Permit ip - , CITY OF TIGARD MECHANICAL PERMIT
: COMMUNITY DEVELOPMENT Permit #: MEC2011 -00292
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/23/2011
Parcel: 2S104AD03101
Jurisdiction: Tigard
Site address: 12976 SW WALNUT ST
Project: Layton- Weihrauch Subdivision: BELLWOOD Lot: 50
Project Description: Install furnace and a /c. A/C unit must meet minimum 3 ft side and rear yard setbacks.
Contractor: THE HEATING SPECIALIST INC Owner: LAYTON, ELIZABETH F
9300 NE HALSEY ST 12976 SW WALNUT
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 503 - 257 -7000 PHONE: 503 - 590 -0236
FAX: 503 - 257 -7702
FEES
Specifics: Description Date Amount
Air Conditioning 06/23/2011 $46.75
Type of Use: SF Furnaces < 100K BTU 06/23/2011 $46.75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 06/23/2011 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $104.72
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 . ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility : ification Ce :. Those rules are set forth in OAR 952- 001 -0010 through OAR • -i i 0090. You may obtain a copy of the rules
or dir: t questions to OUN . • .fling 503.232.1987 or 1.800.332.2344.
Issu = By: — `` �� , "-,� _ Permittee Si• j�♦ a I,��
— r
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.
RECE
IVED
Mechanical Permit Application
. • •• ••• • • .. ... : • USE O ". • • : : . .,, ...., - : ,, " :::
SW Hall Blvd
1 1R
.:'.:::'::-.: City of Tigard Tigard OR 97223 JUN 21
r :0 N Received , _ Dimiati
Date/By: 1-0 ) Permit No.: ed 2_
,.': .... 13125 , Plan Review
Phone: 503.718.2439 Fax: 503.5619ma Date/By: Other Permit:#60 ....a5c
TIGARD
- ' , , . ':', • Inspection Line: 503 5 Br 1 .639.417 . uuy
11 -1)" —1Tr ivQ Date Ready/By: Juris: El See Page 2 for
rn
Inteet: www.tigard-or.gov ''' Notified/Method: Supplemental Information
_,,_,,.;]:7 H.-,.,:' ..;.E ---
Mechanical permit fees* are based on the value of the work
0 New construction ag Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition E:1 Other: . mechanical materials, equipment, labor, overhead, and profit
Value: $
:'1 E'::.: ii.,:= . 1fektiedbiit,ok ..,:.: , ,
Jg I- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
0 Multi-family 0 Master builder El Other: Description I Qty • I Ea. I Total
! • ' - .': ';' : :'. ' 1: :'
JOB : SITE INFORMATIONi: AND LOCATION -.-- : : ' 1 ; ::' ', , ' .=-. _ Heating/cooling:
Job site address: /47- ( 5),v w bc t. (requires site plan showing placement) 46.75
Fumace 100,000 BTU (duets/vents) j 46.75 y
City/State/ZIP: T 4 cur 0R_ / -7 az_3
Fumace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: `') Project name: Heat pump
(requires site plan showing placement) 61.06
tk
Cross street/diredions 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 any of above 23.32 (
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
jAgettliTicidi iWORK
Iv c'tint. I. L Tcu r IA e.c.-e..- : A /C, Gas fireplace 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) _ 23.32
oodpellet stove 33.39
Wood fireplace/insert 23.32
.:.::: , : i ,;; , !:::: _::: :, : ;! Chiney/liner/flue/vent 23.32
23.32
, i
Name: 14 tirb Lo -\,0-e j h raL,Li.r, c.-1-) Environmental exhaust and ventilation:
Address: La 01 7( ---) w u. ,-\
a y \ -. Range hood/other kitchen
equipment 33.39 ...
City/State/ZIP: 7 , ,, & E__, ct - -vaa,3 Clothes dryer ethaust 33.39
Single-duct exhaust (bathrooms,
Phone: ti5-0 I 6 0 ( k( Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT' :-,, , ,-; ---..;-.1: =;;. .' ;,.,,.-, -, ,': :01:;CONTACT:PERSON '', 1 , Attic/cmwispace &IS 233
2332
Oth2
Business name: er:
Fuel piping:
:1
Contact name: S14.15 for tint four; S4.03 for each additional
Fumace, etc.
Address:
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace _
E-mail:
.. Range
-,,,,:.:: ,i: - c,91 , ,i144 , 0:*,; :-..,;:' :,::: ]',;.,,,,:::, ;:i:.: :•;::. ::::::.:.,, ::::, :.:',;;;;...,:,;::::: Barbecue
. .
Business name: ML 0 . eack s pect e a\ s st Clothes dryer (gas)
Other:
Address: CI 3 ma (...k_ seLi (51- , ;: ',:;;,:;';':'::::;':`,
City/State/ZIP: pc- cd (9(.. 97 0 Subtotal ei3 .60
Phone:6a a 5 1 -- 7 ea) Fax5)3) Qr.-,--7 minimum permit fee ($90.00)
Plan review (25% of permit fee)
CCB lie.: 5 (a Co 'L) 54 8,43
State surcharge (12% of permit fee) i 1, 7-.D-•
T TOTAL PERMIT FEE Efrtrfer
Authorized signat rn UttS)--.1A-' This permit application expires if a permit is not obtai ed w hin 180
days after it has been accepted as com ! ! !
• Print name: KOLir_e_iN N\C'abt,q IN Date: ip , ).,_A - ik . Fee methodology set by Tri-County Buildi . : <IV Service lo aIl, 9_,
I: \ Building \Permits \MEC-PermitApp.doe 09/09/10 440-06I7T (1 1/02/COM/WEB) / . - ,
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