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Permit n CITY OF TIGARD MECHANICAL PERMIT ;_ COMMUNITY DEVELOPMENT Permit #: MEC2011 -00235 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/31/2011 Parcel: 251036606500 Jurisdiction: Tigard Site address: 12195 SW 121ST AVE Project: KEERINS Subdivision: YE OLDE WINDMILL Lot: 0 Project Description: Gas furnace and vent in basement. Contractor: AAA HEATING & COOLING Owner: KEERINS, HERMAN 0 & PATRICIA E 5017 NE GRAND AVENUE 12195 SW 121ST AVE PORTLAND, OR 97211 TIGARD, OR 97223 PHONE: 503 - 284 - 2173 PHONE: 503 - 501 -5509 FAX: 503 - 284 -1552 FEES Specifics: Description Date Amount Furnaces < 100K BTU 05/31/2011 $46.75 Type of Use: SF FlueNent For Any of Above 05/31/2011 $23.32 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 05/31/2011 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 05/31/2011 $19.93 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: . - / t / / rte ��1 «,� t.► Cali � 3 639.4175 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: R ECFY 10:15 #288 P.001/002 r: 71 .. Mechanical Permit Application 1 ii 61 1 u i litil o f City of Tigard MAY 2 7 2011E �� . ..:.,,.. 13125 SW Ball Blvd., Tigard, OR 97223 �y y r• I *nal . 0 4 N , C Phone: 503.639.4171 Fax: 503.598.1960 CITY O F TI G k I L) P 1ae l>ate/y: B Other Permit: y: ,r 16 R n Inspection Line: 503.639.4175 a S t BUILDING Di f 91 Note edAte S See Page for Internet: www,tigatd- or.gov Notified/Method: MI Supplemental information : :. ' ., .... :. ... ° ?. .., T OF WORx . , FF:E `s ,. ... <� : . - -� IILE�' ;USECHECKLIST ❑ New construc ',: Addition/alteration/replacement Mechanical permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. - y . azr.;.a:a":,,- :;w,7 :'r al . CATEGORY= :OF- ;GONSTRIILTdON ` Value: M" .L oe: $ V IPMENI /.SYSTEM3_FEES *�'.'; / 1- and 2-family dwelling ❑ Accessory building v G T ..:._, 2. ....., _ . y... �. ,,,,,:. Y g ❑ Commercial/industrial For special information use checklist. ❑ Multi- family ❑ Master builder 0 Other: es Qty . Ea. I Total Description I'" =JOB SITE DWORMA TION'i` LOCA �, :: ;.r= "t': ':t;,s:.r �..:�� � .: • AN1D TION: "rim -'i ... ...,.._ >... �. a..._.. ..... :.�..._;� :- : , .. �,a Heating/cooling Job site address: \ 1. \q 5 s W l'L t f4 O V E Air conditioning (requires site plan showing placement) 46.75 r City/ State/ZIP: .. k ` q �� ' ©a � ...� ,� 3 - Furnace 100,000 BTU (ducts/vents) 1 46.75 _y� ;Z J 3 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.: 1 Project name: iyQ e 1Z \ c Heat Pump 61.06 \ Cr_oss street/directions to job site: LO O a,l 2 a e ` 2.1 t ,-v 8 Duct work 23.32 'd 4 2_ 1 1 - 1„),3 2�hr,_ S'w V.� 3 t-\,..., t Q. \Y1 a .Skim V..>` `. 1 4 Residential hot water system 23.32 A � /� hh Residemial boiler (radiator or V4tinc�2 5W Os,A. f., SA-- 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. _ Subdivision: Lot no.: Flue/vent for any of above l 23.32 24.3 Other 23.32 Tax map /parcel no.: Other fuel appliances t ti r )5 t:r' -c-„ 7 :, aa; r x rx'4a ,�=a .. u ,::,,:.:),�saa , ' 70.. 7?TI®N OF`fVOR C�' .,.E `•t ° 11• ., ! Water heater 2332 , � ( L � Gas fireplace 33.39 -3- _ l �t �, t rv[ 2 °f' V- *- Flue vent for water heater or gas kkA. \iDt.t to I t V �� fireplace . 23.32 V"�`' V Log lighter (gas) 23.32 Wood/pellet stove 33,39 _ Wood fireplace/insert 23.32 WRFC *, ,, rl f , :. 7r G ix; , ..1,k. .., 7� c 4..ao - _ , uelvem 23.32 i� :a.�0p.�T_,3Y�,s {7t��tpQ�LM rt ! tk�`{%� - Ly r: �.. �. i^�u�a: � af0.'" :t";,�:' yralv�l�- v'''..n�= ,ry'' " ®��I'EP fr � 1' , . t i ;<.; i ,v: Other: Chimney/linedfl 23.32 Name: a t t J ems- 4 e A-4 � Q \ tt� Q+Q.t e,' , S Environmental exhaust and ventilation Address: 2 \1.5' sW k 2\ S N.. V e ehood/other kitchon 33.39 • City/ State/ZIP: ¶, e &�' Q 2 C(-1 . 3 Clothes dryerexhaust 33.39 c) Single -duct exhaust (bathrooms, Phone: ( 5 59,E - 3 O 61 Fax: ( ) toilet compartments, utility moms) 23.32 :Tiger= /`, v'., Y,;� :�i :'s'Yn1i#" _ :� ?a�2 °.: Rai: i -i"` "•_ -_ �,,.;��'�;,, 1di :o;,,5 ;: `yi? "� ": a ® ( 0111rAcrOiliSON,, ; Attic%mawlspace fans 2332 Business name: AAA HEATING & COOLING INC. Other 23.32 `` _ Fuel piping Contact name: V. c_ke,(Z■ 4:k A \` ear.. _ $14.15 for first four; $4.03 for each additional Address: Sp V - 1 N C , a 4.rAvk� Furnace, etc. , City / State/ZIP: �p ` ++ A p Gas heat Pump l 042.A. 4.kHc11 a -1 -I Z a Wall/suspended/unit heater Phone: ( 3) s Ol _ s S . q I Fax:: (So3) ?AA \ S S y - _ Water heater E-mail: Fireplace CONTRACTOR Range . ` Barbecue Business name: AAA HEATING & COOLING INC. Clothes dryer (gas) • Other • Address: 5017 NE GRAND AVE AIEC HANI . ... GAL s:p City/State/ZIP: PORTLAND OR 97211, Phone: (503) 284 -2173 Fax: (503) 284 -1552 Minimum permit fee ($90.00) Ck O. 00 . _ Plan review (25% of permit fee) CCB lic.: 000222 State surcharge (12% of permit fee) I , e,,, TOTAL PERMIT FEE ipp.. $rJ Authorized signature: \ J '" � j OA. This permit application expires if a permit is not obtained within IS0 days after it has been accepted as complete. I Print name: VICTORIA ALLEN Date: C)/ a 1111 " Fee methodology set by Tri -County Building Industry Service Board • r 1:\ Building \Pemits \MEC- PermitApp,dmc 10/01/09 440 -461 T (11 /0J M/WEB)