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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2010 -00618 13125 SW Hall Blvd. Tigard OR 97223 503.718.2439 Date Issued: 11/30/2010 TIGARD 1S135CC01500 • Jurisdiction: Tigard Site address: 10275 SW MEADOW ST Project: Nelson Subdivision: THE MEADOW Lot: 10 Project Description: Gas furnace replacement. Contractor: EASTSIDE HEATING & AIR CONDITIONING Owner: NELSON, BETTY JANE 7200 SW JOHNSON CREEK BLVD 10275 SW MEADOW ST PORTLAND, OR 97206 TIGARD, OR 97223 PHONE: 503 - 774 -3281 PHONE: FAX: 503 - 774 -3057 FEES Specifics: Description Date Amount Furnaces < 100K BTU 11/30/2010 $46.75 Type of Use: SF Flue/Vent For Any of Above 11/30/2010 $23.32 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/30/2010 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/30/2010 $19.93 Stories: Fuel Fuel Types: Natural Gas 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 •UNC by calling 503.232.1987 0 ::0.3322344. Issued By: Permittee Signature: • 03.639.4175 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: 11/29/2010 14:53 #464 P.002 /002 CE1VED Mechanical Permit Application i:oli Ole 1I(F t SE ONLY' NOV 3 0 2010 City of Tigard Date/13y: I ' , permit No.: a 13125 SW Hall Blvd., Tigard, OR 97223 - Plan Review ■ i - Phone: 503.639.4171 Fax: 503.598.1960 %F 1 Date B Other Permit: 'fl G A R'D Inspection Line: 503.639.4175 B UILDING DIVISION Date Read ® See Page 2 for Internet w vw.tigard or,gov Notified/Method: Supplemental Information TYPE 5 OF WORK i, COMMERCIAL FEE* SCHEDULE USE CHECKLIST ❑ 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 QF CONSTRUCTION YI1- and2 -fami] dwelling Cotnmercial /industrial RESIDENfIALEQiTIPIKENT /SYSTEMSFEES" ' /� y g ❑ 0 building For special information use checAlisl. ❑ Multi -famil y ❑ Master builder ❑ Other: Description Qty. Ea. Total ' JQB SITE WFORMATION, AND LOCATION Heating/cooling Job site address: i 0 Z1 S S 'CY\e..a © (.L) Air conditioning (requires site plan showing placement) 46.75 City /State /ZIP: "`, Q - } 22 3 Furnace 100,000 BTU (ducts /vents) t 46.75 y(v :1,5 t Furnace 100,000+ BTU (ducts/vents) 54.91 Suite /bldg. /apt.no.: Projectnanne: Heat pump 61.06 Cross streeUdirections 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 tto.: Flue /vent for any of above ( 23.32 23 .3 Other: 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 ` Gas fireplace 33.39 P `QC e Vu, Q C Q Flue vent for water heater or gas J fireplace 23.32 Log lighter (gas) 23.32 Wood /pellet stove 33.39 Wood fireplace /insert 23.32 PROPERT OWNER 1 ' 0*, T y finer /flue /vent 23.32 Chimne 23 32 Other Name: Q k- ‘A e \ Sts Environmental exhaust and ventilation Address: i O Z - 1 1 S � © „ � s+, Range r hood/other kitchen e ui ment 33.39 City /State /ZIP:'`t^ ; ::7/ � fit\ -- � 223 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (So3 ) f 39 d 5'13 Fax: ( ) toilet comp_artments, utility rooms) 23.32 . 1;: A RLICAIVT Q CONTACT PERSON crawls acp a fans Atti 23.32 ` l Other: 23.32 Business name: S� S., C1C�a A ��o` C'C \v I t - c v Fuel p ipi ng Contact name: jG\1v^� E `� OC , t A $ 14.15 for first four; $4.03 for each additional Address: 7 100 5 Furnace, etc. S GhYvSr '✓1 � cue K Ll ` - Gas heat pump City /State /ZIP:� `0.h� c g s _ 20Ls Wall/suspended/unit heater Wafer heater Phone: (503) "1-- 1Lk_ Zr C i l Fax:: (5t`.,j)- _]'7A-36rJ1 \ \ \ Fireplace E-mail: ail 1 rx. e SS \C1L Ca— T\YNCt ,, Y ( C t\ Range x CONTRACTOR - `` \ Clothes dryer (gas) Business Warne Clot � Otfier Address: S M e - Ns Pkvo V e_ MEC}L4.NICA 1 PERMIT FEES *.' City/State/ZIP: Subtotal Min munl permit fee, ($90,.00),, 96,00 Phone: ( ) Fax: ( ) Plan review (25% of permit fee) CCB lic.: 2 5 State surcharge (12% of permit fee) 10,80 TOTAL PERMIT FEE j60. A(' Authorized signature ` t This permit application expires it o permit is not obtained within 180 r 01; /" "�� ^� days after it has Meer accepted as complete. Print name:T , �s? V Q� Date: 1 — . `a ' Fee methodology set by Tri- County Building Indus ry Service Hoard f \ Building \Permits \MEC- PermitApp.doe 10/01/09 440 -0617T 1! t!02�COM/WEB)