Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Pe COMMUNITY MEC2012 -00353
T f C; ARE) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/10/2012
Parcel: 2S103BB03400
Jurisdiction: Tigard
Site address: 12505 SW KAREN ST
Project: Hershfield Subdivision: BROOKWAY Lot: 34
Project Description: (1) flue vent, (1) furnace, and (1) fuel piping
Contractor: AIR PRO HEATING & NC INC. Owner: HARSHFIELD, RUTH A
7405 SE POWELL BLVD. 12505 SW KAREN ST
PORTLAND, OR 97206 TIGARD, OR 97223
PHONE: 503 - 771 -7871 PHONE: 503 - 704 -2724
FAX: 503 - 771 -5579
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 07/10/2012 $46.75
Type of Use: SF FlueNent For Any of Above 07/10/2012 $23.32
Class of Work: ALT Type of Const: Fuel Piping 07/10/2012 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 07/10/2012 $10.80
Stories: Minimum Fee Adjustment - Mechanical 07/10/2012 $5.78
Fuel
Fuel Types:
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 / o or 1.800.332.2344.
ARC
00.332.2344. ^ M /� Ti sued By: tip Q!�/l Permittee Signature: OL /CA f
)&J
Call 503.6 39.4175 by 7:00 a.m. for the next available inspection date. AR A/
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.
07/10/2012 1 0: 05 503771 5RECEIVED AIR PRO HTG PAGE 01
Mechanical Permit Application , o li O I1 1( t; 1 ,, i ( 'IN I ,1
Ci of Ti JUL 10 2012 Received PamieNo j Jo id---- Do 3C3
I ll 13125 SW Hall B Blvd., Tigard. OR 972 �� u
' • Phone: 503.639.4171 Fax: 503.598 1 O '/ F � TIG I► ARD Flan Review
Date/BY: . Other Permit
i ' I r . :\ I. i , Inspection Line: 503.639.4 B ILDING DIVISION Date Repdy/By rude; S5 See Page 2 for .
Internet: www.tigard- or.gov Noti4ed/Mahod /'l& Supplemental torermetloa
_ I
❑ New construction Addition/alteration/replacement
Mechanical permit s are based de to value oldie so
performed. Indicate the value (rounded to the ncare_at dollar) of all
❑ Demolition ❑ Other: mechanical materials e.ui.mcn Tabor overhead, and . . fit.
'
/ /Ale
■2 l- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building . nl,f ia
For special Wortnarto>t use checklist.
❑ Multi - family ❑ Master builder ❑ Other t ipyon Qty. Ea Total • f —
`: , ,' s i ,, ;' neati eooli , -
Air conditioning
Job site address. Z "1 C.. f roe site , hm showin: •iaceme IS 46.75 s- 0
City / State/ZIP: 7 ter 0 r .1_2,. Z„-3 Furnace 100,000 BTU ducts/vents t1 46.75
Furnace 100 000+ BTU duets/vents = 54.91 MN
Suite/bldg./apt. no.: 1 Project name
Heat . um . • 61.46
Cross slrxt/diro Duct work 23.32
to job site: r 23.32 NM
H ie hot water
Residential boiler (radiator or
h dronic . 23.32
Unit heaters (fuel -type, not electric). _EE
in -wall in-duet, sus. •- . etc_
Subdivision: I no.: Flue/vent for of above 23.32
Lot Other: 2332
Tax map/parcel no.: Other fuel a t i , lances
r ; Water heater 23.32
i: Gas 8 lace 33.39
.i... . s re_ it ei . S' 7 Q�_.s sea C L Flue vent for water heater or gas
/ J p fi ..Iace -- 23.32
GG�t r I ✓+ e• y -o / t X e.5 sir 0: ✓ (J e a. / -1 #' . _ Ii: ter _ as _ 2332
e ,. L . • G `K - J wood/. llet stove Mill 33.39 MIN
Wood fi -.lace/insert 23.32
ili a- L C Chi Am er /fl 23.32 il r.:. !. ' L , ! is ' Oh NM 23.32
Name: . •� �fi �� A. �e /1 Environmental exhaust and ventilation
[+ /� Range hood /other kitchen
Address: /2.] Og r7 /C € Y err 3 i.meat 3339
City /State/ZIP: • . 0 . ' 2 2 Clothes d cr exhaust 33.39
Phone: Tai ) Fax ( ) toilet . .tam util' roo 23.32
: ,, _, - , Attic/cr • ... fans 2 � -
� , ... Atli
Other: REM
Business name: . - - a Fuel , i . ,11_
Contact name: 514.15 lbr first four $4.03 for each additional
Address: Furnace etc. UMW Gas heat • urn •
City /State/ZIP: Wail/sue. ended/unit heater MIN
Phone: ( ) I Fax: : ( ) Water heater
11=91111.111M. 1.111
E-mail: i• To a G. C o
" Barbecue
Business name: A e l P /-1:4,....-4,-, 1 .4-1‘,. IK c. Other
Address: O I ✓ . ; ,
City / State/ZIP: /, a . ^ A ! 6 Subtotal 1 4f Lo
Minimum permit fee ($90.00)
Phone: (SO) ,• 7 Fax: (5 ) Plan review (25% of permit fee)
CCB lie.: 72 O b ► ( State surcharge (12 %ofpermit fee) Sif
Industry Authorized /f /) � / y TOTAL PERMIT FEE wT. ll ✓
Authorized signature: / .�. / `'. v� rbi! pelmtt days after i t has be been A accepted a tG� A! oat complete. O WINO IRO ,p / ! _ G / dpi p�lr t 6! m CCtp
[ name: L [ � / L o & • � I Date. 7- j p —/ 2_ • Fee methodology set by Tri County Bw Industry Service Berard
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