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Permit CITY OF TIGARD MECHANICAL PERMIT y COMMUNITY DEVELOPMENT Permit #: MEC2010 -00585 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2010 Parcel: 2S103ACO3900 Jurisdiction: Tigard Site address: 12578 SW 114TH TER Project: Stephens Subdivision: WALNUT GROVE Lot: 8 Project Description: Gas furnace installation with fuel piping. Contractor: A- ACTION HEATING Owner: STEPHENS, GAIL 0 & JAMES F 18245 SW TV HWY 12578 SW 114TH TERR ALOHA, OR 97006 TIGARD, OR 97223 PHONE: 503 -649 -3524 PHONE: FAX: 503 - 649 -6095 FEES Specifics: Description Date Amount Furnaces < 100K BTU 11/16/2010 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 11/16/2010 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/16/2010 $43.25 Occupancy Grp: Fuel Piping 11/16/2010 $14.15 Stories: Fuel Fuel Types: Gas Pressure: Total $114.95 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: / 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. 03/03/2016 07:50 FAX Z001/002 08/24/2010 69:49 5895981,6© CEIVED CITY DF TIGARD PAGE 01/01 Mechanical Permit Applicati 1 roll tlhhlt 1 : frsE i)N1,, Ci of Ti alyd �QV 5 2010 DateBy; °J Dntc /13y; i� V I l , , ., Ill 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503,639.4171 Fax: 503,598.1 L am / OFr1Cj Other Permit • i :, ; 'inspection Line! 503.639.4175 1 i Interact; www.ti iud of, ov T i T r�t� D IVISION Date Rendy /By: S See Fagg 2 for g g BU1LDIN Notified /A46111od: Supplemental information ' TYJPlir' tllF wt7ttlt: . ... ..'. .. „ Ai rSl6ii ' '�", El New construction 'IS dditionialteru.tinnlreplaccmcn! Mechanical permit fees° arc based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition IN Other: mechanical materials, c ui ment, labor, overhead, end profit. CA AGlO.RY OF.'CONSI'PIUC`TI 1�l, Value; S - - ,..- :'`f1w +1Glh``Ig1k'}'' ICY', . '.- a nd 2- family dwelling ❑ Commercial /industri ❑ Accessor bui For special /►t(ormarlan use c.h , •• cklf.et. _ _,....... ❑ Multi- family ❑ .Master builder ❑ Other: Description Qty, Ea. Total ' .J OE S1Tm 'XNFOUMATION I'x ' tAC LION Retain!. cootin_ Job site address; �� `_ Air conditioning ___ 111 n site lnnshowin:.leccmenr 46.75 City/State/ZIP: 11 „ 0, q 1 7 i Pumace 100,000 BTU (ducts /vents) 46.75 A .--■ Furnace 1 BTU (ducts /vane) 54.91 Suite/bldg./apt. nn.: 1 Project name Heat pump 5 1.06 Cross street/directions to, job site: Duct work 23.32 Hvdronic hot watcrstcm 23.32 , Residential boiler (radiator ar 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 l��ll$CR1PiIllN Olc:l7RK. water heater 23.32 • G as fireplace 33.39 tm r)ve • r ', , , Q Flue vent for water heater or gas • fireplace 23.32 &S . • . Lop, lighter (gas) 23.32 Wood /pellet stove 33.39 • _ Wood fireplace /insert 23.32 _ Chimney/linct_/flvc/vcnt 23,32 - ' Ois,f.R' �'(34'YNE'R . • . ❑ :TENANT' Other 23.32 Name: ` '. � `i - IJ I # $ ti nvironmental exhaust and ventilation Address: ii .,.. � 4 � Range kitchen 1 e ui ment 33.39 City /State /ZiP: _ 1” r Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phonc:533 Fax: ( ) toilet compartments, cat Iity rooms) 23.32 . 0., APELicANT..• . • . C] ( oNrAcr PERi,9ON Attic /crawlspacc fans 23.32 t3usincsa name: Other: 1 23.32 A ACT1flN 1- 4 i . i, Fuel piping Contact name: 18245 S.W. HWY $14.15 for first four; S4.03 fir each ! Address: ALOHA, OREGON 97006 Fumacc, ctc, 1 1 J CTas heat .um. City/State/ZIP: Wail /suspcndcd /unit heater Phone: (- ) Fax: : ( ) Watcr heater Fireplace _ -/nail: Rengc • . CLt1Y11tAt `t•'U'1t . :. Barbecue • Business name: A- ACTION HEATING p a /r Other dryer (gas) �.CLU Other: Address: 18245 S.W. TV. HWY .. .• - . i Ftt14 , ::•:. cicy/State /Z1P: A LOHA, UKLUUN MN subtotsl . Phone O) . ' Lie .35' Li 1.1 1 Fx: ) a.) ,. / 9 — t o ©l B Minimum permit fee ($90.00) --^� 1 Plan review (25 /a of permit fee) CCB lie.: / b e * State surcharge (12% of permit fee) p / r______ TOTA1, PERMIT FEE 1 Authorized signature: 47I 1k — 'Mir! permit application expire, if 0 permit le not obtained within 180 days After It bas been accepted ai complete. Print name: Date: • Fce .ncthod,fn Tri- County Building Industry Service Hoard I:1Buildinewarn C- P.*mltApp. 10/01709 440.4617T(II/M2iCOMJWE5)