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Permit Er CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2011 -00543 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2011 Parcel: 1 S134DC00102 Jurisdiction: Tigard Site address: 11455 SW 115TH AVE Project: Bourque Subdivision: 2008 -038 PARTITION PLAT Lot: 3 Project Description: Replace gas furnace. Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: BOURQUE, GARY PO BOX 80607 11455 SW 115TH AVE PORTLAND, OR 97280 PORTLAND, OR 97223 PHONE: 503 - 233 -1779 PHONE: 503 - 684 -8551 FAX: 503 - 651 -3345 FEES Specifics: Description Date Amount Furnaces < 100K BTU 11/30/2011 $46.75 Type of Use: SF FlueNent For Any of Above 11/30/2011 $23.32 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/30/2011 $8.41 Occupancy Grp: Mechanical Permit - RES 11/30/2011 $19.93 Stories: 12% State Surcharge - Mechanical 11/30/2011 $2.39 Fuel Fuel Types: Natural Gas Gas Pressure: Total $100.80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC b calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: 6, �/`/" 6/x ,1 -77 N Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application t- V FoR c)rl�l( I. tiI ()NIA \ at J C E ED Received I ' City of Tigard Date/By: iI/,30/ Permit No.: 0 ii -- OK 13125 SW Hall Alvd., Tigard, OR 97223 CC.• Plan Review ' a ' Phony 503,7152439 Fax: 503.598.1960R \; t I 'V% 2 ( 2011 Date/By: Other Permit- Ti t; . t P I) Inspection Line; 503.639.4175 DaleReadyfsy: ru.r," fa Set Pose . for Internet; www.tigard- or.gov CITY OF TIGARID NotiliciA4adIod: 1 ' CJ suppiemen rnformatio P ►. II . I - : TYPE OF WORK • 1 COMMERCIAL FEE" SCHEDULE -- US! C)UEC , ST " Mechanical permit fees' are based on the valu f the wor d [] New construction A Addition/alteration /replacement pertbnncd. Indicate the value (rounded to the n , st doll ; I of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, , .r . , d .m'i t. - Value:$ m ', I CATEGORY OF CONSTRUC RESIDENTIAL EQUIPMENT / S t_' - • 1- and 2- family dwelling .0 Commercial /industrial ❑ Accessory building knrapeNre!lormallnv, arse aher ,:. Multi- family ❑ Nester builder 0 Other: Description J Qtr. JOB SITE INFORMATION AND LOCATION Air conditioning /cooling: f nditioning Job site address: / NS .W ) Air co / I 0 - (te uirr sire plait showing placement) .6 .75 • (� Furnace 100,000 BTU (ducts/vents) 1- . 6.75 City/State/ZIP: / s ` f< ,� Furnace 100,000+ BTU (ducts/vents) _ 54.91 Suite/bldg. /apt. no.: 1I Project name: Heat pump (requires site WW1 allowing placement) 61.06 Cross street/directions to job site: Duet work 23,32 Hydronie hot water system 23.32 _ ...._ Residential boiler (radiator or h drone 23.32 Unit heaters (fIel -type, not electric), in -wall, induct, suspended, etc. 46. 75 Subdivision: 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 23,32 Gas Tiire'lace 33.39 if ' A. i mv- r — Flue vent for water heater or gas fireplace 23.32 l,og iil3litersgas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 PROPERTY OWNER 0 TENANT Chlmneymerlflue/vent f 23.32 Other: 23.32 Name: 4 i.. {/ ,QQ 6C /2 GC E Environmental exhaust and ventilation: / Range hood /other kitchen -I PRI III Address: //ii�� d I- equipment City /State/Z1P: "`� Q 1 a Q , , Clothes dryer exhaust 33.39 E b i . - g Single-duct (bathrooms, Phone; 03 ) C]�r Fax: ( ) toilet t compartments, utility rooms) 23.32 ISt APPLICANT © CONTACT PERSON Attic/crawls .ace fans 23.32 ' Other: 1111 ■ Business name: Fuel • i • I n : t ct� - Contact name: atf,t6A./ $1 4,15 for first lour; S4.03 for each : c ditional IIIIII EIMMEMIIIIIII Address: Gas heat pump City /State/ZIP; Wall /suspended/unit heater P III hone: EP. ) — 1 -2-21 Fax: : ( ) .T .. Water heater Vire. lace E -mail: Range — -. ■ IIII CONTRACTOR Barbecue Business name: a/ w ,� f Clothes dryer (gas) _ I S �Fil F� ►� JG Other: Address: P �O L r7 MECHANICAL PEruvirT FE '° City /State/ZIP: , f 7 V . Sub tall ,- t7 r Minimum permit fee ($91 't ) 9y • ri) Phone :.(�) 4.3.-17 I Flax: ( ) Plan review (25% of permit oc) CCB lie.: 6 !is-- 9 State surcharge (12% of permit zsIM;' i f / TOTAL PERMIT : b i C) j1 . . AuthOrl9gct signature; ' This permit application expires if a permit Is ao ! . Molded WI f t1n 180 .r days after it boa been accepted as e pkte. -" � - / • pee methodology sal by Tri- County Building In.i , *try Service card Print name: r • G pate: / r pl ` t: 1BuildinaWermita l4EC- Parmi1App.doc 009/10 44 6171 (I r02(COlvl/WPn) Z00 0 2IIV'BDNI.LHHH - SNHH SbCCT29C0S XYd LS:8T L00Z /6T /T0