Permit (11) • 4
CITY OF TIGARD MECHANICAL PERMIT
°. COMMUNITY DEVELOPMENT Permit #: MEC2009 -00096
Date Issued: 03/24/2009
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S1018600401
Jurisdiction: Tigard .
Site address: 11880 SW PACIFIC HWY
Subdivision: Lot: 0
•
Project: Russ Chevrolet
Project Description: Replace existing oil furnace with gas furnace, extend existing gasline.
Owner: FEES
KNAUSS, WAYNE ET AL Description Date Amount
C/O HUMBERSTON, RUSSELL D, REVOCABLE Permit Fee 03/24/2009 $130.00
TRUST, PO BOX 4300 Plan Review 03/24/2009 $32.50
PHONE: 12% State Surcharge 03/24/2009 $15.60
Contractor:
ANCTIL HEATING & COOLING
4320 N WILLIAMS AVE
PORTLAND, OR 97217
PHONE: 503 - 281 -0752
FAX: 503 - 282 -5722
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load: •
Stories:
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressue Units > 10000 cfm: 1
•
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 1 0 -3 HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP: -
• Air Conditioning:
-
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $178.10
Hoods: Comm Incinerators:
Woodstoves: Gas Fireplaces: Required Items and Reports (Conditions)
Clothes Dryers: Other Mech Units:
Gas Outlets: 2 Other Desc: •
Duct Work:
Fire /Smoke Dampers:
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, o • • • - ' suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility • ification Cente T •. e les are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Iss ed By: / hi, .I Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business ay.
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.
ass C 1 I Imo t- 14145P
Mechanical Permit Application NOISING JNIOII -
ClEIV911 JO All -- City of Tigard Rece - -- -
q 13125 SW Hall Blvd., Ti Date/By: 3' t k Permit No.: l' tsc J tip r • •
C Tigard, OR 97223 T 8I I�t'
Phone: 503.639.4171 Fax: 503.598.1960 6U�Z O ` �dW Plan R r: -
Inspection Line: 503.639.4175
Dat Other Permit:
Tic AI P� `Uate'ea.yBy. 23 p
Internet: www.tigardor.gov ° f y: - Q 1 ® See Page 2 for
® AI m! 3 , „otified/Meth _, Supplemental Information
TYPE OF WORK 55 ssdd COMMERCIAL FEE• SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction 21 Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other:
mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ yy.76+,e0
❑ 1 - and 2- family dwelling Ix CommerciaYindustrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
Other:
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ p
Description I Qty. I Ea. I Total
-
JOB SITE INFORMATION AND LOCATION
Heating/cooling
Job site address: 1 I U lijJ ->i W �, 1 �/� [: ] y 1 Air conditioning or heat pump -
0 U (requires site plan showing placement) 14.00
City/ State/ZIP: y� 1 9.4 0 (4 r? 99 / Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: �} 1 Project name: ' n Furnace 100,000+ BTU (ducts/vents) 17.90
► l li � J 0.1 -1 If 14 /T Gas heat pump 14.00
Cross street/directions to job site: Duct work
, 10.00
Hyrimnic hat water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: I Lot no.: Flue/vent for any of above 6.80
Tax map /parcel no.: Other: - 10.00
Other fuel appliances
i� DESCRIPTION OF WORK Water heater 10.00
'` - vWL/ 1 J6 n 1.iCl ((. �`)A�Ir Fly, lt) Gas fireplace 10.00
(I L G /� ieki . Flue vent for water heater or gas
T I till Alt l) � m4 2 .,� le / 1 fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
❑ PROPERTY OWNER I ❑ TENANT Chimney/liner/flue/vent 10
Name: '' nn �.. ce Other:
Vim is `' CC A V 1-a.Y Environmental exhaust and ventilation
Address: ' I St oil p e, ` Range hood/other kitchen
C a Y1 �W equipment 10.00
City/ State/ZIP: 1)604, 0 t 0 9 )g Clothes dryer exhaust 10.00
Phone: ( C71t ) �-30-_, i-yl Fax: ( ) Single -duct exhaust (bathrooms,
�\�t ((11�/ ❑ APPLICANT J U toilet compartments, utility rooms) 6.80
❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: n f r z o , t A l r a) Other: 10.00
� ► Fuel piping
Contact name: ` xi f� n
V j , L f( )1. $5.40 for first four; $1.00 for each additional
Address: t�3� `i. ail/ l mo w( , , Furnace, etc.
City/ State/ZIP: 1e ^Lkl n Gas heat pump
� ' i)rQ' ? 1 / Wall/suspended/unitheater
Phone: (- ) �a Fax:: ( ) Water heater
E -mail: P eta -6-P3- _ Fireplace
�(M- Qh0 ) kL/g.P . CJYi'1 . Range
CONTRACTOR Barbecue
Business name: e. .�, I 4 (L) , Clothes dryer (gas)
Address: 1 �
MECHANICAL PERMIT FEES*
City/State/ZIP:
Subtotal
Phone: (S03) a 8 I • n -i 5 Z I Fax: ( ) Minimum permit fee ($72.50)
CCB lie.: Plan review (25% of permit fee)
S' 10• to State surcharge (12% of permit fee)
TOTAL PERMIT FEE 178.10
Authorized signature: y ile /� Thi permi application expires if a permit is not obtained within 180
!C/L days after it has been accepted as complete.
Print name: i` Ali
L l Date: 3 ._ �O ___O_9 I • • F metho dology set by Tri�ounty Building Industry Service Board
I:\Buidmg\Pemdb■�C PamitApp.doc 01/19/07 440.4617T(II/O2ICOM/WEB)