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Permit
CITY OF TIGARD MECHANICAL PERMIT ' 2 ' COMMUNITY DEVELOPMENT Permit #: MEC2011 00076 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/22/2011 Parcel: 2S110DD03300 Jurisdiction: Tigard Site address: 10490 SW CENTURY OAK DR Project: Stensrud Subdivision: SUMMERFIELD NO. 1 Lot: 40 Project Description: Replace gas furnace. Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: STENSRUD, KATHRYN R PO BOX 80607 10490 SW CENTURY OAK DR PORTLAND, OR 97280 TIGARD, OR 97224 PHONE: 503 - 233 -1779 PHONE: 503 - 245 -7563 FAX: 503 - 651 -3345 FEES Specifics: Description Date Amount Furnaces < 100K BTU 02/22/2011 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 02/22/2011 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/22/2011 $43.25 Occupancy Grp: 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 OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: �_ � A 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. Mechanical Permit Application ' City of Tigard Received n J ! ,y �r 7 Date/By: o? f /9#{ Permit No. / E C 2 /� - 4D0 13125 SW Mall Blvd., Tigard, OR 97223 . ' Plan Revie '� t« t /i / / /YYY ' . Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: I I i ; A t: t , Inspection Line: 503.639.4175 -- Date Ready/By: Jura 6d sec Pape 2 for Internet; www,tigard- or,gov Notified/Method: 1� Supplemental lnformation • TYPE OF WORK . • . _ COMMERCIAL .FEE* SCHEDULE - USE CHECKLIST Mechanical permit toes" are based on the value of the work ❑ New construction 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 2 ?. value S_ „ 0 1- and 2 - family dwelling CI Commercial/industrial © Accessory building For spetllr EQUIPMENT use checklist. ] Multi- family Master builder r ❑ Other: RESIDENTIAL EQUIPMENT / SYSTEMS FEES* Description Qty. Ea. 1 - Total JOB SITE INFORMATION AND LOCATION .• i Healing/cooling Job site address: Air conditioning /01/90 ) /' -A) tr a�� 04k St/ (requires siteplan ahowingplaccment) 46.75 City/State/ZIP: , G� 7� � Furnace 100,000 BTU (ducts/vents) / 46.75 I t Furnace 100,000+ BTU (duets/yenta) 54.91 Suite/bldg. /apt. no.: Project name: Heat pump _ Cross street/directions to job site: Duct work 23.32 Hydronic hot water system 23,32 Residential bailer (radiator or hydronie - 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 D ESCRIPTION OF WORK Water heater 23.32 � Gas fireplace 33,39 ) � 6/4 1 !✓1/V9 L� Flue vent for water heater or gas ... fireplace 23.32 Log lighter (gas) 23,32 Wood/pellet stove ,- ... - 33.39 Wood fireplace /insert 23.32 Chimney /liner /flue /vent 23.32 PROPERTY OWNER ❑ N Other: 23.32 Name: /64:144 � �,` ( f ' e Ci Environmental exhaust and ventilation 1e • c , C c � � Range hood /other kitchen Address: J 7 equipment 3339 City /State /ZIP: rl'Ai4 9 7 a a 4 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: (sV3) D iiS'_ '7 (7 Fax: ( ) toilet compartments, utility rooms) 23.32 Cif APPLICANT U CONTACT PERSON.?.. . Attic /crawl pace fans 23.32 Other: 23.32 Business name: - W Fuel Q1ping Contact name: A �v 514.15 for first four; S4.03 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: WalUsuspendcd/unit Phone: (gel j -3 v Fax:: ( ) water heater Fireplace E -mail; • Range CONTRA OR Barbecue Business name: ' 4 t✓ N gt l l '- i+ 4 /6 Clothes dryer (gas) 4 Other: Address: f" 0 (4,214 4 o 7 MECHANICAL PERMIT FEES" City /State /'LIP; PO Ytsf•rti.. CIZ- G g'Q Subtotal —.cud) a 3 3 -) -7 "7 F ax: ( r) & s1 _ 3 3 ! M inimum perm fe (5 90.00) ZQ , p- � 61,{ /� Plan review (25% of permit fcc) S te ter) iie. F f State surcharge (12% of permit fee) /0 , (� TOTAL PERMIT FEE /0 0 , YI) , r / Authorized signaturle This permit application expire if a permit is not obtained within Igo days after It hes been accepted as complete. Print name; lo, ). ,1r� I if � Date: ' Fee methodology set by Tri -County Building Industry Service Board / r,. t:\ suilding 1 permite,MEC - PormitA. .dee 10/01109 440-4617T(t1/021COM/Wt?9) Z 00 HI V'BONI,LVaH 9bCCTS9CO2 XV I CT :60 TTOZ /TZ /Z0