Permit CITY OF TIGARD MECHANICAL PERMIT
• $ COMMUNITY DEVELOPMENT Permit #: MEC2012 -00054
Date Issued: 01/27/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel 2S104CD04200
Jurisdiction: Tigard
Site address: 13759 SW BENCHVIEW TER
Project: White Subdivision: HILLSHIRE ESTATES Lot: 42
Project Description: Replace Furnace
Contractor: PYRAMID HEATING & COOLING Owner: WHITE, LAURENCE E
9409 NE COLFAX 13759 SW BENCHVIEW TERR
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 503 - 786 -9522 PHONE:
FAX: 503 - 786 -3432
FEES
Specifics: Description Date Amount
Furnaces >= 100K BTU 01/27/2012 $54.91
Type of Use: SF 12% State Surcharge - Mechanical 01/27/2012 $10.80
Class of Work: ALT Type of Const: VB Minimum Fee Adjustment - Mechanical 01/27/2012 $35.09
Occupancy Grp: R - 3
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure: Low
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: rd / , Permittee Signature: ON A p p�T LA f� U �l
V
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. `I r
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.
01/25/2012 WED 13:34 FAX 503 786 3432 PYRAMID HEATING Z1001/002
Mechanical Permit Application Fo12 OFFICE USE ONLY
City of Tigard , ' E I'7 -1'2 PermitNo.: 131 Hall Blvd, Tig. t r, 2 p Phone: 503.718.2439 Fax: tk . 60 � Other Permit:
Inspection Line: 503.639.41 5 'L Date /By:
T I G A RD Date Ready /By: funs. 61 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
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i ' } Mechanical �.....Y it fees* L,n '4 A.. a.0 *. 'G'Mk' I�k"dikOeSt. *'
❑ New construction ' _ ,' t Mechanical permit fees* are based on the value of the work
® Additi . ion/replacement performed. Indicate the value (rounded to the nearest dollar) of all
El Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Y i � Value: $
- : : 42 .��',{�a ''§ t�''iit4t.� �" , 1 • 6 : 't` :16 .
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® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder El Other: Description I Qty. I Ea. I Total
1 ` t ,; e s l N a 9a n IO I e rI Heating/cooling:
• w. -.. :-4''t ai Air conditioning
Job site address: 13759 SW Bench View Terrace (requires site plan showing placement) 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000 BTU ( ducts/vents) 1 46.75 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: I Project name: White Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: it work 23.32
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
Subdivision: I Lot no.: Flue/vent for any of above 23.32
I
Other: 23.32
Tax map /parcel no.: Other fuel appliances:
t X: '".:- : w;;r �., 7.a 17 "2 „i ` e v .R'=t ' ' k'Il 4: emu• Water heater 23.32
�.,4:. _r -. ._7.. .642'3.; xran..ir ....:aw:tx cr, .a::..... .
Install Furnace Gas 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
^'� s e i G } , ,n . " 7 ;qt r �" 17- 5 �' s' ;: Chimney /liner/flue/vent 23.32
.4,444.2 rc.,==' s: ..I S- 1.4 l it '�t � .,.- ,,, „ ; t, " . t : - Other: 23.32
Name: Larry White
Environmental exhaust and ventilation:
Address: 13759 SW Bench View Terrace Range hood/other kitchen
equipment 33.39
City /State/ZIP: Tigard, OR 97223 Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: (503)740 -5335 Fax: ( ) toilet compartments, utility rooms) 23.32
'� '''4.1 >... BY �• *te .^ `` . sT `r m om ° ', x , ,yi"�.,,,i, c c N `� e" . i ts E • Attic /crawls ace fans 23.32
Business name: Pyramid Heating & Cooling Other: 23.32
Fuel piping:
Contact name: Tina Bronson $14.15 for first four; $4.03 for each additional
Address: 9409 NE Colfax St Furnace, etc.
Gas heat pump
City/State/ZIP: Portland, OR 97220 Wall/suspended/unit heater
Phone: (503) 786 -9522 I Fax: : (503) 786 -3432 Water heater
E -mail: tbronson @pyramidheating.com Fireplace
Range
Z . " . :ia ro*+ -11- ” � s o .. ? . . . Barbecue
Business name: SAME AS ABOVE Clothes dryer (gas)
Other:
Address : i� '
s. - :r. ` :. > ` , 4 ;). .. -r ' u .
City /State/ZIP: Subtotal 46.75
Phone: ( ) Fax: ( ) Minimum permit fee ($90.00) 90.00
Plan review (25% of permit fee) -
CCB lic.: 59382 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Tina Bronson Date: 1 - 2012 " Fee methodology set by Tri -County Building Industry Service Board
J
I:Building PermitsMEC-PeemitApp,doc 09/09/10
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