Permit CITY OF TIGARD MECHANICAL PERMIT
/111 COMMUNITY DEVELOPMEN Permit #: MEC2011 -00303
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/29/2011
Parcel: 2S 109BA00700
Jurisdiction: Tigard
Site address: 13621 SW MOUNTAIN RIDGE CT
Project: HENSEY Subdivision: THREE MOUNTAINS ESTATES Lot: 15
Project Description: Gas furnace replacement.
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: HENSEY, JOAN B 2001 TRUST
1005 INDUSTRIAL PARKWAY BY HENSEY, JOAN B TR
NEWBERG, OR 97132 13621 SW MOUNTAIN RIDGE CT
TIGARD, OR 97224
PHONE: 503 - 538 -1950 PHONE:
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 06/29/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/29/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/29/2011 $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: rt_ / . Permittee Signature:
Ca 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.
06/29/2011 09:01 FAX 5035380165
RECEIVED 0002/003
Mechanical Permit Amlication I ()R vi 1 i( i i si (r.,
City of Tigard JUN 2 9 2011
Door 01 Mk • g M E I r W° ! fir Mg a - ;_, A _
13125 SW Hall Blvd, Tigard, OftLM.3,, _ ,.,,, , ,, Plan anvicer
Phone: 503.639A171 Fax: 50.M.I9t0V I IliruitUi Droa/By;
im"cticel Tale: 503-639.417BUILDING DIVISION rota Rnalyilly. MIESEE30111 '
internee viv.rwtigard-ocgov NorifterObbitheit
c� I ' '* 'i ''' • '' 'actItta 'a4 , , i. ..12EIral
1 [ 16 * - 0.';' • VItEt ",,:,, : , ‘'-' ' .' ' - ,. ' , ' s
Mechanical permit gems are based on the value of the work
El New construction 74 Additionialtecationtreplacement performed, Indicate the value (rounded to the nearest dollar) of all
0 Demolition II Other: mechanical materials - ii ; 4L, 1 1. i. labor' — . . and ., .
Value; s
ok noray,0ir a ,.• si: . ,'"r"k ., ':'-'• ' . ' . ue
. atattottilia EQOPMENT !SWOTS nps , •
O. I - and 2-family dwelling 0 Commercial/indusaial 0 Accessary building For ;pedal Infonnation use checklist.
0 Muhi-thmily 0 Master builder 0 Other: Desch , • • . mem Total ,
JOB SITE 4114 ' • ''' . ' Head ' cools
i Air conditioning
Job site address: , IA i 4 ..., * -• '1 ShO .10,8,11ant 11111,111111111
_
,
City/Stare/VP: go, i i/I • - Furnace 100 000 BTU ducts/vats MS 46.75 NM
791111.4112M11111111111111 Furnace 10mrmili,...004 ductahrear• MN 54.9 MIN
- , Suite/bldg./apt, no.: .. NM . • ■ eet mane: j _i _.,;_..„ ,,,., 1E11 61.06.
Cross skeet/directions to job site: Dud work 1.1.11M11.1.11
H. . .. ' hot water ,.., ME 23.32 .111.
Residential boiler (radiator or 11111,111111
Unit heaters (fuel-type. not eloini4
in-wall, in-duck:impended, etc. MIMI
Flue/vent for an of above 111111111M11111•1
Subdivision: Lot no.: Other 1•11101111111•1
Tax map/parcel no.: Other Nei * tJ ' OM
11116/4*4161441br '1.1'e ' ' ' beater
IIIIMIN31•11111
I . I I I WI I r I 'Pr i . .tiMi_Lr al FM ■ I 11= I i m a II Flue vent for water heater Or gas MI
- lace
WIMU
Woo s . 'let stove NM 3339 NMI
---------
Wood fireplace/insert MIMI MIN
Ch .. ineriflueivent IIM 23.32
ROW d • . - .I ' OmMit. ' . ' ,. '" ,' ii,404ililli . ' ; ,'',' other: INIIIIMIMIIIII
Name: TM,. Illeir Environmental exhaust and ventilation
1 1,PIIIIPM• 4, , , Range hood/011w Intel=
111
2:MI 33.39 1111
., A - — ..1. rf 4 MM 1
• - ., t
City/Stub:20:M a. • c l 012., 1 2.2. Clothes , - exhaust MI 33.39 MIMI
Phone: ) to
....„•• Air
e --vf Crilla Siligle'duct exhatit (hItirwins' 1111
,,,t,....,. .,•,., utiht rooms
_ ,_.: ... v,, ....,. 4 .,, , . IrrirOran110610 , 1 L .... _ !i p6toigtoct,oRsoN , ' . s,' . Awe/crawls .. - fans MIMI
• I
! Business name: ...., • .. . TING
Contact name:
, $14.15 for first four 54.03 for each additional
- ...... ..•a • , i. ,C 1 L
Furnace etc. IMIIIIMIN
Gas heat
City/StaleIZIP: 1 I I • 1 Ya li - - 1 Wall/s.. — , unit heater 111111111111111111111
Phone: ( ) NEWS. - '-'' 0 ' " "II?? ) Water heater -
IIITION1111111•1
E-mail: MEIIIIIMIIIIIIIIIIII•11
'. 111.11111111011111111711,ERVIONIIIIIIIIIII Bottom IIIMINIIIIIIIIIIIM
Clothes ., - :,. 11.11111.1.
Business , :. i •*.- ar ' - --'
1 .. ••• . ■ c - , Other: MI111111.111.111
, Address: AND AIR • • • I. • -
biyoLiNicALpiamrittris0 '. .: . •
. ,
owstuturapt • _ Nov: TRIAL - subteud wirluW., 1
, k . A " ' : ' . 9 rsnMIIIINIIMIIIII Minimum permit fee 090.00) ji lgrikihi
)
. . Flan review (23% of . - , ; it fee
1 ; State surcharge ( of permit tee) ilelgal.
. . TOTAL PERMIT FEE VAMP
Authorized si .., •, . c 0'
et_ _r. ..41
I - This permit applieollon expires if a permit is sot ohesthood wl . SO
days after It boy Mon soccisteel is wooplete.
Print name: - ..c KA_ I A plitc: tailaill * Few methodology us by Tri Building lodusay Servies Board
. .
-- - , . . ..—..... , VT l I 1/02/00141WIEB)