Permit II CITY OF TIGAR MECHANICAL PERMIT
' s' COMMUNITY DEVELOPMENT Permit #: MEC2012 -00614
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/29/2012
Parcel: 25115AA03200
Jurisdiction: Tigard ,
Site address: 16450 SW 108TH AVE
Project: Conroy Subdivision: DOVER LANDING NO.2 Lot: 71
Project Description: (1) furnace replacement and (1) fuel piping
Contractor: CARSON OIL COMPANY INC Owner: CONROY, BRIAN J
3125 NW 35TH 16450 SW 108TH AVE
PORTLAND, OR 97210 TIGARD, OR 97224
•
PHONE: 503 - 471 -4365 PHONE: 503 - 620 -5896
FAX: 503 - 227 -8521
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/29/2012 $46.75
Type of Use: SF Fuel Piping 11/29/2012 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/29/2012 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/29/2012 $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: i Jl tit " ` j ewi b / /, 'r Permittee Signature: Oki APPt(C4�UN.
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.
- 29. 2012. 5:07A10' 'Carson Oil Dispatch-Sal es (. 'No. 4985 1 , ` - ch-- 930
Mechanical Permit Application 7 k FOR ()1:1.1(:t. l ISE ON LY
/Oil . Received ( )-(7 / Per
City of Tigard Date/By: ( a e.._ mit No.:M _ 1 t e ), -.op -
Phone; 503.639,4171 Fax 503.59 1 i
; I N - 18, 13125 SW Hall Blvd., Tigard, OR 97I r- Plan Review
: ARD Date/By: Other Permit
TI
Inspection Line: 503.6394175 Julia: el See Page 2 for
G
Internet www.ti Date Ready/By:
gard NO V 2 9 2012 Notified/Method: 1,.. I Gs Supplemental Information
.. Typt:*: :,(1:.01iliy0f4g . 0
Mechanical permit fees* are bascd on the value of the work
0 New construction VAddition/akittONStelinSION performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit,
Value; $
0 •:-.;,: . .1.. , ... : . , ::,
CATEGORY OF CONSTR
. UCTION ,s 'OU,•E..:. . ' :.-- • : - : . . ‘ . . . t . .'. ,. ,
:• ,-.,,e : '''• ' ' ' ' '• 1 '''''" ' " .. 2..... - " • • . •• • - ' • --' '. '-• ' " '' . " . ..".. ' "'•'-''' ' '''''- '''' ''• •- •,.4
un- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special Information use checIdist
111 Multi-family El Master builder il Other: Description J Qty. I Ea. I Total -
401 Oft* *0 :. Ilea tinfriml
....s -
,., b V Air conditioning
Job site address: a ' .,„1 /0,- (requires site plea showing placement) 46.75 .
Furnace 100 BT(_ 46.75 -
City/State/ZIP: ' i . L ... I a c _ • •
Furnace 100,000t BTU (ducts/vents) 54,91
Suite/bldg./apt. no.; Project name; ( Ait2oi Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
,S I geker ST. Residential boiler (radiator or
hydronic) ' 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-du; suspended, etc. 46.75
Flue/vent for any of above 2332
Subdivision: I Lot no.:
Other 23.32
Tax map/parcel no.: Other fuel appliances
iiESOVPTI,ON;jii! ;.'... , Water heater 2332
' Gas fireplace 3339
0 i 1 +0 3n ow rf pia CLenf,n-i' 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
. Chimney/liner/flue/vent 23.32
. ,
•.•;„;• „1,?(!., .., : . ,, . r.ER. : ,...;, . , -...,! ::.;.`.: ,.,:-:: , i,r! .17;,•: .• z. . :. ,. - • .r`j-ck''.2. '':'",•• - ~: ' • Other: 23.32
Name: .
BrttXra C '' r - Environmental exhaust and ventilation
Range hood/other kitchen
Address: / 5 0 . s i /be, 7 equipment 33.39
-
City/State/ZIP; Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone; (563)62 ,_ 5-gfe, Fax: ( ) toilet compartments, utitilvooms) 23.32
• ' Attickrawlspace fans
;' . ; .:;f ::'... ii41'.144' ::-.'. i l . 4 .. ''' ,.- :•: ( •:::: , 4, .5'.''.:..0,14...°i.4'1,..kgrt$..CP,1:;').....::::,':... 2332
23.32
Business name: p 5 C) k
Si& Fuel Piping
$14.15 for first four; $4.03 for each addition 1
Contact name: i ri ( it \ aci 1 .
As ..i . *It.
Furnace, etc. i 5. 53 3. 6 2
Address: 3 )7 , 1 . 3 510 .11,,,E Gas heat pump
City/State/ZIP: 9 w .. r) (') k 9 72, wasus. ended/unit heater
Phone: ( 503 ) 4/ 7 / • 4134 5 Fax! ! (5 2.2.7- e 5 Z I Water heater
Fire , lace
E-mail: . Range
. ' 7 . •••
. . - -
■,,;:i.V...: .I .....::'... :;;:::' t ,F;' tisisriittsoijits ,, ,....::, ,.,,,,,,,:, Barbecue ....
.. Clothes dryer (gas)
Business name; ca 0 ■ t a . Other: . . . .. , . .. , . ...
Address: 3 , 2. s- ivy), 3 5 v. 4,,,„. 2:'.....i,. ' ..:tllArfdr:40P1*.tiJ*7:::':;'
. . . . .
• ;,. a
City/State/ZIP; : a-Tu 0 R q 7 z.l 0 , Minimum permi Subtotal 56 ? t fee ($90,00) 912, p 0
Phone: ( 56,5 ) /U V3. 5 Fax: (S' 63) t Z7- 852 i - plan review (25% of permit fee)
.. -
CCB lic.: S 3 E3 e State surcharge (12% of permit fee) /)J)
•
/ , TOTAL PERMIT FEE A
a24- .
This permit application expires Its permit is riot obtained within 180
Authorized signature:
deya oiler it has been accepted as complete.
Print name: c Date; q- /2
• fee methodology set by Tri-County Building Industry Service Board
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