Permit CITY OF TIGARD , MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00048
T1GA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/25/2012
Parcel: 2S110DD04100
Jurisdiction: Tigard
Site address: 15685 SW OLD ORCHARD PL
Project: Power Subdivision: SUMMERFIELD NO.3 Lot: 143
Project Description: Replace gas furnace
Contractor: MECHANICAL INC Owner: POWER, ALVIN & DOROTHY
PO BOX 19569 15685 SW OLD ORCHARD PL
PORTLAND, OR 97280 TIGARD, OR 97224
PHONE: 503 - 244 -1730 PHONE: 503 - 708 -5779
FAX: 503 - 245 -7613
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/25/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/25/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/25/2012 $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: Permittee Signature: 4 e, t
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.
Jan. 23. 2012 1:15PM No. 5643 P. 1
Mechanical Permit Application FOR t)FFI(•r, t1Slt: °Nt,v
City of Tigard Received �� �-
tr •` Date/By, t _ -wa- -permit No y pia - Dv,
e 13125 SW Hall Hlvd., Tigard, 0: • Plan : ■ Phone: 503.639.4171 Fax: 50 Lni.: ' Plan .,.. ti1� Date/By: QtlzerPermit
1 I i 1 A 6u) Inspection Line: 503.639,4175 A\ N Date Ready
C4 Filla See Page 2 for
Internet: www,tigard- or.gov 0 G4 NotiSed/Method: Supplemental Informa
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El New construction [P4ddition/alteratOplIcement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
1 U 111„ '.1, I I, , M Y ,,, value. $
_
' Y k I! b -i�, aster �.w7a r r ❑t ht xi n x +. .1 V + o t' Nr�,ri' y+a usur6saa �;1 ''`agx;1wp t { , r e [ I +
i f �i7 tSrZ 'IBS Y a � q it 8 �1.�t 6l- gl a3 'tt ti • . i P 6� 6:
0-1• and 2- family dwelling In Commerciallindustrial ❑ Accessory building LL is tixrdisu n.31, . 5tatt.nr9�Hs.rY ]trau ik11ffi�ts ,s nc aaa 1 r
❑ Multi-family ❑Master builder ❑Qom; For special hlformation use checklist.
Multi-
0M ,� f a �} l t, �w t 4t �nq� �s f Description Qty. Ea I Total
1 a 1 ilrB f;l,4lli I y(kt I � i u'1: a u a l • ` „! i iamr {Ji ll�a�Su ' t tilhit i� it i6liirt? E l ►i1 d tiil4lf Heating/cooling
Job site address: ` i 5 s t+J °t P� Mr conditioning
-' M� a • m ulna cite fan ehowin lacement 46.75
City /State /ZIP: Of • ' (7 Furnace 100,000 BTU (duetelvents) 46.75
Furnace L00,000+137; (ducts/vent') 54.91 I
Suite/bldg. /apt. no.: Project name: P _ cr. Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Er r Hydtonio hot water sys 23.32
• Residential boiler (radiator or
r 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 m /parcel no.; t l # �yy ` ,���� ,i�, q { Other fuel appliances
A r1 1. =1 .tt 1. 1 1 Ai i. 9 I s 6 s e a o Yam Rauu ` 1311Y e '. s } J (' i I '' Water heater 23.32
6 7 � 11 �• , , i �1���1 �ilhd.� s r i1
4as fireplace 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33,39
} Wood fireplace/insert 23.32
!" +. t i" Cil� ( 1 s kl dlRrua r >r OChither: mneyll6er /flue/vertt 1 23.32
sit �` 1 23.32
Name: •
j'i � , 6 ■ s.-. o W Environmental exhaust and venHIetlon
Address: S _ - 5 0 a, r r - Ran had/other kitchen
equipment 33.39
City /State /ZIY: T . it cV7 �, Clothes drye exhaust 33.34
Single -duct exhaust (bethrooms,
Phone: ( 1 of . 51 79 {Fax: ({� )) toilet compartments utility rooms) 23.32
Gill ILeliti"stli�' f �r�,� d n�� tt '(F f "{s i i � ai�1111 i IET,'„ m ° ; r e+•,t , i !' ' 1 ; l i Attic/crawispace fans 23.32
Business name: % _ f' • ,
Other: 23.32
_ -•: _� s Fuel piping
Contact name: y 514.15 for first fou 54.03 for each additional
Address: p s O 1 • Q1 - Ramage. etc.
• Gas heat Epmp
City /State /ZIP; ,.__ M WaWsuspended/unit heater
Phone: ( tr rt . Water heater .
Fireplace
- • Range
t 111 + die - '7't 61' 7'' 1 7 1: F {, Id ii _
I
' "' ti: 1.i411i �� d SP u�,n1} A 1l1 1 � I 1 $at iRR b1 tt s
Y o ���� C6! }' 1' dL6��{I�' &�� t 1� :1�����1�L/�� "' �, 1111 ';'It'.1 Barbecue
Clothes dryegas)
Other:
Address: ` a f Y 7 1 V!h), 1 ' t1"'a' ac t 9 ,' 4,1'
City /State/ZIP: Subtotal
Minimum permit tee ($90.00) goo.
Phone: ( ) P lan review (25% of permit fee) rr '' •
State surcharge (12% of permit fee) ,q V
TOTAL PERMIT FEE I q $ f-
Authorized sigtlattire: This permit application expires If a permit Is not obtniae& within 150
days after It has been accepted as complete.
Print name: o i A ca litot. , Dateo k 0 .):10) 201 * Fee methodology set by Tti•County Building industry Service Board
illuildln oem7; :szaC,venn:tnpo.doe taolt09 440.48177 (t1Po2ICOM11ve81 i