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Permit L � y n CITY OF TIGARD MECHANICAL PERMIT ''! .' - COMMUNITY DEVELOPMENT Permit #: MEC2010 -00055 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/04/2010 Parcel: 2S104AB10600 Jurisdiction: Tigard Site address: 12365 SW 132ND CT Subdivision: MORNING HILL NO. 6 Lot: 135 Project: Harral Project Description: Replace gas furnace. Owner: FEES HARRAL, GENE D & Description Date Amount PATTIE M REVOC TRUST, 12365 SW 132ND Furnaces < 100K BTU 02/04/2010 $46.75 CT 12% State Surcharge - Mechanical 02/04/2010 $10.80 PHONE: 503 - 590 -2684 Minimum Fee Adjustment - Mechanical 02/04/2010 $43.25 Contractor: BEN'S HEATING & AIR CONDITIONING LLC PO BOX 80607 PORTLAND, OR 97280 PHONE: 503 - 233 -1779 FAX: 503- 651 -3345 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressue: 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, • • work is s. 'ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility .otification Center. • •: - r -s are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or •. ect questions to OU ' b calli g or 1.800.332.2344. Iss ed By: Permi tee Signature: AVM/7p Call 503.639.4175 by 7:00 a.m. for an inspection that b = ness day. This permit card shall be kept in a conspicuous place on the job site completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application 1 I ;1 er elsL ONty City of Tl and Received IT' / g Date/By: , �t l0 � � Permit No.: ern Ole 'e 13125 SW Hall Blvd,, Tigard, OR 97223 ' ti Phone: 503.639.4171 Fax: 503.598.1960 Other Permit: 7'It ;AIt1) Inspection Line; 503.639.4175 Date Ready/By: 0 See Page 1 for Internet: www.tigard- or,gov Natifed/Ivtethed; • I( c1 , Supplementer Information TYPE OF WORT{ : '' COMMERCIAL 'FEE* • SCHEDULE- USE'CIIECICLIST ID New construction ddition/alteratiott/replacement Mechanical permit secs' ore based on the value of the work performed, Indicate the value (rounded to the nearest dollar) of all C] Demolition Other: mechanical materials, equipment, labor overhead, and profit. CATEGORY OF CONSTRUCTION ' °' " v ,00 � Value: $ 0 dwelling Commercial /industrial 'RESIDENTIAL 1aQUTI'MENT /SYSTEMS FEES* t- and 2-family B ❑ 0 Accessory building For spacial Information use checklist. Multi _family ❑Master builder ❑Other; Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Hcatlnp,/cooling Job site address: ` �` p � /+ Air conditionin 1 t2 3e ,s ! ,J Q. „ L/ (re site plan showing placement) 46.75 City /State /ZIP: I 0 ► i ` e) a a • Furnace 100 000 BTU ducta/vems 4b.75 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg./apt. no,: Project name; �1-- Heat pump 61.06 _ Cross street/directions to job site: Duct work 23.32 Hydronic hot waterystem 23,32 • Residential boiler (radiator or hydronic) 23,32 Unit heaters (fuel -type, not electric), in -wall, in -duet, suspended, etc. 46.75 —_, Subdivision: of no.: Flue /vent for any of above 23.32 Other; 23,32 Tax map /parcel no.: Other fuel appliances • DESCRIPTION OF. WORK' ': t' - Water heater 23.32 Gas fireplace 33.39 P� pItlt�'e- 6 Aj .�►� vent ,� Flue vent for water heater or gas `" fireplace 23.32 --- - - - - ' Log lighter (gas) _ 23,32 Wood/pellet stove 31.39 Wood fireplace/insert 23.32 __ _ i PROPERTY OWNER Chimney /liner /flue/vent 23.32 • � 23,32 ❑ TENANT Other Name: a r :a al vl Environmental exhaust and ventilation Address: t 4 ' Range heed/other kitchen ? equipment 33.39 City /State /ZIP: q Clothes dr er exhaust 33.39 �� Single -duct exhaust (bathrooms, Phone; I) / .. Fax: ( ) toilet coat artments, utilit rooms 23,32 APPLICANT l; ^.;':':.:,Ei, CONTACT; PERSON:; Attic /crawlspace fans 23,32 Business name: 1 Other; 23,32 Fuel_uiping Contact name; (4 It $14.15 for first four; $4.03 for each additional Address: Furnace, etc. - Gas heat pump City /State /7.IP; Wall/suspended/unit heater Phone: ( 62 7 i 3 Q g 0 F ay; ; ( ) Water heater - E - mail; r '/ Fireplace Rat CONTRA OR ;`l;' :'.' Barbecue Business name: a e 1 4-- /� Clothes dryer (gas) !� Other: Address: 411 Q 0 Ifef. i ' . • MECHANICAL PERMIT FEES* City /State/ZIP: • ` r ► O R,- q 7a, © Subtotal - - _ L _ 0) Phone: (&Z) a &6 - 1 -7 '� l Fax: ( �'r ) 0s!- ' 3 Minimum permit fee ($ Phut review (255'0 of permit fee) CCB lie.: 7 State surcharge (12% of permit fee) ��, 0 t TOTAL PERMIT FEE /GO, Authorized signaturl, I This permit application expires If a permit Is not obtelned within 180 days after it has been eceepted as complete. Print name: . r AWAIMPr il 4 unw Dutc; r Jfi f • Fee methodology set by Tri- County Building Industry Service Board I, lB uildinglPermhelMEC- PermitAp..doc 10/01 /00 440- 4617T(II /02 /ComiweB) Z00 HIr8ON -SNdfi Si7CCTS9C0S XVd 8C :6T L00Z /T0 /T0