Permit , CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00300
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/29/2011
Parcel: 2S111CC21300
Jurisdiction: Tigard
Site address: 10250 SW GREENLEAF TER
Project: Lawrence Subdivision: SUMMERFIELD NO 5 Lot: 271
Project Description: Replace gas furnace.
Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: LAWRENCE, JANET
PO BOX 80607 10250 SW GREENLEAF TERR
PORTLAND, OR 97280 TIGARD, OR 97224
PHONE: 503 - 233 -1779 PHONE: 503 - 620 -4998
FAX: 503 - 651 -3345
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: gif ,� Permittee Signature: 62 L
-
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.
06/28/2011 09:42 FAX 5036513345 BENS - HEATING &AIR 0 002
Mechanical Permit Awe 111.,1 Ei1E l., i tii: (l�l..�
' Received x rtn' N
City of Tigard �UN 8 2.O Date/By: ' 29 // s /� ` it FCa0 //°'00 Oif
13125 SW Ilall Blvd., Tigard, OR 97223 Plan Review Other Fermi':
503.718.2439 Fax; 503.598,196 Date/By:
i ; n u i > lnspeclivn Line; 503.639.4175 OF TIGARD Date Ready /Dy: ® See Page 2 for
Internet: www,tigard-or.gov B��LDtNG DI V I SI QN Notilied/Metliod: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction .Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
III Demolition Other: mechanical materials, equipment. labor, overhead, and profit.
... — �- . Value; $ c pp 00/,/ -
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES" t 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special Information use checklist.
Multi - family ❑ Master builder ❑ Other: Description Qty, Ea. I Total
JOB SITE INFORMATION AND LOCATION Ileating/cooltng;
— f Air conditioning
Job site address: 1 bas-0 ,$1a free t e rs re I',, x4 P (requires site plan s howing plac ameot 46.75
Furnace 100,000 BTU�ucta/v i— 46.75
City /Stale /ZIP: 'ri 4 b ti IQ 4 7.9+ V Furnace 100,000+ BTU (ducts/vents) , 54,91
Suite/bldg. /apt. no.: f Project name: 40t 4 ,5 re c to _ Heat pump
(reviles rile plan showing placement) ` 61.06
Cross street/directions to job site: Duct work 23.32
_,------- I lydronic hot water system - 23,32
r Residential boiler (radiator or
hydronic) • 23,32
- . — . Unit heaters (fuel -type, not electric),
in -wall, in -duct suspcndcd, 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
"""' -"
r Gus fireplace 33,39
, 0✓ ; Flue vent for water heater or gas
fireplace ,. 23
— - — Log lighter as) 23.32
Wood/pellet stove 33.39
" Wood fl 23.32
23.32
- 23.32
(PROPERTY " OWNER a TENANT Chimneiner /flue
Other: 23,32
Name: '/�a/ P1-- 1--a-4401'144 c1 Environmental exhaust and ventilation:
Lea- hood/other kitchen
Address: 3
0 14 `' 0 Cr .rte Ge rb-� .....
City /Stale/ZIP: equipment 33.39
' ► t` fl 0 - (� Clothes dryer exhaust 33.39 r
Single -duct exhaust (bathrooms,
Phone; (S 4, ac ,_ G19 e f , Fax: ( ) toilet compartments, utility rooms) - 23.32 _
EA APFUCANT 0 CONTACT PERSON Attic /erawlspace fans �w 23.32
/ / `� Other: 23.32
Business name; 2,t,, ltpaA "f" /'t' -,"r (r'o„rd --r tk '., ytq' u-G -Fuel pipi
Contact name: ,I ,, P +-- �J — 514.15 for nest four; 54,03 for each additional
Address: rJ—` Furnace, etc.
e 20 6 0'? Cfas heat pump
City /State/7..IP: t 0 . Mp Q�. g Wall /suspended/unit heater -
Phone: (S ) g33 1 7,2 9 N Fax:: i573 ) ( a S 3 Y.iS` Water heater -
Fireplace -
It -mail: 1,011 1~S al"It U CC A L - CO/>t Runge
CONTRACTOR Barbecue ,
T Clothes d r . s
Business name: a",, tie „. T 1 ” , ,,, C . tl-; °v, s p'y (f �'' • Other:
Address: P, D Q, ii 6 , 07 MECHANICAL PERMIT FEES"
City/State/ZIP: PO -f' 1 t 0IL. 97 subtotal
Mi p ermit toe ($90.00) ( rf ,
Phone: (V))) �.,''S - I) 7 r Fax: (SZ)3) -- 33 if 5 Plan review (25% of permit fee)
CCB lie.; I ( /Oh State surcharge (12% of permit fee) /0_
tilir
_ , TOTAL PERMIT FEE ,
This ptrmlt application expires If a permit is not obtain within ISO
Authorized signature: days after it has been accepted as complete.
Print name: fin f , , Date: - a a Fee methodology set byTO-County Building Industry Service Board
I3 auildinglPermile1MaC- Pamrinpp.doa 1)9/09/10 440 -4617T(ii 2/C0M/Wca)