Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00529
Date Issued: 11/23/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1 S125DB07700
Jurisdiction: Tigard
Site address: 7150 SW SHADY CT
Project: Williams Subdivision: SHADY DELL NO.2 Lot: 50
Project Description: Replace existing oil furnace with gas furnace and install gas piping.
Contractor: FAITH HVAC, INC. Owner: WILLIAMS, CLARK
610 NE SUNDANCE CT. 7150 SW SHADY CT
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503 - 268 -1000 PHONE: 503 - 245 -2149
FAX: 503 - 941 -5144
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/23/2011 $46.75
Type of Use: SF Fuel Piping 11/23/2011 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/23/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11 /23/2011 $29.10
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: , �5 / " Afa-�_ Permittee Signature: - �G,/ e -77
"` ---"��� 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.
Nov 20 11 10:13p James Ebrahimi 503 - 447 -1152 p.1
I Mechanical Permit Applicat I, CEIVE FOR OFFICE USE ONLY
R eceived 4. Ci of Tigard - Permit No�y �a2��r
g N 1 ' / ,y 1 ? 01 1 Date /ay: If O?3 / ��d /' , ! �( � -/ 707
q
II 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
E Phone: 503.718.2439 Fax: 503.598,1960 DateBy: Other Permit:
TIGARD Inspection Line: 503.639 CI OF TIGARD Date Ready/13y: FM WI See Page 2 for
Internet; vvww.tigard- ar.gov BUILDING DIVISION Notified /Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
- Mechanical permit fees* are based on the value of the work
❑ New construction W Addition /alteratio replacement performed. Indicate the value (rounded to the nearest dollar) of all
Q Demolition ❑ Other: ----' mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT 1 SYSTEMS FEES*
I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist t.
❑ Multi- family ❑ Master builder ❑ Other: Description [ Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
c� Air conditioning
Job site address: 7/.54. r3 • t J .0 d LI CI • (requires site plan showing placement) 46.75
22 Furnace 100.000 BTU (ducts/vents) . 1 46.75 'r .9-f
City/State/ZIP: Ti-do.,.:::‘ , o- 3 Furnace 100,000+ BTU (ductsrvents) 54.91
Suite/bldg./apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross stree to job site: i' , Li) 17a..cj IO rs F�-rr1 �r^A Ductwork 23.32
^� 4 1`"t A . ` 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
Flue /vent for any of above 23.32
Subdivision: 1 S 12-5Z B O?- q 2. 00 Lot no.: Other: 23.32
Tax map /parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
�^ // / Gas fireplace 33.39
✓ h 0 .€t I p (c tv - i rr cz) 'tits 0 - OLj Flue vent for water heater or gas
V fireplace 23.32
d P ,• j 3 rn � R, - 'L�j ur 4.-1 -le Tr-- , --1.. 0----, rin �t r Log lighter (gas) 23.32
ll Wood/pellet stove 33.39
Wood fireplace/insert 23.32
0 PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Clot" k / Other: 23.32
Name: M i.. C_ C �� K {�) t' I 1 r ese in s Environmental exhaust and ventilation:
Address: ?-e s U w S } fil C-{- • Range hood/other kitchen
V equipment 33.39
City /State/ZIP: ''r'• glaro�, e_e 9 7 .3 Clothes dryer exhaust 33.39
�J Single -duct exhaust (bathrooms,
Phone:
(3- 21 f S` -'Z/ t{ 9 Fa x: ( ) toilet compartments, utility rooms) 23.32
54 APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32
Business name: ; 7- ■ bilth - e., (rte. -
Fuel
piping:
Contact name: a s . e _S b !0-4 , AA ti S14.15 for Grst four, $4,03 for each additional
Address: 6 / d /V E See- n clot:," C C- fi • Furnace, etc. I 144.5 14
Gas
City / State/ZIP: H-t I I c 6 ora 42 heat pump
u..-i. Wall/sususpendedJunithcater
Phone: (54) 26 8 f 0 a o Fax: : (5c,3) `I It I_ 5t 4 4 Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: 6.......e 04 -0 Opp' •r I i •Cs of Clothes dryer (gas)
f Other:
Address: MECHANICAL PERMIT FEES"
City / State/ZIP: Subtotal
ho : { ) Fax: ( ) Minimum permit fee ($90.00) qp . °"
I Plan review (25% of permit fee)
CB tic.: 189686 r / / /-2 _, State surcharge (12% of permit fee) / 6 • R d
TOTAL PERMIT FEE / 00 •2 o _ iv
This permit application expires if a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
/ // i * raP mnlhrvinlnm cP, by Tr:_("n„nr.. A,;r,t;,., lr,rt.,cer•. eonriro Rna.ri