Permit CITY OF TIGARD MECHANICAL PERMIT
Atz COMMUNITY DEVELOPMENT Permit #: MEC2011 -00499
Date Issued: 11/04/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Parcel: 2S104BB04900
Jurisdiction: Tigard
Site address: 13994 SW CHEHALEM CT
Project: KNOWLTON Subdivision: CASTLE HILL Lot: 18
Project Description: Gas furnace and water heater installation
Contractor: THE HEATING SPECIALIST INC Owner: KNOWLTON, MARK E & SHARON L
9300 NE HALSEY ST 13994 SW CHEHALEM CT
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 503 - 257 -7000 PHONE:
FAX 503 - 257 -7702
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/04/2011 $46 75
Type of Use: SF Water Heater 11/04/2011 $23 32
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/04/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/04/2011 $19.93
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: - / _ Permittee Signature:
- . eir
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.
Mechanical Permit Application . I OR t11 is E t F ONl
Cl of Tigard Received
' �'� Date/By: it C Permit No.: , YI D I I --ooL lK'
13125 SW Hall Blvd., Tigard,OR 972 k ` t. % Plan Review
, . n Pho 503.718.2439 Fax: 503.598.1 0 V % Date/By: Other Permit:
Inspection Line: 503.639.4175 ��
T I G 12 D , ♦ O ate Ready/By: Jurir El See Page 2 for
. : Internet: www.tigard- or.gov �� 0 C � � �`Sl Notified/Method: i7"T Supplemental Information —
TYPE OF `WORK ��\V' COMMERCIAL FEE* SCHEDULE • -4 ,USE CHECKLIST
j Mechanical permit fees* are based on the value of the work
❑ New construction rzr Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF 'CONSTRUCTION _ RESIDENTIAL EQUIPMENT •! SYSTEMS FEES* '
ja I- and 2- family dwelling ❑ Commercial /industrial El Accessory building For special lnfornation use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE, INFORMATION -ANTI 'LOCATION - ' _ Heating /cooling:
3 eig C s C � a I CT Air conditioning
Job site address: i
µ+ requires site plan showing placement) 46.75
t ( � 1 0 .. 00u 3 Furnace 100,000 BTU (ducts/vents) i 54.9 {.f t�.
City /State /ZIP: _ Poace 100,000+BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: f Project name: Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 2332
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:
DESCRIPTION OF WORK Water heater r _ 23.32
Gas firep
04 tV Urn d 1 k t2�-Q.Y h e C ler Flue vent lace
water heater or gas
T 33.39
n S .�.� fireplace 23.32
�� Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
' Chimney/liner /flue /vent 23.32
'� PROPERTY OWNER ,- `I :O. `I'ENANT -
Other: 23.32
Name: M `t P'1 Environmental exhaust and ventilation:
Address: {
l Range hood /other kitchen
° � q 11 h� �� -^ equipment 33.39
City/State /ZIP: .t i air 0 co AD.3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: 0 LANeesb Fax: ( ) toilet compartments, utility rooms) 23.32
' 0 APPLICANT - _ • • - ❑ CONTACT. PEI LSON • _ Attic/erawispace fans 23.32 _
Business name:
Other: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Fumaoe, etc.
Gas heat pump
Wall /suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
E-mail: - Fireplace
Range
Barbecue
/ . _CONTRACT
Business name: j�}�l'/ 7 4.)e c � I ` ` Clothes dryer (gas) T " w� a � 1 Other:
Address: - D� 1V� � er . . - , MEC13i#7VICAL;PE _
Cit - t 1 . , d a ° fl ;.C) Subtotal
� � `7 Minimum permit fee ($90.00) CYO azv
Phone: S`-' ac 7 p ®Q _ Fa 3) a-) — 2 - 7 - Plan review (25% of permit fee) `r"
CCB lie.: d - State surcharge (12% of permit fee) i 0 ettO
a `� TOTAL PERMIT FEE I /10 .
Authorized signatu �_pAy�� P `� q luk, This permit application expires if a permit is not obtained within 180
lJ days after it has been accepted as complete.
Print name: Kann nv b In Date:\ 1.. fi , i ( * Fee methodology set by Tri County Building Industry Service Board
I•\ Building \Permits\MEC- PermitApp.doc 09 /09/10 440.4617T (I1 /02 /C0M/WEB)