Permit II ,� CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00401
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/08/2011
Parcel: 1 S 136CA05401
Jurisdiction: Tigard
Site address: 11285 SW 78TH AVE
Project: GALLUCCI Subdivision: Lot:
Project Description: Gas furnace replacement.
Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: GALLUCCI, NAOMI ALVIA TR
PO BOX 80607 11285 SW 78TH AVE
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE: 503 - 233 -1779 PHONE:
FAX: 503 - 651 -3345
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 09/08/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 09/08/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/08/2011 $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. Speci. ty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will - pire if w. I not - arted within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires u to fol .w tho rul- adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 I 1090 You ay o,.tain a cop o - rules— -
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
1111111h Issued By: ✓ � Permittee Signature: t
/
- ,
Call 503.639.4175 by 7:00 a.m. for the next available inspection d.te.
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.
a
Mechanical Permit Application 10 1�la N"
Ca \a��I FOR OFFICE USE ONLY - ,
tS 0 Received
City of Tigard x. ‘ Permit No
��(� y Da / 1ZCG, • I( — CM�6
III
° 13125 SW Hall Blvd., Tigard, OR 97223 W p a C3 Plan Review
t! Phone: 503.639.4171 Fax: 503.598.1960 ,, o Other Permit.
Date/By:
Ti GA RD Inspection Line: 503.639.4175 ``� r(� Date Ready /By. Juris. ® See Page 2 for
Internet: www.tigard- or.gov �� Notified/Method: Supplemental Information
TYPE OF WOR
. • .. • COMMERCIAL' *, SCHEDULE — USE CHECKLIST
•
❑ New construction Addition /alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ' ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY. OF CONSTRUCTION`...,•• :' .!. ;x ; z;.. ; w,"_._,.. .,_ Value: $
dwelling : ;,;RESIDENTIAL EQUIPMENT / SYSTEMS FEES* '•' •
Ai_ and 2-family g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
• - <. JOB SITE INFORMATION .' AND
P, .. i s = ,.'`:; Heating/cooling •
��LOCATTON���- ,;:': ^,,���;,:�,z1�a,
Job site address: ! , S� g`'l Air conditioning
1 (requires site plan showing placement) 46.75
City /State /ZIP: 9-7 aa.� Fumace 100,000 BTU (ducts /vents) / 46.75
�� Furnace 100,000+ BTU (duds veins) 54.91
Suite/bldg./apt. no.: Project name:
6,1/(4 Gl (c_ Heat pump 61.06
Cross street/directions 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 _ _ 3-32-- —
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF' WORK ;` =-- .'..:. • Water heater 23.32
Gas fireplace 33.39
aseislArie. 6^ > K ,/ /tA'Lt✓ Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
Ilg "PROPERTY OWNER , - ,12 . • TENANT;;;'' }, ' •
Other: 23.32
Name: A� (I , - t1 A
v Environmental exhaust and ventilation
Address: / I .Z Q- S CA 7 S Range hood /other kitchen
equipment 33.39
City /State /ZIP: 1 .- q '7 ° 3 Clothes dryer exhaust 33.39
1 '� Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
. g APPLICANT • • • : r4t " - ' D; CONTACT.; PERSONP..''°rV-i Attic /crawlspace fans 23.32
•
Other: 23.32
Business name: Fuel piping
Contact name: a(A a k,,r- -' $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State /ZIP: WalUsuspended/unit heater
Phone: (SC/ ,Z j 3- 3 9 g ( Fax: : ( ) Water heater
/ Fireplace
E -mail: Range
_ CONTRACTOR. . "'. = & " l ` ; : i; i `` - .: Barbecue
Business name: 13 S Clothes dryer (gas)
N. L i• �^ I ' iI J �' Other:
1
Address: Q 1� / � 0 Q) ( 7 .,6.!, '','' MECHANICAL PERMIT FEES *'. ,
City /State /ZIP: PO 'f'� f` i& 0/2- c 1 7 a. g'O Subtotal
-'') a-33 - '77 7 Fax: ( . 1r ) / si 3 4 Minimum permit fee r it fee — ,u0 se: (
l (Y 3 -! Plan review (25% of permit fee)
-. _13 lic.: 6 4 SC 7 State surcharge (12% of permit fee) I .
n TOTAL PERMIT FEE top ..
Authorized signatur : This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
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Print name: Date: 1/ * Fee methodology set by Tri- County Building Industry Service Board
I.\ Building 'Permits\MEC- PermitAp i.doc 10/01/09 440 -461 T (I1 /02/COM/WEB)