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Permit
,, CITY OF TIGARD MECHANICAL PERMIT 11111 'g;: C OMMUNITY DEVELOPMENT P ermit #: MEC2011 00548 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2011 Parcel: 1S 134CB05100 Jurisdiction: Tigard Site address: 12390 SW NORTH DAKOTA ST Project: Tajipour Subdivision: ANTON PARK Lot: 13 Project Description: Replace furnace. Contractor: ENERGY SAVERS INC Owner: TAJIPOUR, REZA P.O. BOX 2829 12307 SW MORNING HILL DR OREGON CITY, OR 97045 TIGARD, OR 97223 PHONE: 503 - 512 -5338 PHONE: 503 - 524 -8584 FAX: 503 -512 -5339 FEES Specifics: Description Date Amount Furnaces < 100K BTU 11/30/2011 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 11/30/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/30/2011 $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 question _ : o _ .0 by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Sign tune: a 61 J 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. From: Energy Savers Fax: +1 (503) 512 -5338 To: Fax: +1 (503) 598 -1960 Page 2 of 3 11/30/2011 7:58 Mechanical Permit Application �j roes ()iii( -1 l s1: 0\IA City of Tigard C 9 IVED D er rlJ�tr Permit No.: . 1 a 13125 SW Hall Blvd., Tigard, OR 9 � � Phone: 503.718.2439 Fax: 503.598.1960 D�u�y: Other Permit: T it; A it r, inspection Line: 503.639.4175 NOV / 0 2011 Internet: www.tigard.o.gov `) / Notified/Method: : - S ] pl Pent for Supplemental Information j OF T1S1ARD TYPE O I'I ING T2[VIS1.0 COMMERCIAL FE£• SCHEDULE - 1713E CHECKLIST Mechanical permit far* arc based on the value of the works ❑ New construction (`Addition/ teration/replactment performed. Indicate the value (rounded to the nearest dollar) of all . ©Demolition 0 Usher mechanical materials, equipment, tabor, overhead, and profit Value: S CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES* l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special InfotmtniotruetherAtlsc Multi- family ❑ Master builder ❑ Other: Description 1 Qty. 1 ea. I Total 3013 SITE INFORMATION AND LOCATION Heatirrecooling: Air conditioning Job site address: 1 390 Si ,/ /1/04-7-4- n� t_ 5 , 6 (re site plan showing pent) 46.75 .r� r✓ IJ Furnace 100,000 BTU (ducts/vents) 1 46.75 4. City /State/ZIP: j 6- /Oto Furnace 100,000+ BTU (dams) 54.91 Suite/bldg./apt. no.: 1 Project name: Heat pump (requires site plan showing plectrum) 61.06 Cross street/directions to job site: Duct work 2332 Hydronic hot ualcr system 23.32 Residential boiler (radiator or hydronic) 2332 Unit heaters (fuel -type, not electric), in -wall, in-duct, suspended, etc. 46.75 Subdivision: 1 Lot no.: Flue/vent for any of above 2332 1 3 Other I Tax mapfparoel no.: a L 8 05( CO D� Other fuel appliances: 23.32 DESCRIPTION OF WORK Water heater 23.32 Gas fireplace 33.39 FL/ f/` C- 1 Iv,,,-7 Hue vent for water heater or gas - fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 3339 Wood fimpbsee/insert 23.32 PROPERTY OWNER ❑ TENANT Chimney/lincr /llue/vent 23,32 Z4- r - „-� Other 23.32 Name: ` +� ov / Environmental exhaust and ventilation: Address: f Range hood/other kitchen - 7 jfl 7 S L✓ 1n of / 1 p/• - .ui•ntent 3339 City/State/ZIP: l 64,/) Clothes dryer exhaust ' 33.39 Single •duct exhaust (bathrooms, Phone: (Co V 5,,V,-/- es S C Fax: ( ) toilet compartments, utility rooms) 23.32 {a} APPLICANT tJ CONTACT PERSON Attic/crewispacc fans 23.32 ff Other 23.32 Business name: j G�/ Cllr St3 v Cl C L r^ C Fuel pipinu: Contact name: ' r f L Y►f i4,7„./.., r+ At St0.15 for first four, 54.03 for each additional Address: o i�'.�' (?-.51 "�f Furnace, etc / Gas heat pump CityfState/Z1P: 04,4-- n+--- t% f 7`t r ore.. €77 04f .4^ Wall/ strsptnded/unR heater a Phone: (. S) 6 �q /7> z j Fax:: ( ) Water heater E -mail: Fireplace , Range ,� CONTRACTOR By Business name: N Cf fr - cd (-( fi j -C . oth d (gas) Other Address: MECHANICAL PERMIT FEES* City/State/ZIP: Subtotal ti}. 74 Minimum permit foe ($90.00) 5 0 Phone: (5 OF 5/2 -5 33 3 j Fax: (jo 3 ) 3" /. , 5 ?3 7 Plan review (25% of permit fee) CCI3lie.: i Q79y6 7 State surcharge (12%of permit fee) /C'. gcr TOTAL PERMIT FEE /00, l'0 `� This a e: " Authorized signature: permit application expires if a permit not obtained within 180 • - 0301P! days after it has been accepted as complete. Print name: jerCr,.l // e. 4 07±44.-' Date: )) 307// • fee methodology an by industry Service Board , 1; .dot o9A9/to 440461710 urnico /van i