Permit CITY OF TIGARD MECHANICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00225
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2011
Parcel: 2S111CC14600
Jurisdiction: Tigard
Site address: 10155 SW HIGHLAND DR
Project: BERNHARD Subdivision: SUMMERFIELD NO. 4 Lot: 197
Project Description: NC and gas furnace installation. NC unit must meet 3 ft. minimum rear and side yard setbacks.
Contractor: MIDWAY HEATING CO Owner: BERNHARD, RICHARD A
12625 SE SHERMAN 10155 SW HIGHLAND DR
PORTLAND, OR 97233 TIGARD, OR 97224
PHONE: 503 - 252 -4003 PHONE:
FAX: 503 - 252 -5881
FEES
Specifics: Description Date Amount
Air Conditioning 05/24/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 05/24/2011 $46.75
Class of Work: ALT Type of Const: Fuel Piping 05/24/2011 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 05/24/2011 $12.92
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $120.57
Required Items and Reports (Conditions)
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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. 175 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.
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Mechanical Permit Application ��. ` - FOR OFFICE I SE ONLY
,N.-6-* � ('' 1. t..,
I • City W of �
Tigard �`p , ' ' \I\ Received . ..111 ��
• 13125 SW Hall Blvd., Ti OR 47223^ D aleiRY . .��i
i �' ' Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 .--% M �O ,DazelBy: Other Permit:
3.1 e: n R Inspection Line: 543.639.4175 y + ', 4 D ? a te t R eadyBy: H See Page 2 for
Internet: www.Rgard Or.gOv �� Rye,.. Otioified/Method: Supplemental Information
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• TYPE OF WORK 0\ n\ P COAJIEERCIAL FEE* .SCHEDULE - USE CHECKLIST
❑ New construction [' Addition / alteration /repia20ent Mechanical permit fees` are based on the value of the work
perfomted. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other:
mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF- CONSTRUCTION - Value: S
1- and 2-family dwelling RESIDENTIAL EQUIPMENT I SYSTEMS FEES'
y g ❑ C ommercial /industrial ❑ Ac cessory building
[] Multi family ❑ Master builder For special information use checklist.
❑ Other: Description 1 Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
lob site address: ICI . S S " ._ 4 (C 1,,' & n .Q Air conditioning l
a (requires site plan showing placement) 1 46.75 idlt 7S+
City /State/ZIP: 1 --- I G 0 trLO {9 C-. . Furnace 100,000 BTU (duets/vents) 1 46.75 4(f,7�
Furnace 100.000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 1 Project name: t Heal pump 61.06
Cross street/directions to job site: Ductwork 2332
Hydronic hot water system , 23.32 1
t - - _ 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 any 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
.A-_, - s- l\ Cjn S rAack - i Flue vent for water heater or gas
0- r CO Ca, 0, -C �-- I fireplace 23.32
Log lighter (mss) 23.32
Wood/pellet stove ' 33.39
1
Wood fireplace/insert 23.32
0 PROPERTY OWNER; • I ❑ _TENANT - 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 33.39
t Single -duct exhaust (bathrooms,
Phone: ( ) k Fax: ( ) toilet compartments, utility moms) 23.32
0 APPLICANT- ' ' ❑ CONTACT PERSON Atli c/crawlspace fans 23.32
Business name: Other: 2332
Fuel piping
Contact name: l $14i5 for first four; $4.03 for each additional
Address: f Furnace, etc. 1 IV,
Gas heat pump t
City /State/ZCP:
Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E-mail: Fireplace
Range ,
• CONTRACTOR Barbecue
Business name: - c `' Co Clothes dryer (gas)
Other.
Address: - S -- c c -- c 1 SK.Qj' l eN c i -- I • MECHANICAL PERMITFEES*
City /State/DP o r .44 Ct`t 0 Q. q -t ,:.- 33' Subtotal ., 3
Phone: t ) , Li olsa Fax: ) �j sei Minimum permit fee ($90.0!
Plan review (25% of permit fee)
CCB lie.: Stale surcharge (12% of permit fee) "rU •
TOTAL P FE E - - I 1 S7
�� t
This permit r
Authorized siglatur+e: A } f - e. day � n ttttin l8D after it has been accepted as re Plete
Print name: Q � - ' Date: .-t / * Fee methodology set by Tri- County Building Industry Service Board
t:\Buildis cnnitAMEC.PemiitApp.dnc 10/01/09 440- 1617T(I1/02/COMAYEB)
' d 6889Z9ZEO9 eiggep dO9 :ZO 6 6 OZ A J
May 20 11 02:50p debbie 5032525881 p.2
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