Permit CITY OF TIGARD MECHANICAL PERMIT
111
1- COMMUNITY DEVELOPMENT Permit #: MEC2012 00507
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/08/2012
Parcel: 1 S 134CA00513
Jurisdiction: Tigard
Site address: 11150 SW 119TH AVE
Project: Borland Subdivision: PANORAMA NO.2 Lot: 24
Project Description: (1) gas furnace new installation and gas piping
Contractor: BIRCHFIELD HEATING & AIR CONDITIONING INC Owner: BORLAND, NICK
PO BOX 562 11150 SW 119TH AVE
ALBANY, OR 97321 TIGARD, OR 97223
PHONE: 541 - 926 -1374 PHONE:
FAX: 541 - 926 -7278
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/08/2012 $46 75
Type of Use: SF Fuel Piping 10/08/2012 $14 15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 10/08/2012 $10 80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 10/08/2012 $29 10
Stories:
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 or 1 800 332 2344 ,�( /
Issued By: J1 y/ A 12 7 A Permittee Signature: ®1 uer',nr�/�l/
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.
Mechanical Permit ApplYCatio " I ECEI VE FOR OFFICE t SE owl
- City of Tigard 8 ` O o 'y v`
• O� OCT I r Permit No :
I N
U 13125 SW Hall Blvd., Tigard, OR 97223 O 8
Han °"ma C � l d 1 '� ��
an Review P
Phone 503 7182439 Fax u.1 ao, a. _ 00.1
503.5984960 /� D Other Permit:
•i l C A R D Inspection Line: 503.639.4175 CI OF T Date Ice /By: J E1 See page 2 for
Internet: www.tigard -or.gov
BUILDING DlVIS • , Not t TI ( Supplement:1 1pformatioo
;,
TYPE OF WORK COMMERCIAL ' SCHEDULE - USE CHECKLIST
El New construction ®Addition/alteration/replacement Mechanical permit fees* arc 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,
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES•
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For spedal irt/ommdjon tale Checklist
❑ Multi- family ❑ Master budder ❑ Other. Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Headnp,/cooliag!
-- Air conditioning
Job site address: 11150 S W 119th AVE _ (requires me plan showing placement) 46.75
City/State/ZIP: 97223 Furnace 100.000 BTU (duets/vente) 1 46.75 46 75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Project name: Heat pump
(requires site plan showing placement) 61.06
Cross smeeddirections to job site: _ Dun work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit beaters (fbel -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:
DESCRIPTION OF WORK Water heater 2332
NEW INSTALLATION OF 95% GAS FURNACE AND GAS PIPING. Gas f
Flue veent nt for water 33.39
fater heater or gas
fireplace 23.32
Log lighter (gas) 2332
Wood /pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER I ® TENANT Chimney/liner /flue/vent 23.32
Other: 23.32
Name: NICK BORLAND Environmental exhaust and ventilation:
Address: 11150 SW 119 AVE Range hood /other kitchen
equipment 33,39
City/State/Z1P: TIGARD, OR. 97223 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT ® CONTACT PERSON Attic/crawlspace fans 23.32
Business name: BIRCII IELD HEATING & A/C, INC. _Other 23.32
Fuel piping:
Contact name: JACOB B1RCHFIELD 514.15 for first four, 54.03 for each additional
Address: P.O. BOX 562 Furnace, etc. 1 14.15
Gas heat pump _
City /State/27P! ALBANY, OR. 97321 WelVsuspendcdAmit heater
Phone: (541) 926-1374 Fax: : (541) 926 -7278 Water heater
Fiiplacc
E -mail: BFIAC®BIRCHFIELDHEATING.COM _ Range
CONTRACTOR Barbecue
Business name: BIRCH FIELD HEATING & A/C, INC. Clothes dryer (gas)
Other
Address: P.O. BOX 562 MECHANICAL PERMIT FEES"
City/State/ZIP: ALBANY, OR. 97321 Subtotal 60.90
Minimum permit fee ($90.00) otQ I
Phone: (541) 926 -1374 Fax: (541) 926 -1374 Plan review (25% of permit fee)
CCB tic.: 88938 State surcharge (12% of permit fee) /D -$'•
TOTAL PERMIT FEE /(lril ,o s"
Authorized signature: This permit apps cation expires if a permit is not obtained within ISO
days after it hOS been accepted as complete.
Print name: e: —• I Date: 10/05/2012 • Fee methodology set by Tn- County Building Industry Service Board
L -PermitApp doe 03101/12 410461ST (I I/02/COlwf/Wss)
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cy
Birchfield
Heating - Air Conditioning Inc
Serving the area since 1935
P.O. Box 562, Albany, Or_ 97321
Tel (541) 926 -1 374 Fax (541) 926 -7278
BHAC@BIRCHFIELDHEATING.COM
Cover Letter
Send To...City of Tigard From...Birchfield Htg. & A/C, Inc.
Attention... Date...October 5, 2012
Fax...(503) 598 -1960 Phone Number...(503) 718 -2439
Comments:
Please call for payment.
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