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Permit CITY OF TIGARD MECHANICAL PERMIT 1114 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00041 T[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2012 Parcel: 1 S 135DB 12200 Jurisdiction: Tigard Site address: 11369 SW 91ST CT Project: ARCE Subdivision: DAKOTA RIDGE Lot: 3 Project Description: Gas furnace replacement. Contractor: ARROW MECHANICAL Owner: ARCE, JUAN P & ROSA M 10330 SW TUALATIN RD 11369 SW 91ST CT TUALATIN, OR 97062 TIGARD, OR 97223 PHONE: 503 - 692 -1565 PHONE: FAX: 503 - 691 -1879 FEES Specifics: Description Date Amount Furnaces < 100K BTU 01/19/2012 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 01/19/2012 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/19/2012 $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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By a . = Permittee Signature: I 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. 01/19/2012 08:35 5036911879 ARROW MECHANICAL PAGE 02/02 Mechanical Permit Applic on FOR OFFICE:, 1J5,: ONLY City of Tigard R cccivad � r 13125 SW IT¢II Blvd., Tigard, CR 97223 D E ne/sy. / / Il � f.! - .�77�r�1 Datc/By: e f Phone: 503.718,2439 Fax; 503 .598,15�� N 1 9 2 2 Datc/By_ Other Permit TIGARD Inspection Line: 503.639.4175 Data Ready/B y: 171 See Page x for Internet www.tigard- or.gov CITY OF TIGARD Nntified/Method: Supplemental fnfortnation la , l �i IC DIVISION Ct imr RCLAt, FER* SC IElMJLE USE QIECl 1 IST Mechanical permit foes' are based on the value of the work ❑ Ncw construction Addition /alteratiotl/tcplacemcnt pm Tndicate the value (rounded to the nearest dollor)of all ❑ Demolition ❑ Other: mechanical matcrials,csipment, labor, overhead, and profit. -- - Value: $ CATEGORY OF CONSTRUCTION B1rSfIV t td,r.tlJCrtMMN f / SttSTFM§ Frtt4 M1 - and 2- family dwelling Q Commercial /industrial 0 Accessory building For spexlalInformation asetheckal. ❑ Multi - family E] Master builder © Other: Description . I Qty" I Ea. I Total : 4013: iNFt7'RMAT ON A.NI1.LOCATICiN Rodine/eoalieC: Air conditioning Job site address: tl, 3 0 _t i_ , (requires situ plan showing placement) 46 _ City/State/ZIP: 1p 01( 4127-3 Purnave 100,000 BTU (ducts/vents) t 46.75 1 -"p� Furnace 100,000+ BTU (duets/vcrts) 54.91 Suite/bldg./apt. no.: - Project name: A ic. Gta f y L Ileac pump f YC . shawin 61.06 Cross street/directions to job site: Duct work . 2332 t- lydronic 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: Lot no.: Flue-vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: - `:;)hRSC1tFP;r 1ON OF "*OR ' i Water heater [ 2332 Gas fireplace 3339 ' h t V 6 I n �� ✓ I Ji t . _ Flue vent 1br water heater or gas fireplace . 23.32 V — Gag lighter (gas) 23.32 Wood /pellet stove 33.39 Wood ftt+ep nsert 23,32 i ikt italic . ;dig : `IC+i ti V7' . iner /I(luc/vcnt 23.32 .,.. I` Ch m � t]dtcr; 23.32 Name: y i-�-A j t t . 6 Environmental exhaust and ventilation: Address: (3 ' i y -1- C 7 , __ _-- equipment QOd/othar kitchen 33.39 , _ Ci . /State/lfP: Clothes dryer exhaust . 33.39 �/ » �Z'� Single -duct exhaust (bathrooms. Phone: (go 3) k3 ,2, - 3 i 3 Fax: ( ) toilet coinpertments utility roam 23.32 kl' qjj ASV v ► `r, ) , PZOSO19 � � Athc%rnwls ihns 2332 Other: 23.32 Business name: (a ejzos o,r /) /.04 kM,1 cd,, i° Fuel piping: " . . Contact name: 0 u In n $14.15 for first four; $4.03 for each additional Addr Ld 3t 4 it - -�_ �r4^ Gas best — — Gas heat pump City/State/ZIP: To A t AT) ,4 0 ie._ 4 7m,Z Wall/suspended /unit Phone: ((az, eci 2,-1 Fax: : (6;03) 49 jr 1,g7q Water heater W Fireplace E-mail: P f ,i}, 44U`AVK'ie I' . ^ ;t . I: -), r Barbecue _ Business name: A c �,.` gt, tt A.A1, t . / Clothes dryer (gffi) 1 Other: Address: I b ` 3 D 4, Ibr, fNal cu_12. ; I4t ttigNkailt�gibe t,';1 t5o; ' ' ;-.'c,i ,r?4; ,'., City /State/ZIP: tynk bri - o 12_ 47o6 2 S ubtotal z (p ,7 s phone: ( p ) ry — Fax: ( ) minimum permit fee (590.00) q ©k oo h 3 we 7 Plan review (2.5% of permit fee) -0. CCB lie.: t7 1, 3 State surcharge (12% of permit fee) X1`2. ./ („,,i--- / TOTAL 1'F1Et1VII F FEE I i�bD. Authorized Si stare' _ This permit appticstion expires If R permit is ant obtained within 180 b'tt ^ �' days ettcr it has been a .!F,. as rnmpleteti y � f , ���� r ,. I f ? r " Fm m e,thmoinw art by Trwounw node itw 'Mequon/ imary Sn nnn t rn l v (f^ r