Permit n CITY OF TIGARD MECHANICAL PERMIT
3 : COMMUNITY DEVELOPMENT Permit#: MEC2013-00521
Date Issued: 09/16/2013
T[G AR D 13125 SW Hall Blvd,Tigard OR 97223 503 718 2439 Parcel: 1 S134ACO2615
Jurisdiction: Tigard
Site address: 11265 SW WILLOW WOOD CT
Project: LUETJEN Subdivision: ENGLEWOOD NO.3 Lot: 172
Project Description: Furnace replacement with gas piping.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: LUETJEN, HENRY JOHN III
13150 S CLACKAMAS RIVER DR LUETJEN, PAOLA T
OREGON CITY,OR 97045 11265 SW WILLOW WOOD CT
TIGARD,OR 97223
PHONE" 503-557-2220 PHONE:
FAX 503-557-0919
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 09/16/2013 $46.75
Type of Use: SF Fuel Piping 09/16/2013 $14.15
Class of Work: ALT Type of Const: 12%State Surcharge-Mechanical 09/16/2013 $10 80
Occupancy Grp: Minimum Fee Adjustment-Mechanical 09/16/2013 $29 10
Stories:
Fuel
Fuel Types
Gas Pressure
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232 1987 or 1.800.332.2344.
c
Issued By:,.....--- Permittee Signature: -- ■
�- I'
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
SEP-13-2013 07:51P FROM: TO:5035981960 P.1
Mechanical Permit Applica`� . t CEIVED I I)I t 01 1 1(h: l tit't)N1A
City of Tigard Received
E P 1 6 Date/By. ' :1/ Qi7>�_ I
13125 SW Hall Blvd.,Tigard,OR 97221�_i 2013
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Dute/Ny. Other Permit:
1-16 A 1t 1) Inspection Line: 503.639.4175 CITY OF TIGARD Dale Ready/By: twit @J See Page 2 for
Internet: www.tigard-or.gov o BUILDING DIVISION Notified/Method: Supplemental information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
[=1 New construction ®Addition/alteration/replacement Mechanical permit fees*are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value:$
® I and 2-family dwelling RESIDENTIAL EQUIPMENT/SYSTEMS FEES"
y g 0 Commercial/industrial ❑Accessory building
For special informationua chealisi.
❑Multi-family 0 Master builder
❑Other: Description Qty. Ea. 1 Total
.108 SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 I2L Q ) nr i l li* Wood C j Court Air conditioning
(requires site plan showing placement) _ 46.75
City/State/ZIP: Nara 0k_ G j.23 Furnace 100,000 BTU(ducts/vents) 1 46,75 K4,75—
Furnace 100,000+BTU(ducts/vents) _ 54.91
Suite/bldg./apt.no.: Project name: Heat pump 61.06
Cross street/directions to job site: 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 33.39
Flue vent for water heater or gas
a QC15 j (j) f hp ;n'n fireplace 23.32
�WJ 1 (EJ(fy(ti�CJ f 1 Log lighter(gas) 23.32
■ • Wood/pellet stove 33.39 14 Wood fireplace/insert 23.32
lar
Chimney/liner/flue/vent _ 23,32
PROPERTY OWNER I ❑ TENANT Other: 23.32
Name: Henn/� 1 'f' 'revs Environmental exhaust and ventilation
l!" 411 �J yr ' Range hood/other kitchen
Address: equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Ali toilet c compartments,exhaust(bathrooms,
Phone:( i )2-190774 Fax:( ) t compartments,utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name:Same as contractor Other; 23.32
Fuel piping
Contact name:Diane Mason $14.15 for first four;54.03 for each additional
Address: Furnace,etc. 1 /11,5-"
Gas heat pump
City/State/7,1 P: Wall/suspended/unit heater
Phone:( ) Fax::( ) Water heater
Fireplace
E-mail: Range
CONTRACTOR Bnrhecue
Business name:Tri County Temp Control Clothes dryer(gas) _
- Other.
Address:13350 S Clackamas River Drive MECHANICAL PERMIT FEES*
City/State/ZIP:Oregon City,OR 97045 Subtotal
Phone:(503)557,2220 Fax:(503)557.0919 Minimum permit fee($90.00) eh.t'JO
/ Plan review(25%of permit fee)
✓
CCB lie.:72623 State surcharge(12%of permit fee) io.St)
TOTAL PERMIT FEE 100_.11)
Authorized signature: JJ� This permit application expires if a permit is not obtained within ISO
g v�/ days alter It has been accepted as complete.
Print name: �'IQ)/ ,MQ9or [[ Date:4(43 ' Fee methodology set by Tri-County Building Industry Service Board
1.1ltuitding■PormiuN4fC-PermilApp doe 1 0/01/09 440-4617T(1 t/02/COMAWEn)