Permit CITY OF TIGARD MECHANICAL PERMIT
11 11 s COMMUNITY DEVELOPMENT Pe rmit #: MEC2013 00224
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2013
Parcel: 2S103AC06200
Jurisdiction: Tigard
Site address: 11350 SW FONNER ST
Project: Burgess Subdivision: 1996 -063 PARTITION PLAT Lot: 2
Project Description: (1) furnace installation
Contractor: SPECIALTY HEATING & COOLING INC Owner: BURGESS, JAMES F & MARY B
7500 SW TECH CENTER DR SUITE 130 11350 SW FONNER ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 620 -5643 PHONE: 503 - 620 -1387
FAX: 503 - 681 -0793
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/25/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/25/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/25/2013 $43.25
Occupancy Grp:
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: 4 J r i Permittee Signature: QA A/),6 ,/�
-r1 UV
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.
From: 04/24/2013 13:12 #549 P.002/002
Mechanical Permit Applic `� 1-OR 01:1:1( I. l ICI i 51: O"
III City of Tigard ! Rceeiv Permit No.: aU (
• 13125 SW Hall Blvd., Tigard, OR 9722 Date/137d: ® �3�
It Phone: 503.718.2439 Fax: 503.598.1•'► 2 4 2013 Plan Review OtlrerPerrnit:
Date By:
T I G A R D Inspection Line: 503.639.4175 Date Ready'By' Ell Ell See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified Method: Supplemental Information
&t f D iliSI g
TYPiE COMMERCIAL FEE* .SCHEDULE — USECH1r
Mechanical permit fees* are based on the value of the work
❑ New construction ❑ Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: S
CATEGORY OF CONSTRUCTION ' ' •
RESIDENTIAL EQUIPMENT /;SYSTEMS F $ °
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Hea ting/cooling:
Air conditioning
Job site address: (requires site plan showing placement) 46.75
Burgess, Jim R13113 Fumace 100,000 BTU(ducts:vents) I 46.75
City/State/ZIP: 11350 5W Fonner St Furnace 100,000• BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: Tigard, Or. 97223 Heat pump '
(503)620 1387 (requires site plan showinlzplacement) 61.06
Cross street/directic Duct 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: 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 23.32
Gas fireplace'insert 33.39
� �� � Flue vent for water heater or gas
4 , fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace'insert 23.32
`.PROPERTY OWNER Chimney/liner /flue'vent 23.32
''❑,TENANT ,
Other; 23.32
Name: C e CL kd Environmental exhaust and ventilation:
Address: Range hood/other kitchen
equipment 33.39
City /State /ZIP: 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:
Other: 23.32
Fuel piping;
Contact name: SI4.15 for first four; $4.03 for each additional
Address: Furnace, etc. —
Gas heat pump
City / State/ZIP: Wall/suspended'unit heater
Phone: ( ) Fax:: ( ) Water heater _
Fireplace
E -mail: _ Range
CONTRACTOR Barbecue
Business name: Specialty Heating & Cooling, Inc Clothes dryer (gas)
Other.
Address: 7500 SW Tech Center Dr #130 MECHANICAL PERMIT FEES* '''' 7T
y .
City/State/ZIP: Tigard, Or. 97223 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 620 -5643 Fax: (503) 598 -0718 Plan review (25 %of permit fee)
CCB lic.: 665 78 State surcharge (12% of permit fee)
f t w TOTAL PERMIT FEE (0V &
Authorized signal e: ._ v This permit applicati expires if a permit is not obtained vdthla 130
/ ! days after it has been accepted as complete.
Print name: Andrea Dripps Date: 1/ /(_ i * Fee methodology set by Tri- County Building Industry Service Board
I: BuildingPcrmits\MEC- PmntApp.doc 03X07,12 440-461 TT (I 1.02'COM• B)