Permit CITY OF TIGARD MECHANICAL PERMIT
`F'1 2: COMMUNITY DEVELOPMENT Permit #: MEC2012 -00115
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TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03!02!2012
Parcel: 2S110BD04600
Jurisdiction: Tigard
Site address: 11882 SW ELEMAR CT
Project: DAVIDSON Subdivision: ASPEN RIDGE Lot: 11
Project Description: Gas furnace replacement.
Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: DAVIDSON, JOHN J /LAURA L
PO BOX 80607 11882 SW ELEMAR CT
PORTLAND, OR 97280 TIGARD, OR 97224
PHONE: 503 - 233 -1779 PHONE:
FAX: 503 - 651 -3345
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/02/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/02/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/02/2012 $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.
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Issued By ^• — - ermittee Signature:
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.
r 03/27/2007 23:56 FAX 5036513345 BENS- HEATING&AIR Z002/003
Mechanical Permit Application Fo iz 01.1. 1(.1: Iisi• ONLY
City of Tigard R ��11G� opc/„`�
N ___ 4
Hall Blvd., Ti ardR M L y � " -- - :�r� •
13125 SW Ha
g Plan Review
Phone: 503.639.4171 Fax: 501598,1960 Dale/By: Other Permit:
11 (; n RI ) Inspection Line: 503.639.4175 FEB 2 9 2012 Date Ready /By: "T"'rulio. ® See Page 2 for
Internet: www.tigard-or.gov Notified/ Method: �c Supplemental Information
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TY - 6 10 fffliti VISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction DIE Addition /nitcration /rcplacemenl
performed. Indicate the value (rounded to the nearest dollar) ul'
❑ 1)entolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ —
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
I
I. • and 2•family dwelling ❑ Commercial /industrial 0 Accessory building For special irr/ororarrar use checklist.
❑ Master builder ❑ Other:
Inscription For
Qt 1 Fa__ I I'nt
JOB SITE INFORMATION AND LOCATION Heating/cooling _
Job sue address: 5 G l Air conditioning
(requires site plan showing placement) 46.75
City /State/ZIP: \j • rye_ c r 5'2.. Furnace 100,000 BTU (ducts/vents) • ,, , L 46.75
Suite /bldg. /apt. no.: Project name: 00,,,, ��so r� I
Furnace 100,0004 BTU (ducts/vents) 54.91
Heat pump G t .O6
Cross street/directions to job site: - r Duct work ?3 3)
-. Hydronic hut water system 23.32
Residential boiler (radiator or
hydronic) 23.12 ____
Unit heaters (fuel -type, not electric),
• in•wall, induct, suspended. etc. 46.75 —
_.__ Flue /vent for any of above 23.32
. Subdivision: I Lot no.: Other: 23.32
Tax map /parcel no.: Other fuel appliances
- _ DESCRIPTION 23.32 �_.
I TION OF WORK Water heater
.�_._.�_. \" "" — C�� r-. Gas fireplace_._.... . . - - - 33.39 _. ..
k�t.,a C -t r h
Flue vent for water or gas
fireplace 2332
- tog lighter (gas) __ 23.32
Wood/pellet stove — _ — _ 33.39 _.._._..._ .. _.
Wood fireplace /insert 2132
PROPERTY OWNER [] TENANT Chimney /liner /flue /vent 23 ;52
.. `�°` Other: 23.32
Nt11nc: •?fir �',r� v kaC� Environmental exhaust and ventilation
LL11 �� '1 1 Range hood/other kitchen % t f ' Ste) ,,, to. lr`f c equipment 33.3r1
City /State /"LIP: "-c, t V c��azy Clothes dryer exhaust 11.19
Single -duct exhaust (bathrooms.
Phone: (503 ) Q At 33 Fax: ( ) toilet compartments, utility rooms) 23.32
Ig_A_PPLICANT 0 CONTACT PERSON Attic /crawlspace fans 23.32
Other: 1 1 23.32 1 111
Business name:
t _ Fu el Ei�8._. _ ......
C•outuet name: a( ils“--+Of•J S14. IS for first four: 54.03 for each additional — —
.
Furnace , etc. - - --
(ios heat pump
(. it y /Slate /% I P: ' Wall/suspended/unit heater
Phone: (JV 1 ? i 3 -' g () 1 Fax :: ( ) Water heater
Fireplace
1'. -mail: Q91�c
CONTRA OR Barbecue
/ A ! f � Clothes dryer (gas)
Business name: I
- -• - - -- - ---- e iv ' 1 IVY' ./- / 6 Other: _
Address_ P 0 (3o Q
( O t`' 7 (� -�/ r � • MECHANICAL PERMIT FEES*
City / State /ZIP: -- Peril" �'f`t(_ 0' ;• l / z,. O Subtotal yY`_ 5— .
c: ( -��) ° F Minimum permit fcc (590 QQ, GC..
,
a '1.7 (�.�) bS! 33At5
Plan review (25% permit Ice) _
: i State surcharge (12% of permit fcc) na 10
TOTAL PERMIT FEE 1 ' 11V re
Authorized ,ignalur : TMs permit application expires If a permit Is not obtained within ISO
days after It has been accepted as complete.
E print name _ C I ,-1 • Fee methodology set by Tri -CCounty Building Industry Service Board
Dulc: 8Y Y Y g ry
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