Permit II CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2014-00102
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/05/2014
T I Fx 0 g Parcel: 1 S134CA00612
Jurisdiction: Tigard
Site address: 12025 SW MANZANITA CT
Project: CLARK Subdivision: PANORAMA Lot: 11
Project Description: Furnace replacement.
Contractor: FRESH AIR CO INC Owner: CLARK, RICHARD A
PO BOX 399 12025 SW MANZANITA CT
TUALATIN, OR 97062-6329 TIGARD,OR 97223
PHONE: 503-692-1234 PHONE:
FAX: 503-638-6162
FEES
Specifics: Description Date Amount
Furnaces< 100K BTU 03/05/2014 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 03/05/2014 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 03/05/2014 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to fo w the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: — Permittee Signature: /f, /�//i
Call 503.639.4175 by 7:00 a.m.for the next available inspec • date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mechanical Permit Application I OI1 (ti I It 11 "l O\I l
Received
City of Tigard �� ' Date/By: -- 1 ii Permit No.: c r ao to a
114
• 13125 SW Hall Blvd.,Tigard,OR + Plan Review
m Phone: 503.718.2439 Fax: Other Permit:
01� Date/By:
I I c n I:n Inspection Line: 503.639.417 Date Ready/By: 65 See Page 2 for
Internet: www.tigard-or.gov �pt\� �O Notified/Method: Supplemental Information
TYPE OF 34,a, COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
Mechanical permit fees*are based on the value of the work
❑New construction �ddition/alt lacemt� performed.Indicate the value(rounded to the nearest dollar)of all
❑Demolition ❑Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
DI-and 2-family dwelling ❑Commercial/industrial ❑Accessory building For special information use checklist
❑Multi-family ❑Master builder ❑Other: Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning 46.75
Job site address: /a Cc) S a J W4442..a44:41./tet 4 Furnace 100,000 BTU(ducts/vents) j 46.75 h.{',
City/State/ZIP: .40//j a,"1 C, 7 as 7' Furnace 100,000+BTU(ducts/vents) 54.91 _
! Heat pump 61.06
Suite/bldg./apt.no.: Project nar e: C' y' Duct work 23.32 --
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace/insert 33.39
Flue vent for water heater or gas
ap~,90-ei a fireplace 23.32
�/� ��� Log lighter(gas) 23.32
f lr 7�lie t. ten ,. a , -fys Wood/pellet stove 33.39
v Wood fireplace/insert 23.32 _
Chimney/liner/flue/vent 23.3_2
PROPERTY OWNER I ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: p4� ( L!,_ Q Range hood/other kitchen
w� equjpment 33.39
Address: lac ac Clothes dryer exhaust . 3339 _
City/State/ZIP: v 1��yt j 7
Single-duct exhaust(bathrooms,
toilet compartments,utility rooms)s) 23.32
Phone:( S 1 a 0 a �
Fax:( ) Attic/crawlspace fans , 23.32
),APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name: r
Wvi /� �„Q�,r� Fuel piping:
C�V �/v/� $14.15 for first four,$4.03 for each additional
Contact name: /iJ/I/ Furnace,etc. _
Address: / 9 2 Gas heat pump
���/��V/TTT' Wall/suspended/unit heater
City/State/ZIP: `r ! Olio ea4"L q rt L� Water heater
Phone:(5C / y,,, /at; C/ F :( -; 65?C�//_/6 0, Fireplace
F7 Q� / (J Range
E-mail: Barbecue
CONTRACTOR Clothes dryer(gas)
Other:
Business name: r MECHANICAL PERMIT FEES* -
Address: Subtotal 4b-'ZS
City/State/ZIP: Minimum permit fee($90.00) elf),ti)
Plan review(25%of permit fee) —
Phone:( ) Fax:( )
_ State surcharge(12%of permit fee) j0„5.--ti
CCB lic.: 615 ue y/}-/i y TOTAL PERMIT FEE
/ This permit application expires ifs permit is not obtained within 180
<
ge,,,.?Way-----412-1 days after it has been accepted as complete.
Authorized signature: • Fee m ethodology set by Tri-County Building industry Service Board
Print name: C4Z__ & 1,(f r— Date: .2 )T
y
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