Permit CITY OF TIGARD MECHANICAL PERMIT
° 1' 4 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00437
Date Issued: 10/04/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Parcel: 2S103DCO3200
Jurisdiction: Tigard
Site address: 11250 SW VIEWMOUNT CT
Project: Wilkinson Subdivision: VIEWMOUNT Lot: 20
Project Description: Install gas furnace.
Contractor: HEAT RELIEF CO Owner: WILKISON, J ERIC /SARA
13122 NE DAVID CIR # 800 11250 SW VIEWMOUNT CT
PORTLAND, OR 97230 TIGARD, OR 97223
PHONE: 503 - 261 -9915 PHONE:
FAX: 503 - 261 -9814
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/04/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/04/2011 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/04/2011 $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 qu OUNCE calling 503 232 1987 or 1 800 332.2344 Q�
Issued B : e
C t� Permittee Signatur` 4 ih
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.
10/03/2011 MON 8:40 FAX 503 261 9814 Heat Relief 0001 /002
Mechanical Permit Applicatlo FOR OFFICE USE ONLY '
a City of Tigard '� EC E I V E Ir...,:t d �mm P crmitNo.: ie 0 O , '
1, - 13125 SW Hall Blvd., Tigard, OR 97223 : f0
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
TI GAR att;/
Inspection Line: SD3.639.4175 O C T 0 3 2 011 D Read /B
Job: ri See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
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Mechanical permit fees* are based on the value of the work
❑ New construction AAdditionJalteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
, ' - =`' ° e s* s , - -" : ' a': ' , kirl i ' p' z 1� F fir.,, V
r _ . ; .` , Y C � j �. t° F ;ti 5 h 64=1s f ;'',A: ts F ` r f ; t v alue .91 f: $ x i . : �, 34 441::'''Z'7,,
�.fer,£� .�i �.. M �� � r ���a`'� x� x= z':ase,� .�a�F��`�:�:. U, , i;24.1;.1`..::.1",.:1 ��� u 7 �I �^ � "e " �' � �
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
I Multi- family , [0 Master builder ❑ Other Description_ I Qty. 1 Ea. 1 Total
��� �� �•��Ce ���w � •`��� '�_ � `p�a,� ��� � �"' � '" Hcatin cool'm g:
: ;,L �ta� �� N' 'i,3.,r: � " .V... a ` .z<;€, il :fit' te r " ", � 7f
Job site address: 1 (as 3(J 1/ ( t to/ 14 n;g rtes site plan
(requires site plea showing placement) 46.75
City/State/Z1P511 OY 9' 'a3 Furnace 100,000 BTU (ducts /ve nt 46.75
Furnace 100,00D+ BTU(duotslvents) 54.91
Suite/bldg. /apt. no:: , Project name: l cicic Heat pump
Cross street/directions to job site: (requires site plan ahowingplacemeat) 61.06
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: I Lot no.: Flue/vent for any of above 23.32
Other. 23.32
Tax map /parcel no.: Other fuel appliances:
# ; u _: 7 a a- -
t r " (' . � a s ,. Water heater 23.32
1 R e, L , lC rNoe A Gas fireplace 33.39
�l�l�� J 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
' i'..«r ar ^1'ms 'I Chiron /liner /fluc/v ent 23.32
Name: C. W 3 1 `el Other 23.32
1n r� �, t� Environmental exhaust and ventilation:
�
Address: c 5 v �. v 0 e Range hoad/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) Phone: e a, ' 1 g 2 i $ u g v ( � .� ¢ p L x m& 1 toilet compartments, utility O
t ttllty ro ms ) 23.32
i R �3tf` F r F i �•r ar m� (' � n ,!Pn' f <T ' ;ii r
�'._�:. �� L�: � ,.�����ssra�`�,..�,.;:...,�.. sty, �:,., �,.», ��� .. Attic %rawlspacefans 23.32
Business name: - o Other: 23.32 _ ,
Fuel piping:
Contact name: i� v" - $14.15 for first four; $4.03 for each additional
Address: l 'z.a skx, rDeoitok c.A/��' �%� 7S (� Furnace, etc. L
Or ! 7 - �� ``--'' Ores heat pump City/ State/ZIP: -
Wall/suspended/unit heater
Phone: ( 451-1,61 .ci 1 l S r Fax: OS ) Water heater
Fireplace
B 0 c ■ ` ∎ CO- 7 �t !r 1 •4,A C 'a V Range
1 S ` r �. E. a8i 6 $ ' �
r
;;� �i .'�' �����,..:�n. ..� ,��.__, �- �.>u�.�: ��� � " Barbecue
Business name: Clothes dryer (gas)
41 /Address: lgyV Address: w N x p V1- LRi Other
: s b iiWi 4 1 Viii PLIT iii "
City/ State/ZIP: Subtotal ,.. r
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) q v„ 0
Plan review (25% of permit fee) �--
CCB lie.: (L State surcharge (12% of permit fee) /f .
. TOTAL PERMIT FEE // j
Authorized Sigrtl - This permit application expires if a permit is not obtained within 180 _
days after It has been accepted as complete. �J�
[Print name: I" ' AA_ Syr,,, 6\ Date: 1 b 21 l I * Fee methodology set by Tri- County Building Industry Service Board
I:1 BuildinglPennitsUMEC- PermttApp.doc 09!09/10 440- 4615T(/02/COMIWEB)