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Permit , CITY OF TIGARD MECHANICAL PERMIT 2 '.`= COMMUNITY DEVELOPMENT Permit #: MEC2011 -00264 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/09/2011 Parcel: 1S133DB05100 . Jurisdiction: Tigard Site address: 13101 SW WINTER LAKE CT Project: Misener Subdivision: BRITTANY SQUARE NO. 4 Lot: 79 Project Description: Replace gas furnace Contractor: WATTS HEATING & COOLING INC Owner: MISENER, GEORGE W & ELIZABETH C 580 PORTLAND AVE. 13101 SW WINTERLAKE CT GLADSTONE, OR 97027 TIGARD, OR 97223 PHONE: 503 - 786 -2858 PHONE: 503 - 524 -4854 FAX: 503 - 786 -2807 FEES Specifics: Description Date Amount Furnaces < 100K BTU 06/09/2011 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 06/09/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/09/2011 $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: C/i Permittee Signature: eA, .r�/� - /G. / e�/�o�V 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. Jun. 8. 2011 4:14PM WATTS HEATING No. 2110 P. 1/2 Mecnamcal rermtt application. FOR OFFICE USE ONLY City of Tigard r 13125 SW Hall Blvd., Tigard, OR 97223 ® DatrIve 61:74=1:441 pen /�t�, ' R(�� — e,,,R4 A i Phone: 503.718.2439 Fax: 503.598.1960 �'� plan Review D Other Permit: T r A tl 0 Inspection Line: 503.639.4175 e ataIlebdy/By: Et Bee Page 2. for • Internet: w%tw. ligard- or.gov ,� -..� a � NBti [ ed/Method: St+pplemenl r\ TYPE OF WORK _ � ,( N COMMERCIAL FILE! SCHEDULE — USE CHECKLIST � V Mechanical permit fees* arc based on the value of the work 0 New construction NI Addition /alleration/replacen%imt ��ti performed, Indicate the value (rounded to the nearest dollar) of all m_echaniea! materials, equipment, tabor, overhead, Arid profit. ❑ Demolition © Other: 'R) �� Value: $ CATEGORY OF CONSTRUCTION RESIDENs'rIAL.EQIAPMENT/ SYSTEMS FEES ® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special Information use checklist ❑ Multi - family (] Master builder ❑ Other: Description I Qty. I Ea. , Total "JOB SITE INFORMATION AND LOCATION Hcaling/cooling: Air conditioning lob site address: 13101 SW WINTER LAKE CT (requires the plan showing placement) 46.75 Furnace 100,000 BTU (duels/vents) 1 46.75 46.75 City /StatelZlP: TIG��RD, OR 97223 Furnace 100,000 +B'fU (duets/venls) 54.91 Suite/bldg. /opt. no,; Project name: MISENER Heat pump v re was site . tan shpwin :.Iacemenl 6 L06 Cross street/directions to Job site: Duct work 23.32 Hydronic hot water system 1 2 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 REPLACE GAS FURNACE Gas fireplace 33.39 Flue vent for water herder or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 LEI PROPERTY OWNER I 0 'TENANT Chimney/liner /flue/vent 23.32 Olhcr: 23.32 Name: GEORGE MISENER Environmental exhaust and ventilation: Address: 13101 SW WINTER LAKE CT Range hood/other kitchen ." equipment 33.39 City /State/ZIP: TIGARD, OR 97223 Clothes dryer exhaust 33.39 Phone: {503)524 - 4854 Fax: ( ) Single - duct exhaust (bathrooms, toilet companntetits, utility rooms) 23.32 ® APPLICANT ❑ CONTACT PERSON Attic/crawlspacc fans 23.32 Business name: WATTS HEATING AND COOLING Other: 23.32 Fuel piping: Contact name: JON DEWAR 514.15 for first four; 54.03 for each additional_ Address: 580 PORTLAND AVE Furnace. etc. Gas heat pump City /State/ZIP: GLADSTONE, OR 97027 Wall/suspended/unit heater Phone: (503) 786 -2858 , Fax: : (503) 786 -2807 Water heater Fireplace E-mail: JONQ'WATI'SI1EATING.COM Range CONTRACTOR Barbecue T _...._ Business name: SAME AS APPLICANT Clothes dryer (gas) Address: Other: MECHANICAL PERMIT FEES* City /State/ZIP: Subtotal 46.75 Phone: ( ) Fax: ( ) Minimum permit fee (590.00) 90.00 Pion review (25% of permit fee) k r-CCE3 tic.: 134602 l�/2-3//3 - State surcharge (12 %of permit fee) " 10.80 TOTAL PERMIT FEE 100.80 Authorized signature: r -- This permit application expires If a permit Is not obtained within 180 da,ys after II has been accepted as complete. Print name; JON DEWAR Date: 6 - - • Fee methodology set by 'rri- County Building industry Service Board I: t} tut ldinglPcrete11 `"C- Permi[App.dee 09;09/10 4a0-46177 (IUO2/COM/WED)