Permit ,, CITY OF TIGARD MECHANICAL PERMIT
111 1- COMMUNITY DEVELOPMENT Permit #: MEC2011 -00073
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/17/2011
Parcel: 2S 1038 D07400
Jurisdiction: Tigard
Site address: 12575 SW 115TH AVE
Project: Fauth Subdivision: HUNTER'S GLEN Lot: 30
Project Description: Replace furnace.
Contractor: ANDERSON HEATING, INC. Owner: FAUTH, BRIAN T & KATRINA M
6463 DAWN AVE. 12575 SW 115TH AVE
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
PHONE: 503 - 841 -0742 PHONE: 503 - 521 -1943
FAX: 503 - 536 -6615
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 02/17/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 02/17/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/17/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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
issu.. e, or if . • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
U ity Notification Cen - T • rules are set forth in OAR 952- 001 -0010 through OAR 952 -00 -I!!!. You may obtain a copy of the rules
.r direct questions to OUN�'•y calli . )3.232.1987 or 1.800.332.2344.
lif ssued By: I d / / Permittee 410
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.
Fm:MyFax - Art Ander,sen To:Andersen Heating Permit Application (15035981960) 11:15 02/17/11GMT-05 Pg 03-03
Mechanical Permit A II. lication :;g:::::::03igintg:',10:magfp.,r,,„,,,,,,,...
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131,..:" $Ve 1 .lvd., ltgam, Olg • 97223
Plan Review
• gtt:,[t.. ,a4.: . Phone: 503.639.4 I 7t Fax: 503.59g. 1960 Pr Other Permit'
444xii;61 ,:l tine: '503.639.4175 FEB 1 -S 2 0 1 1
Date keadylny: ) 1 , 7'4 , , ' fl.1 See Page 2 for
ItAt[ ...Internet: WWW.tigard
NotifiediMettaxl: supplemental Information
CITY OF TICIA96 _ .. ......_
0.!: . 'i'f"'„'" : :: -... . ' 'I 44 it,t0 4 Eli . .606,..(i; , RUSt
1, Mechanical permit fees* are based 'On the value of the work
1 0 New construction N A dd it ionialterat ion/replacement
I perfonned. Indicate the value o'ourided to the nearest dollar) of all
0 Demolition 0 Other:
mechanical materials, equipment, labor, overhead, .iiid profit.
.-- . .
I . ,, -,.;.....:: : --.;'• ';::- •:-. .• 't."IcA,r4;91.CY-..',..0./!' (,..x..).NTItycylp,N::=:-. ,,,-,,.-.: :,...„ , L. - ....,..i ., . value: 3750.00
• - I 47. V.. t il ) E 1 '''ill ' Ai..1 ; :$ST•ii F.i'ES ''; - , - " C ''''• • • '
i (E)
I- and 2-family dwelling Ej Cominercial/induStrial 0.Accessory budding
For speeittl-infor/ticition nse checklist.
0 mum-famil 0 Master builder 0 Other:
Description Qty. Ea, I Total
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3013 SITE INFORM/0l0 N .AN6 • .:• Tenting/cooling
Air conditioning
Job site address: 12575 SA '115 Avenue I
(require, site plan showing placement) 46.75 t
City/State/ZIP: Tigard, .012 5 Furnace 100.000 Bit (ducts/vents) t 1 1 :46.75
• -
• I Furnace 100,0001. BTU (dam/vents) I ! 54.91
"Suite/bldg./apt. no - Project naine:.'Brairt Fatah • r
' -- , • 1u-letpump ,
- 61.06 • t
—7---- ,, . -I
1 Cross.Street/directions to job site: 'f r Duct work ____ 7 i 3 I
• --
Ifydronicia:t water system . ----- 1 7 2:T.T2 .. 1
1 _
Residential hotter (radiator or
[ hydronie) 23.32
t „
• - - .
Unit heaters (fuel-typc. not electric),
I
in-wall, in-duct, suspended, etc. 4.6.75
_ — I Flue/vent for any of' above 23.32
Subdivision: 1 ot no '
I ' "
..1 Other; 23.32
Tax,map/parcel no.: e R 6/0 5 4 _ l.ot 2 0 7 ev
Other fuel aces
:- '-',':'''' ''''''';'-'"'"-'•- — -1 41 WORK -'.'-; '':,'' ''' '''' ',''''. '' -- \Vale heater 7 3.32
Gas tireplace 33.39 1 1
LReplitee old furnace with a new Coleman 'furnace
Plue vent for water heater or gas • • 1
fireplace
I . 23.32
Log lighter (gas) _ . 2132 L
1
.
! Wood/pellet stove , e 33.39
i --------' — , ,„ ,
...._
1 •Wood'firsplitse/insert 23.32
' D, f,',ReirtER•6' t.0181)4,;R:• .1: ,:,,, ,,, • ,, ,•,1 e ..,,.,......„,.:... .. ,Chirruner/iluchent 23.32
Name . p rainVt, nth Othr
Environmental exhaust and ventilation
_.
. .,
-----7 Range hood/other : kitchen
• Add'ess:. 12575 SW '11,5 ,AVC
- . et lii Merit 7-473339..
---- .._
City/Stair/ZIP: l'igartl, .08'97223 7 1 Clothes exhaust I . 33,39
. . Sn'tgle7ductexhausL(bathrootrig, I •
Phone: (503)521-1943 I Fax: ( ) t toilet compartments utility rooms) 23.32 a .
8P :::-':::: : ' f . : --ci - eOisi? - r .. f.)14' , I . - '= - , - '' -7 A lti#J:71'wl'Imcc fan 23,32
• • -. - "'"' •
Other: , 23.32
13usiness name: Andersen. 11 eati ng, Inc r,--
l tie! piping
I Contact name; Art Andersen
$14.15 first four: $4.03 for each additional
-- -, _ ... . _
1-urnace, etc.
I 'Address; 6463, Dawn Ave t--
1 •
Gas heat parry
eity/Staie/ZIP.: Lake Oswego,.OR 97035
, Wall/suspended/unit heater _ t
— , ±.....71
Phone:. (593) mi-0742 I Ftt,...-:. (503) 536-6615 Water heater ... „— 1
--- --1 Fireplace
E gogreengandersenbeating.cont
1 • Rank:
0NTI4stC FOR - - .- - - - ' - • •-• - - - - - ' • • ' . .. . .„ . . - .
I • Barbecue
' Clothes dryer tots) ---- 4
130iiness nitrite: Andersen Heating,-Ine
. Other:
Address: 6463 Dawn Ave • -- -,;:,20',: z .,: ) ,', Zkl.t.0. 4 20A . :(.;'0 1 j r .t.'i i ii‘i8 4 -'-':-, ,_<,""•':.' .':
1 Ci tv/State/Z I P.; Lake:Oswego, OR 97035
Submit( .1
t -
—,,,,----- '
, _
------
Minimum permit:eta: ($90.00)
l'hone: (503) 841-0742 Fag:, (503) 536-6615
— )
.
■ _
Plan review - t25% of pemiit fee
[ CC71 :.168214 / —
Stale sureharge.(12% of permit -fee) 1
Ta.r.A.,.., PERIVIII FEE L . i
This permit :;ppkeation expires if n permit is nut obtained within IRO
Authorized signature: • - .
Ote 1,
,- . /PEO-K ! Date: 02/17/11 1 days after it has been acetified ns
Print !linnet . .
1 .t Fee metilixILdogy set by Tri-C'ounty Iiiiildin Industry St;rvice fio:Ard
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