Permit CITY OF TIGARD MECHANICAL PERMIT
1111 14 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00172
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/21/2011
Parcel: 1 S135DB02600
Jurisdiction: Tigard
Site address: 11405 SW 90TH AVE
Project: POWLOSKI Subdivision: TIGARDVILLE PARK Lot:
Project Description: Gas furnace replacement.
Contractor: WATTS HEATING & COOLING INC Owner: POWLOSKI, C KENT & LISA
580 PORTLAND AVE. 11405 SW 90TH
GLADSTONE, OR 97027 TIGARD, OR 97223
PHONE: 503 - 786 - 2858 PHONE:
FAX: 503 - 786 - 2807
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/21/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/21/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/21/2011 $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 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 1.800.332.2344.
Issued By: 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.
Apr. 20. 2011 3:48PM WATTS HEATING No. 1929 P. 1/2
Mechanical Permit A tips ratio CE � E � FOR (�t ► lc:c UST. ONLY
of Tigard Date/By: "/ R ei td u
'I 13125 SW Hall Blvd., Tigard, Oft 97223 � /
Plan Review
i llgi
Phone: 503.718.2439 Fax; 503,598.196%p R 2 Q ? 1 Date/By: Other Permit:
- I ICiAt(u
Inspection Line: 503.639.4175 DateReady/By: FA 6J See Page 2for
Internet: www.ligard or.gov CLa G F TIGARD Nolified/Method: Supplemental Information
B`1 [DINCiniL
TYPE OI�9�Tt COMMERCIAL FEE* SCHEDULE -- USE CHECKLIST
Mechanical pemmt fees* are based on the value of the work
El New construction Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
Value; $
CATEGORY OF CONSTRUCTION
f RESIDENTIAL EQUIPMENT I SYSTEMS F,EBS°
I A I- and 2- family dwelling El CommerciaVindustrinl ❑ Accessory building Far special frtfor use checklist.
❑ Multi - family ❑ Master builder El Other: Description I Qt I Ea_ I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditio ing
Job site address: / I L{ OS S (A) c7 ' 7 (requires site plan showing placement) 46.75
City /Slale/ZlP: -f b (7 � 9 ^' Z , �, FumOCe 100,000 DIU (ducis/vents) l 46.75 , 75
I PPntace100,000+ BTU (docts/vents) 54.91
Suite/bldg./apt. no.: Project ^� Heat pump
name: ! �(.l c�G µ pow r! Q5 �{ 1 (requires silo plan Showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
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: Lot no.:
Flue/vent for nny of above 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater ' 23.32
//�� / Gas fireplace 33.39
I� t P (-it G-E 6 A 1 A` ti - ?11 Flue vent for water heater or gas V -
fireplace 23.32
Log lighter (gas) _ 23,32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
0 PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: LISA Te �S GN
� Lo�eK r Environmental exhaust and ventilation:
Address: / Range b , ' q Range hood/other kitchen
1 ! Q equipment 33.39
City /Stale /ZIP: I , 7j7.Y Clothes dryer exhaust 33.39
0 : t'7 - S Fax: ( )
Single-duct c mp compartments, (bathrooms,
Phone: (54 3) Is o
g toilet compartments, utility rooms) 23.32
TA APPLICANT ❑ CONTACT PERSON Attic /crtwlspace fans 23.32
("JAI—TS Other: 23.32
Business name: / 6 1 - , r r w r y ¢, C ( Fuel plpin
COntACI name: J N c 514.15 for first four; SJ.03 for each additional ~
Address: Qt
0 A r..fE �Y. Furnace. etc.
y ,4�.0 Gas heat pump
��
City /Stole/ZIP: L4 ( A Tr,l OQ 7 701-7 Wall/suspended/unit heater
Phone: (503) 6 _ - 4 zsg. I Fax: : CO3 ) 7 3 6 _7_ Water heater
Fireplace
E-mail: V a K t ( -) c.45 Le_.t .4- v , CQ 0.1 Range
CONTRACTOR Barbecue
Business name_ �5 P1 CAIN r_ Clothes dryer (gas) .
Other;
Address: MECHANICAL PERMIT FEES'
City/Slate/ZIP: Subtotal y 6, � $
Phone: ( ) Fax: ( ) Minimum permit fee ($90,00) 9 O , t�
I Q � Plan review (25% of permit fee)
CC13 Iic.: State surcharge (12% of permit fee) 1 6 , cro
TOTAL PERMIT FEE I o , $ 0
Authorized signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
Print name: ' T „3 111111 AF' - Date: L p- — I 1 * Pee methodology set by Tri•Counly Building Industry Service Board
hule ildiagwennitnatEC- PermitApp.doc 09!04 /10 440•1617T (I1102/COM/wEll)