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Permit 1 q CITY OF TIGARD MECHANICAL PERMIT `F'! 8 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00146 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/07/2011 Parcel: 2S102BB00810 Jurisdiction: Tigard Site address: 10240 SW BROOKSIDE PL Project: HENRY Subdivision: BROOKSIDE PARK Lot: 4 Project Description: Gas furnace replacement. Contractor: EFFICIENCY HEATING & COOLING LLC Owner: HENRY, LARRY J & DEANNA L 10117 SE SUNNYSIDE RD STE F #19 10240 SW BROOKSIDE PL CLACKAMAS, OR 97015 TIGARD, OR 97223 PHONE: 503 - 698 -5588 PHONE: FAX: 503 - 698 -9378 FEES Specifics: Description Date Amount Furnaces < 100K BTU 04/07/2011 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 04/07/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04 /07/2011 $43.25 Occupancy Grp: Stories: Fuel Fuel Types: Gas Pressure: Total $100.80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987. :0 Aim Issued By e -� Permittee Signature: - / Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application FOR OFFICE 1.1SE ONLY 1 City of Tigard Received . rertnll Ni 1 3 125 SW Hall Blvd., Tigard, OR 97223' • Date/By: ! j/= / y1 ;! J (� -- t j t—( atNe ■ Phanc; 503,718,2439 Fa;c; 503,59$;19110 Dato /B view Inspection Line: 503,639.4175 M I y: Other Permit T I G A RI) Date Ready/By: Juris: t,r.gnv Sec Page 2 for Internet: www.tigurd- APR — 6 2011 Nafl♦ial/Mclhod; – 776 S11Pplcmcnialinfarmnfine , . �. (.. r . ,, I , r,,d, 'li• ,r� �'�i. ;�.,�:i i� I ,, . (� , ... r ., � i ,,' :;:r r• • , ,,;, , ,,,, , , , I , , , ��.1 . .,, .: •�:•:�:I,'.r:, „ ,. � " >:�;' �' �: �i`3'�l1il��tl�"luV,a;;i�'�! � '!' I ,r , , ,, ,! q . ' 1 • . ,� . . , .,. . : da d . , . rr.,.. ✓ .. �, I {,� L 7�' ��� ■ � � � �. , � ';;i.• ��' tiv , 'yi lil• � � `� ..,i � .. �„r�l ., r, � ,.,,,`�h�I� ,, ,,.,.:.,,,,, , nvv,, " , a, 'u.,� rlh,111 :11 ,. , , , ,. , ,ma'1 ,,, .� , , ∎n, , I.∎eq I•b, , I',LI:; °?; ;;RS,:, :t01.1 ?J'f∎E'i1V:1' ?;I:. ., ... hu Mechanical permit foes" are based on the value ofthe work ❑ New construction ® Addition /alteration /replacement performed, Indicate the value (rounded to the nearest dollar) of all ❑ Demolition 0 Other: mechanical materials, ! equipment, $ , labor, overhead, and profit v6 {.. •.rti(: -' I'll!'I;,y`i,,' n�1,I FI ,'. ; ,y,y � .,u , , yd ,..,M,. •, , I: ;;,,, .I rr, Value; $ ', ; : r;;I :.1!,1;; i• , i n I L{i ,: } 1 ;. J r , lei l ! I I ;;H:,; ',. ; . " : ;.;?!,,i• „,,.,;.�, _ , eu r,. � '. �,,, r,',,..,: r!. u;,:; r'.•'. r, L!!!,:,- „,,.,.,•I,.r,,..,1,,,, ,..., : , �„ , E.I ; 6 i `i;' yl� `�' , ® 1, and 2- family dwelling © Cammercial /industrial ❑ Accessory building Far Apedal !11 ormorionMfinechecklisv. ❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I ha. I Total , ,,,,,,,:,;!,,;.!,,,';,!1., • s(:':' : ;•',I!aitiyilkI,ft11� > t.:„•,i :.i. i... l .ti” „iY' ', ., �,,,r�,, Ai con Job Site address: 10240 SW Brookside P1 rc•uirca sitc •Ian ahowin • •iaccmciit 46,75 Furnace 100 000 BTU ducts/yenta I Ran 46,75 City/State/71P: 'I igard, OR 97223 .._ Furnace 100,000+ 13Th) ducts/vcnta 54,91 Suite /bldgJapt. no.: Project name: Henry Hest pump - .. - -- - (rr.cuircs site plan showing placement) 61.06 Cross street/directions tn,joh site: Duct work 23,32 Hydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not cleOlric), in -wall, in -duct, suapcndcd, ctc, 40,75 Subdivision: __- Lot no.: ____ P1uc/vcnr for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other Fuel appliances: , . .