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Permit CITY OF TIGARD MECHANICAL PERMIT ' , COMMUNITY DEVELOPMENT Permit #: MEC2011 -00027 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/13/2011 Parcel: 1S 134CB08400 Jurisdiction: Tigard Site address: 11115 SW 124TH PL Project: Johnsen Subdivision: ANTON PARK Lot: 46 Project Description: Install gas furnace. Contractor: SPECIALTY HEATING & COOLING INC Owner: JOHNSEN, BRUCE & LAURIE M 7500 SW TECH CENTER DR #130 11115 SW 124TH PL TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503 - 620 -5643 PHONE: 503 - 750 -3926 FAX: 503 - 681 -0793 FEES Specifics: Description Date Amount Furnaces < 100K BTU 01/13/2011 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 01/13/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/13/2011 $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 Utility Noti a i'n 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 • estions o OUNC by Iling 503.232.1987 or 1.800.332.2344. Issued = • : ( /+ Permittee Signature: 7 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 /13 /2011 /THU 08:57 AM FAX No, P. 001 .mr Mechanical Permit Applica !it ' �i � l • ` v FOR OFFICE USE ONLY rl b t G nv Date/By: Array] Array] Permit No.: J7% ,eDUo? , , City of Tigard s / 13125 9W Hall Blvd., Tigard, OR 97223 �AN 1 201 P lan Review Phone; 503.639,4171 Fax: 503,598.196 Date/By: Other Permit; T I G A RD Inspection Line: 503.639.4175 CITY r y /� y Date Ready /By! Jana; El See Page 2 for Internet: www,ti.gard - gov OF 1 1GA 1D Notified/Method: Supplemental Information BUILDING DIVISION - Y O W ORT ' ; k',E � � ; .: ZYItG 4:k S(.WbW q ! 4 (57; ❑ New construction Addition /alteration /replacement Mechanical permit fees' arc based on the value of the work petfamed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit. " `- - T � Q * R ] QF Cl?N 7 .--* ,- --tr 77,7 Value $ ■ ,., , r 1 an<1 2-family dwelling ;',4$0.613 g( V i r h A ? O N ' f f S ' \ 1 S F 1 S * y g ❑ Commercial /industrial ❑ Acc essory building For special information use checklist, ❑ Multi family ❑ Master builder ❑ Other: -""° <(' , > : � � � i � i � r 4 n J , Description I Qty, I 8a. I Total ,N .., ' � � . oa �"C UT !'1?± X` ?1 Ech1 ; ,A)(I ►k�,," Heating/cooling Job site address: 1 I 115 SW 1A4 F 1 Air conditioning placement) (requires site plan lacement 46.75 City /State /Zip: 11 � (4 a Furnace 100,000 BTU (duets/vents) t 46.75 ; Furnace 100,000+ BTU (ducts /vents) 54.91 UUU Stlite/bldg. /apt, no.: Project name: 5 Float pump I 61.06 r Cross street/directions to job site: Duct work 23.32 w- Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 _ Unit heaters (fuel -type, not electric), in -wall, in -duct, sumpended, etc. 46.75 Flue /vent for any of above 23.32 Subdivision: Lot no.: Other: 23.32 Tax map /parcel no,: Other fuel appliances �: `„ } ` to : s, n y r" " O "i d"� Water heater 23.32 , ; ;,�, 6 'l .. '':.:',,;A. (l h d „ ,V � :. . ,� .. : .,f;, . r�.�� , .., ,9 " 4L,,, ;4,, , Pf h P.Z , : Gas fireplace 33.39 4 S 1, ■ ,,I trte rno C.Q- Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 • Wood/pellet stove 33.39 _j Wood fireplace/insert 23,32 r 'jl . V;� ��Q ' " �4 ��i V i V l ti ` � ; t l �+�t i g ut r 1.r. � . i it s I r l , Ot 4y /ling /flue /vent 23.32 m k,,,a, J � .� m.sa � ,�,a,.r�::.E,. s,,.�..�p,,9',T,,,�.a, ,�, ki,...,�l.r,.n w, Other: 23.32 Name, �o haser, Environmental exhaust and ventilation i Address: , \ , f ['' J' i 1 .4' ~;i gage hood /other kitchen �.�IAJ 1 equipment 33.39 City /State /ZIP. 01 (Ir 0!Z.) O' J I 3 Clothes dryer exhaust T 33.39 �^ 1 Single-duct exhaust (bathrooms, Phone: ( It r � Fax ( ) toilet compartments, utility rooms) 23.32 ." n t y W, yin 1 � V(irr d}�a ©.w,''f0f�°�'t*: r s l r � , �5. j � ' �T°o'� � 0i. "' , 1 :E Attie /cfawlspace fans 23.32 Business name: Other: 23.32 ,µ� PueI piping Contact name: $14.15 for first four; $4.03 for each additional Address: Furnace, etc. ... _____________ Gas heat pump City /State/ZIP: Wall/suspended/unit heater Phone: ( ) Fax: : ( ) Water heater .._,.- , --- Fireplace E-mail: Range '� Barbecue Business name: Specialty Heating and Cooling Clothes dryer (gas) Other: _ Addtcss; 7500 SW Tech Center Di #130 ' `r ' ' ,,: I V City/State/ZIP: Tigard, Or. 97223 Subtotal Minimum permit fee ($90.00) go.ao Phone, (503) 620 -5643 Fax: (503) 681 -0793 plan review (25% of permit fee) CCH lic.: 66578 State surcharge (12% of permit fee) J I a .O TOTAL PERMIT ermit Is IT FEE ( th , w within 150 This permit a If ermk Ihud w 18U Authorized signature: _ days spplication after It has explre been a accepted p as not complete Print name: Andrea Dripps (� lryl r) Date: tI -.---1 U - 1 * Fee methodology set by Tri -Cotmp Building Industry Service Beard I:muilding\P rmitellvi&C- PermitApp.don 10/01/09 440.4617T(1 I /02 /CONUWEH)