Permit CITY OF TIGARD MECHANICAL PERMIT
:� COMMUNITY DEVELOPMENT Permit #: MEC2011 00353
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/28/2011
11CrARD Parcel: 2S111DD14200
Jurisdiction: Tigard
Site address: 15762 SW 87TH AVE
Project: Mason Subdivision: Lot:
Project Description: Install gas furnace.
Contractor: A TEAM HEATING Owner: MASON, MATT
2307 PRATUM AVE NE 15762 SW 87TH AVE
SALEM, OR 97305 TIGARD, OR 97224
PHONE: 503 - 365 -8326 PHONE: 503 - 968 -1804
FAX: 503 - 365 -8333
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU • 07/28/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/28/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/28/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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: �� \ le____ Permittee Signature: o"/ /5 L /(•" 9 -j 0
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.
07/25/2011 08:22 5033658333 A TEAM HEATING PAGE 02/02
Mechanical Permit Application r ', roi: oh'hlc E t :SE ONLY
City o Tigard q
I ...„ . V i Received i �� Fertnit No.' .4
13125 SW hall Blvd., Tigard, OR 9 632' fE 9 " Date/Dy: 7 oZr // 6' f/ /f E ? —/ &5
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
a' I c. n R n Line: 5 Inspection Lin 503.639.4175 J U L 2 6 2 011
Internet! rd - or.gov Date Rcady/tly: IM la See Page for
CITY OF TIGARD Notified/Method: Supplemental l Information
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Mechanical permit fees' are based on the value of the work
❑ Now construction ❑ Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
"° �Irie p : :V6 Mm q ' tii ' ti ( ;ck Value: $ '
g
,, v aL ' � ' L�•. ;'. <' tN..da t � : ,4 4i s4E.i.. 4.1. a' u,�} .w"� . : u't P Y ti+y .: , rc"' -'-, ' q ' C fa7 w <t 3" e •5- '' '
Y'1.;.'S '
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
'r•' r ',. , y � i N Z; ;. . 1 ; "' A;• T T' . ng/cooling:
�ti \ .i r ' . l 5 d` t e , g 0 a i
a tt it ! Aeati
9 „.. S^ . L.,^e,^ewlara 1�`L l.1'i' 1 � .ta - i .'1 Air COndi[tOnit)
• Job site address: 15 7 , 5k! ' etA (requires site plan showing placement) 46.75
t Furnace 100,000 BTU (ducts/vents) l 4n.75 t. y 7S
City /State /ZIP: '"'r, 3 - 7a a4 Furnace 100,0001- BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name; NA ,- Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Ductwork 23,32
Hydronic hot water system 23.32
- Residential boiler (radiator or
hydronic) 23.32 _
Unit heaters (fucl -type, not electric),
. _ in.wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue /vent for any of above 23.32
Other: 23.32
Tax map /parcel no,: Other fuel appiances:
.,C "•1� VwC 1?P a § y r r ,.: C, t h n t A i r ,/ f;
. ,•
> s`` ,t ac e o , a 14,,.15 t a a `p y e / :ti l . ` ry Water heater 23.32
, �:ch'i�4::F��,.L�C.` ." , 4•.`:�5 . �pltt' :.� � `ti �' �lY'al`Cw� '
Gas fireplace 33.39
t h 5 I I . A ■ 2 Flue vent for water heater or gas
fireplace 23.32
Lo s lishtcr, (gas) I 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
i .r, v " �y"" " t "t 7 cw ra r � y nA 41:0 •,-,t.,, tr. Chimney /liner /flue/vent 23.32
;. ,,c j ' y t, t `2s y . , , .st�'rx s l . t .ls; fio4V s�h ez h g �? . "a� !'8ec a f ` m • Other: 23.32
Name: M0,4 (\ \r>, Environmental exhaust and ventilation:
Address: Range hood/other kitchen
City/State/ZIP: Ca/�/�(� n equipment 33.39
J r ' Clothes dryer exhaust 33.39
Phone: ( L - � - 3 Gt(D D -- \� O4 Fax: ( )
Single-duct compartments exhaust (bathrooms, ro oms) 23.32
• s,
� toilet rtten� utility rooms)
" : t0.',, ..,' ``kt.F'il0v . gls• tilt s ,, ..` . k ° e s ld � o a q '. Attie/erawlspace 2332
Business nam': �
,//�� Other: 23.32
A., T ea- vv\ CA ICJ ` . Fuel piping:
Contact name: I ra X14.75 for first four; S4.03 for each additional
Address; 3 0 �'al-ut v i CL f I �_ Furnace etc.
� �L� Gas heat pump
City /State /Z/1) ' /1/\ Dl_ g7SU5 Wall/suspended/unit
Phone: ( , • _ , ce , I Fax:: (, 3c,5 333- Water heater
E -mail. Fireplace
Range
a :',.'4 'r �"q�. W ; l •^ : � 4X h��� 1 • ', ' F "s" �y 5 '', , _ ...; �y � : ' J '.. � W , ` a "t -., / Barbecue
Business name: Clothes dryer (gas)
^' Other:
Address: L:r :".l:W'/r Ci. vr�7 �1 ?. '..rstil'at> a '`�5 $,S' :�1'
City/State/ZIP: Subtotal 4 (n.'?)
Minimum permit fee (890.00) 1c CO
P 'be: ( ) Fes' ( ) Plan review (25% of permit fee)
CB lie -: t 3 C l State surcharge (12% of permit fee) 10_ C'U
TOTAL PERMIT FEE i0().<0 Tbis p ermit application expires if a permit is not obtained witsin 150
Authorized signature: /� days after it has been accepted as complete.
Print name: ( 7),,:, - , - , - . , Date: ""r f ' I ( • Fee methodology Set by Try County Building Industry Service Board
ga440-4617 (I1 02/COM/w28}
t: $ui1du' ?e Itits\MEC- PermitApp.doc 09 /09 /10