•,•: {•,'r'!;,..I.: ; ' ,; ii% i i11; ' i11;i1 :1;;t;: t�i�lithu•4' y,t iiiii b 1t1 ' 1'! F1'V'i',ICir'!i0! };: ,pI ;'l %i} i;I;;il•,.• � 1 ,, , u , t l e' i !, i ., y ! it, h . .. ;. ( 7ic . ii;V11%; * � •'ii:• Y.I r;i, l; „I,� ,•,1.,. „ . 1 : : • ; ; ;;;l:; ,'i`t ti "1r•, ,;.; ,, '., I � '..., :,•,• W ater h eater �' +I4:;J„ : "::�,',.::.�.,,,.:,,: � ,:,. 'k ,:,:, • .,.,e •r,,,,,I,I ,,,,,,I,,., ,r,,., , : , ��I,a:.r::,,'..;•.r ro,: � NY. 011E i ,,,;!!,h!'1, !':, s. „ ' •::,l;,., 23.32 G as fire • lace Replace as furnace Flue vent for water heater or gas ■ Lire 1 lace I.e l li hg t (ga 23,32 Wood/pellet stove Wood fireplace/insert '!;.1,:,;:,,,,:.!,:;:i ;; ?. Mi' ;!!; 1 : y 'I (: " •.i' i• ?i ;h ;; h. r ;:;;;;,; " ;!,; Chirre /liner /11uc gar.1> lfv .! ;;lei tli tt( ' iiil'• .!!:! � �,, ' •,.:. • ,,, ,,.,, , ,,, •_ ,, , l.,.1 t:: iJa 'id,....e.,;!, •.., tt ii', iuk;•1!!dil.;i Other; _ Narnc: Environmental exhaust and ventilation: Address: Range hood/other kitchen ��.__. - — _,-„ equipment 33.39 City/State /ZIP: Clothes dryer exhaust 33.39 Phone: ( ) Fax: ( ) Single -duct exhaust (bathrooms, toilet com • artmenh atilt rooms) 23.32 0∎1∎:i , 1r ': �; ^•;1; •K; 6i `ii: lii: ;?,; ip i � i ?i(�� `1�,'i' . i t 1;ir i'•;'i! 1 ri .;�j!! i ;1 I "'�!I�)I�f'h.r ', i:�;.• y !1,ilii; ,,,; ,• �'), . !! . , ,'I�E.,�E� I':: ',h; „ �( w s ace fans � 1! I '•.,, , , ,, �;1�i� {, Attic/cra '! , ,,,,•,,.rl.r.,,,. (u „h �, t�':1;':'` •,•,�:,v:.d,•, ' „� „•;, ? p 23.32 Business name: Other: 23.32 Fad CripisA: Contact name: - •_. - ....... $14.1S fur first finer; 54.03 for each additional Address: Furnace, etc, City/State/ZIP; heat hum J Wall /sus. ended/unit heater Phone: ( ) Fax: : ( ) Water heater E-mail: - — ^ _., Fireplace _.__ Runge i; y r ,., , , I!'r9; +, 'd!,l, r ry , ;1 1 ,w.,�t:� . y [x,,,� y(yy viii :!P''' "'hLl. I''fi ^;ti)iili c I ass :1r; hin,i ; , I,I; , ;'.;g; 1, +!'1„ ii;?;:;';1:'a;, I :;; . , ; I; „; *:.; ,iix. :;: i•l ii . , lei, .,,.. ...1 „ :li o it : :. , r::;; „ r,'1;i ; „ 1 ,J' : ; ' G � � RarbCC11C Business name: Efficiency Heating & C:OAiInQ Clothes dr Cr _as ..,.. ----- Other; es Addrs: 10117 SE Sunnyside Rd Suite 119 �I City /State/ZtP: Clackamas, OR 9701:1 Subtotal nill Minimum permit fcc ($90 Phone: (503) 698 5588 Fax: (503) 698.9378 Plan review (25% of permit fee) CCB lie.: 187834 State surcharge (12% of permit fee) '/CS TOTAL PERMIT FE j?� Authorized signature This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Matt Rohman L Date: 4,5.201 M ” Fcc methodology sot by 'fri.County Building Industry Service Board t:\ nuilding \IrrmilatMFC- PcrmiIApp.dnc 09/09/10 445- 4617T(IUe2/coM/wt?8)