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Permit 1 CITY OF TIGARD MECHANICAL PERMIT IN 2 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00109 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/16/2011 Parcel: 2S111AD12300 Jurisdiction: Tigard Site address: 15140 SW 89TH PL Project: CULBERTSON Subdivision: SCHECKLA PARK ESTATES Lot: 36 Project Description: Gas furnace replacement. Contractor: WATTS HEATING & COOLING INC Owner: CULBERTSON, CHARMIE 580 PORTLAND AVE. 8750 SW PINEBROOK ST GLADSTONE, OR 97027 TIGARD, OR 97224 PHONE: 503 - 786 -2858 PHONE: FAX: 503 - 786 -2807 FEES Specifics: Description Date Amount Furnaces < 100K BTU 03/16/2011 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 03/16/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/16/2011 $43.25 Occupancy Grp: Stories: Fuel Fuel Types: Gas Pressure: Total $100.80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. Issued By:, • ee Signature: LAC e7._____. � 9���"`���`"������ I. .. --- ..0 Call 503.63 1.41 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mar, 15. 2011 3:00PM WATTS HEATING No. 1788 P. 1 Mechanical Permit Application Ion da rter, USE ONLY City f Tigard Received 71 y g Date/By: -, Peml(l No,: /y) — �. L • it' 13125 SW Hall Blvd., Tigard, OR 97223 plan Review Phone: 501718.2439 Fax: 503,598.1960 Date/13y: Other Permit T t t ; A R D Inspection Line: 503.639 Dale Ready/13y: 0 See Page 2 for Internet: w' ww,ligard•or.gov Notified/Method: j_ Supptemental Inform o don TYPE t" ;Wink ..' C RC AI, CI1gDI1 l) „� a� • � w. , .., O ��.. . ���e ',� � , .�.�tCH$CICLIS'1' Mechanical permit fees° arc based on the value of the work ❑ New construction E) Addition/alleration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. .t : CA 'X'$GOV..P,;i�`0 r t :''' Value $ ® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist [ I Multi - family 11 Master builder 11 Other: Description I Qty. I Ea. I Total ,.: JOB'Si'I'13 XP ItIFikkirtii digna ` ,..1;a5=,.) Heating/cooling: ` `` ` Air conditioning Job site address: 15140 SW 89" PI (requires site plan showing placement) 46.75 — City /Stalc/zIP: Portland, OR 97224 — Fumpce 100,000 DTU (duets /vents) 1 46.75 46.75 Furnace 100,000+ BTU (ducts/ vents) 54.91 Suitc/bldgJapt. no.: Project name: Hasson Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 23.32 1 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 Subdivision: I Lol no.: Flue/vent for any of above - 23.32 _Other: _ 23.32 Tax map /parcel no.: Ocher fuel appliances: DESCRIPTXOP4 OF NO:t}K ' :. Water heater 23.32 • • Repla ce gas furnace Gas fireplace 3139 Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23,32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 171 PROPERTY OWNER I p ®.'IE ART r Chimney/liner/flue/vent 23.32 Other: 23.32 _ Name: Environmental exhaust and ventilation: Address: Range hood/other kitchen equipment _ 33.39 City /State/ZIP: Clothes dryer exhaust 3139 Phone: ( ) Fax: ( ) Single -duct exhaust (bathrooms, toilet compartments, utility rooms) 23.32 ❑ APPLICAN'C • `. ,. 0 Ci 144C71 PERSO Atlic%rawlseal>,ns 23.32 Business name: Watts Heating & Cooling Other: 23.32 Fuel piping: Contact name: Jon S14.15 for Urn four; 54.03 for each additional Address: 580 Portland Ave. Furnace, etc. Gas heat pump City /Stale/ZIP: Gladstone, OR 97027 WalUsuspended/unilhsater Phone: (503) 786 -2858 I Fax: : (503) 786 -2807 Water heater Fireplace E -mail: jon ©wattsheating.eom Range • CONTRACTOR Barbecue Business name: Watts Healing & Cooling Clothes dryer (gas) Address: 580 Portland Ave Other: MECHANICAL PERMIT FEES* City /State/ZIP: Gladstone, OR 97027 - Subtotal 46.75 Phone: (503) 786 -2858 Fax: (503) 786 -2807 Minimum permit fee ($90.00) 90.00 Plan review (25% of pennit fee) CCB Iie.: 134602 State surcharge (I2% of permit fee) 10.8 TOTAL Is n t FEE 100.80 Authorized signature: This permit application expires if a permit Is not obtained within 180 days after it has been accepted as complete. Print name: Jon Dewar I Dote: 3 - - • Pen methodology set by Tri- County Building industry Service Board t:l fuildinglPermiiA .�OC•PermilApp,doc 09/09/10 440.6617r (Iimitcoat/w5a)