Permit CITY OF TIGARD MECHANICAL PERMIT
11111 c. C OMMUNITY DEVELOPMENT Permit #: MEC2013 -00425
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2013
Parcel: 2S109DB03100
Jurisdiction: Tigard
Site address: 15046 SW 132ND TER
Project: Cossa Subdivision: SUMMIT RIDGE Lot: 69
Project Description: Install gas furnace.
Contractor: WOLFER'S, INC Owner: COSSA, KEVIN
290 YOUNG ST 15046 SW 132ND TER
WOODBURN, OR 97071 TIGARD, OR 97224
PHONE: 503 -981 -4511 PHONE: 503 - 330 -1838
FAX: 503 - 981 -0801
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 07/25/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/25/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/25/2013 $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: /' - Permittee Signature: e 9N /97 0, e o..r77Q
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.
JUL /25/2013/THU 02:49 PM MOLFERS HEATING FAX No, 5039810801 P. 001 ED .
. .
Mechanical Permit App.- . ,IV FOR OFFICE USE ONLY
• City of Tigard D �
11
q C ate/By: �-, Pen.1040,: eC'� /3
q 13125 SW Hall Blvd., Tigard OR 9M. 2 5 201 m/gN yo?
. g Phone: 503.718.2439 .Fax: '503.598.1960 Daatt� Other Permit
T rC An Inspection Line: 503.639.4175 CITY OF TIGARD , Date Ready/By. fid See Page x for •
Internet www.tigard or.gov. U CITY 1 N otlfied/Nlatho& Supplemental Information
BUILDING DIVISION �7 -44,41414,104
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; � y - S�� ��* ial.,�+?� ;: k 1 k,.�.l.• $r � 7 ,r• '4 a t ,:�-T 1 7 i' , � 'I. - '\
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.
'�� ": k~,+ n ,, J I (3 3 y �r'1` t �`T1'. •*r* ar �� - �-�¢ ? T- ;r , �t v e - . ( � Value $ _
«"Fit= - -.- 4, nn ,:- . :-- 1,- .. �n�r .-'l •I:.Gti� fi...( ` f 4�.•?:∎,- ",:, , fi,i'a i. Xc 1. ; -Tao, i y�f,`11.1q r.gli. czit ,\aE} - ti� � � VD F.. del. c. . ..e.. A 0 ., , i
n i 1- and 2- family dwelling ❑ Commercial industrial ❑ Accessory building For speda1Information use checklist
Multi- family [] Master builder ❑ Other: Description I Qty. I Ea. I Total
a w,?.2 ,cJ I , ,.,.p 4.41.1-3 w ,. w 1 . VI vi I k 1': Heatiapfeooling:
k Air conditioning 46.75
Job site address: ) ' O (i t S () • ) 3Z � 7,e r t t`4_ Furnace 100,000 BTU (duots/venta) 1 46,75 yitg,
City /State/ZIP: `j ; t.✓ a . Q 9 7 ZZ4f Furnace 100,000+ BTU (ducts/venta) 54.91
Suite/bldg. /apt. no.: � Project name: t // �1` Heat pump 61.06
V r n. v(:bCSa,„. Duct work 23.32 •
Cross street/directions to job site: Rydronic hot water system , 23.32
Residential boiler (radiator or
• — - hydtonic) ` 23.32 -
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 2332
•
Subdivision: I Lot no.: Other 23.32
• Other fuel appliances:
Tax map /parcel no.: Water heater 23.32
q ' 4, , ` a. At,,:, t 1i ti- n ' 11E r S '' o} , j 3 rto) :44. i � ti� + •r .4 r .- Gas fireplac�nsert 3339
•--� ^.� a....s.:,, ,Ft k.v..- ..wz . ax... r& a y. � «./ . i -._, .........•.� _ �.4.. _L Flue vent for water heater or gas
.i Vt t:54.'y1`1 ai...S J J r+►,aLt - fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fiacplac e&isett 2332
• Chimney/liner/flue/vent 2332
.., I "F 2. 44 ,� i e . t t t — r „ l: 0 w 7 :, .,4'' ' r a 6 I + ti j0; Met: 2332
a, . in , .,.. ,. c :. -r .4. ;41,A >F:•^. w , ; M1 ,k ` „a P i 4,: °. : Environmental exhaust and ventilation:
Name: ) v‘. C.064 Range hood/other kitchen -
equipmt
Address: i 5` c 0 (0 5 13 t " ' ' i rG ' G n Clothes dryer exhaust 3339
City/State/ZIP: "�^; C d C7 � `° t t iled com partnents. utilryrooms) 2332
�y
Phone; (SO ) 6- 3 b . - - .. .. Fax_(_ - - .; ..). - .... -- • — ------ --- -- -- Attic/crawlspace. fans - .. - - -.. - . - - 23.32 :. _- -- -
w ?tr '1 ., •w t e !; Nr-,71 my fEti Y ,. c+ ;t:
i,: a 11 n 1 > s 1 i ,' s a t• c , r , c u a c [ ;: r; Other: 23:32
klwk 4.•. - tiA'' S. �,� t,P,.t�I,i�a,- .. } 1 1 y1MN.n1Y 44 �+ 4�/: IwY terww . .
� �'WnIJ .
Fuel piping:
Business name: kid 1 Q. S14.15 for first four; S4.03 for each additional
Contact name: 1,�i r I I \ j , f lt, 5 Furnace, etc.
Address: ay D `lO J r► S. L. Gas heat
f Wall/suspended/unit d/unit heater
City/Slate/ZIP: Q C ) ( ) d J i . 0 2- CT 70 -2 1 Water heater
Phone: (603) 9 h d ( ill I Fax:: (301) C l. t I •0 Vf . Fireplace Range
&mail• T er. b . Wolf~ -� �+ °i..h.tl-.' • [r/.+,,, Barbecue _
u . T °? . r
" .v im irt3i+ er'ili iC:« , :il O.a! u-lz.. •':.- . .ivri:4 . . y ;: •W. ,n-, S., - 4 ,,, : : Clothes drYe (. )
Business Damp: (,) J ' r q e `. ,/ t :.
Address: a9 D o , n y ,S 4-- Subtotal 4(p. 7 5"
/State/ZIP: ,yeya ,,,- • t r _ - Minimum permit the ($90.00) /0.9O
an rev iew o o p e - - /
Phone: ( 1 ,_ '- ) , 4s ,ii Fax (, S D.) V w 0 To State surcharge (12% of permit fee) id . 5-0 (/ /
CCB tic.: 1 9 f TOTAL PERMIT FEE - /CO, •
This permit application expires if a permit is not obtained within 180
• .days after it has been accepted as complete.
Authorized sig iatur * Fee methodology set by Tri -County Building Industry Service Board
Print name: 7:4_,-, (, J r n. S Date: %Z,y` - / /3
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