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Permit CITY OF TIGARD MECHANICAL PERMIT III tt' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00133 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2011 Parcel: 2S102BC01300 Jurisdiction: Tigard Site address: 10230 SW WALNUT ST Project: Ziglinski Subdivision: Lot: 0 Project Description: Oil to gas furance conversion. Contractor: AAA HEATING & COOLING Owner: ZIGLINSKI, KEN 5017 NE GRAND AVENUE 10230 SW WALNUT ST PORTLAND, OR 97211 TIGARD, OR 97223 PHONE: 503 - 284 -2173 PHONE: 503 - 639 -4306 FAX: 503 - 284 -1552 FEES • Specifics: Description Date Amount Furnaces < 100K BTU 03/30/2011 $46.75 Type of Use: SF Fuel Piping 03/30/2011 $14.15 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 03/30/2011 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 03/30/2011 $29.10 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 N• ' • • enter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or dir t questions to • by calling 503.232.1987 or 1.800.332.2344. Is ued By: fy/ 4, 4 , j Permittee • ` a i�' , ces— • 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. From: 03/29/2011 09:30 11178 P.001/002 Mechanical Permit Application FOR OH ICI 1[SE ONI.1 Received � City of Tigard Re Date/By: iv c a q / Permit No.: G(� // , _0D /3 . u 1 3125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 Pla e/By: ew Other Permit: T I G A R D Inspection Line: 503.639.4175 141 H 2 1 L U i naDatelBy: tc Read iuris: ® See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information ftt! � rAigi TY OFD •4 ._. tl x ,� . , > 4 1 ` fa Viz >x FEE! BCfIEDULIE Gl t Mechanical permit fees" are based on the value of the wo ❑ New construction XAddition/alteration/replacetnen ❑ Demolition ❑ Other: performed. Indicate the value (rounded to the nearest dollar) of all mechanical materials, equipment, labor, overhead, and profit. ' ;� Value' $ ''art , .a,., -gars�s„�-,is... ....,,.,3a .rs _,,. Ao4'_a.�� sc• �i yr � rr la, - and 2- family dwelling ❑ Commercial /industrial ❑Accessory building '' `" -°' -'�" .# ^"- M^ -� ' - ❑ Multi -family builder ❑ Other: For special fnjornwtion use checklist. ly ❑ Master Description I Qtr. ty. I Ea. I Total T-r K t . __- 11. Mm ; ``, ' . . ,•�"��, c,..�.��:z. .. .:� a%....,. :rr �: 11 .s tk }kitin Job site address: kQ 30 s wA , vkv. , � , S� . Air conditioning (requires site plan showing placement) 46.75 _ City/State/ZIP: yl O CA 22 3 Furnace 100,000 BTU (ducts/vents) I 46.75 .It ac, J r Furnace 100,000+ BTU (duels/vents) 54,91 Suite/bldg. /apt. no.: Project name: .i.', 3 \ \ ‘A. s VI,. Heat pump 61.06 Cross street/directions to job site: \-'‘- W 1.-1 "--( e -RI. Duct work 23.32 i {� Hydronic hot water system 23.32 � g a A vn O Vt 3%1) ` R e -■Ri c- � CA •� �,t,tL,1.. ` , Residential boiler (radiator or 'IN . `� "k ��r "n �e�� " ' t Unit heaters (fuel-type, not electric), _ 23.32 >Bf A tl .v a As S ,x), G, cuN ih fit. �vx I. j C , 44. .c v.1 tim� K \•n S in -wall, In -duct, suspended, etc. 46.75 Subdivision: Lot no.: Flue/vent for any of above `-' 23.32 Other 23.32 _ l' Tax map /parcel no.: Other fuel appliances la"! -. , „ , S , r� iFWtK i u ' Water heater 23.32 ,... ���.'r6e'.ryv:�.€ .. ..._.,- ..,- .. -..... _F.- .. ±�.n.. , .L3 :t H`,..?r € :. �.. _ ,, -u © x i r �' r R p Gas fireplace 33.39 l 1 "\ C k 3 -{ 70 v. -N- C2. •'\h C'(L,9 k, Flue vent for water heater or gas ' R C.-MS C © VN \O--CA CV- ra \ S-e. -e dCk 21 i-k aN 2. A ((11` Log lace 23.32 Log lighter (!'as) 23.32 \AaAAS e- Wood/pellet stove 33.39 • Wood fireplace/insert 23.32 23.32 PIc 7 u Q r E'.'� s ! ® Ot eYiliner /fluelvent 23.32 • Name: • _ � �� i (� 1 � g N Environmental exhaust and ventilation Range hood/other kitchen Address: c] C1Z3o Si.,) li A k •`n•-t g 1 ipment 33.39 City/ State/ZIP: 7 Cl dryer exhaust 33.39 Phone: j G 3� / Single-duct exhaust (bathrooms, ( c 3) lh 3 ! ' � F ax: ( ) toilet compartments, utility rooms) 23.32 /`'w: �s.A . r ❑ (CONTACT PERSON <'' Attic/crawlspace fans 23.32 Other Business name: AAA HEATING & COOLING INC. - 23.32 Fuel piping Contact name: ,A CZ�� �J , „ 4 e �,, $14.15 for first four; $4.03 for each additional Address: ` v ar Furnace, etc. I `>t- i f Gas heat pump City/ State/ZIP: Wall/suspended/unit heater - Phone: ( ) Fax: : ( ) Water heater E Fireplace Range r } '1«a }ax' �" l fi mpg Barbecue - Business name: AAA HEATING & COOLING INC. Clothes dryer (gas) Other Address: 5017 NE GRAND AVE t J "fi 11KGBA 01: P&Ltbl itli . = h City/State/ZIP: PORTLAND OR 97211 Subtotal Stk. VI. Phone: (503) 284 -2173 Fax: (503) 284 -1552 Minimum permit fee ($90.00) C , CO Plan review (25% of permit fee) CCB lic.: 000222 State surcharge (12% of permit fee) % p , co C) - TOTAL PERMIT FEE %00% € O Authorized signature: Thus permit application expire ifs permit Is not obtained within 180 days after It has been accepted as complete. Print name: VICTORIA ALLEN Date: 3 zq 6I * Fee methodology set by Tri -County Building Industry Service Board IABuilding ■PermionMEC- PamitApp.doe 10/01/09 441-4 17T (I I /0 /COM'WEB)