping Contact name: S14.15 for first four; $4.03 for each additional Address: //yy Furnace, etc. / U �� Gas heat pump City / State/ZIP: 'J C()° Wall/suspended/unit heater Phone: ( ) Fax: : ( ) Water heater E -mail: Fireplace Range CONTRACTOR Barbecue Business name: ()Op ex - f /1 I C � ! r�� - � � Clothes dryer (gas) I) Other: t LJ Address: �� r' /,, }{ h� { VPs�i ✓ J l MECHANICAL PERMIT FEES" City/State/ZIP: 6GA QQ VI op_ q7a 4 Subtotal , 75 Minimum permit fee ($90.00) • Phone: ( ) 5i .- � , r5/ c Fax: ( ) 51..1 3b93 93 Plan review (25% of permit fcc) CCB lie.: 769 "7 8 i ( / A State surcharge (12 %of perrnit fee) l©. /CO. �18 SO r 42/tC/1 ( / "TOTAL PermMsT FFE �. c This application espires if a permit is not obtained within 180 Authorized signature: permit after it has been accepted as complete. Print name: L JOI t e, (I SD n Date: J - / _// • Fee methodology set by Tri- Count} Building Industry Service Board 1 1 BuiIdingTennits 'Mf EC-Per miIApp.doc 1 4.01/09 440-451 (I l /02/COM/WID)