Permit CITY OF TIGARD MECHANICAL PERMIT
" COMMUNITY DEVELOPMENT Permit #: MEC2011 00137
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2011
Parcel: 2S111CB01715
Jurisdiction: Tigard
Site address: 15285 SW 100TH AVE
Project: LUDES Subdivision: HOOD VIEW Lot: 14
Project Description: Furnace replacement.
Contractor: A TEMP HEATING & COOLING INC Owner: LUDES, KAREN A & STEVEN M
16000 SE EVELYN ST 15285 SW 100TH AVE
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97224
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/30/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/30/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/30/2011 $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 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 1.800.332.2
Issued By: y 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.
03/29/2011 12:53 5035572990 A TEMP HEATING PAGE 02
Mechanical Permit Application \ E l) � . IO1i o1•l•1(. F 1.1' O \I.1
City of Tigard % -1� ...
'' 13125 SW Mall Blvd.. Tigard, OR 97223 , - pl. RtYiew paler Permit:
Ph one: 503.639.4171 Fax: 503.598.1
� patty:
Id ection Line: 503 Ready/By: H See Page 2 far
: -
1 11: ady Y
Internet; t ww.tigard or.gov r .< Notified/Method: IMI, supplemental lnfi rmatton
TYPE OF WORK COMMERCIAL FEE,* SCHEDULE - USE CHFCKUST
❑ New construction "VAddition/altera . reply Mechanical permit .fees' s ic based on the value of the work T
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead. and profit..
CATEGORY OF CONSTRUCTION .. Value: $
XI �,,g, RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
1- and 2- family dwelling ❑ Commercial /industrial U Accessory building
_ For ,rpecral information use checklist.
111 Multi - family 0 Master builder ❑Other: Description I Qty, I Ea. I Total
JOB SiTE INFORMATION AND LOCATION Hcating(cooli ng_ --
Job site address: Ni _ Air conditioning
t♦ . (requires she plansbowing trzcement) 46.75
City /Slate/ZIP; °"----- '1 Furnace 100,000 BTU (ducts/vents) f • 46.75 a Pr/ a�
5uite/bldg. /apt_ no.: Project name: I ' Furnace 100,000.1 BTC1 (ucta /vents) 54.91
ty�„ • Heat pump _ 61.06
Cross sircetldircclions to job site: Dud work 23.32
_. Hydrnnic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32 _
... Unit heaters (fuel -type, not electric),
in-w alL in -dud, suspended, etc. 46.75
— Flue/vent
Subdivision: Lot no.: forany of above 23.32
— — Oilier; 23.32
Tax map /parcel no.: Other fnel appliance,
-- DESCRIPTION OF WORK Water heater _ 23.32
Gas fireplace 33.39
Flue vent for water heater or gas
. 1�-i ii :fireplace 23.32
• . .� iiiI cTge 23.72
• Wood/pellet stove 33.39
Wood £mcpiaae /insert 23.32
r, PROPERTY OWNER ❑ TENANT Chimney /liner/lluelverrt 23.32
Other: 23.32
Nam c; c-x ` .L_ e_ S { Envbrpnmental exhaust and ventilation
Address: Range hood /other kitchen
equipment _ . 33.39
City /State/ZIP: (1 Clothes dryer mcbauat 33.39
Single -duct exhaust (bathrooms.
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
Tr PPLUCANT [] CONTACT PERSON Attic /erawlapacc fans 23.32
Business 23.32 1
name:
Fuel piping
Contact name: 1 6101 SR Fttelyn St r _ - 314 for first four; 54.03 for each M Ittioaiel -
Address: Clackamas, OR 97015 Furnace, ate,
3o3- 65131114 Gm heat pump
City /State /ZIP: Wsl1 /au,pcnde heater
Phone: ( ) Fait; : (7 j v � r Water heater -
E - mail: k_ .0,.Vk t 1 r a R ang e
�S
CONTRACTOR Barbecue
Business name:
Clothes dryer (Fac)
A- .i.,d• v 1 W\ t a ►Ill Os ii 1►11 1. r
Other:
Address: 16000 SE Evelyn St. MECHANICAL PERMIT FEES" •
City /State/ZIP: C1ackalflaVZ31cy /(115 ^ " - Subtotal s $
_ �.._ _.. 511 1- 15 5(1-50141. _
f Minimum permit fee (590.00) , ITO
Phone: ( ) FaN; (.�' `� Plan review (25% of permit fee) •
CGB lie 1� ` State surcharge (12% of permit fee) /00
TOTAL PERMIT FEE / Q. r e)
Authorized • nature: �� This permit upplieetinn expires If n permit IA r.nt nbtaieed within 180
days otter k has been accepted as complete_
Print name' „ \ 1.. ,. ij j Date: ' * Feb mathodaiogy set by 7H -County Building Tnclmery Service Beard
is \Btultna \Pants \MIIC•PconitApp.dac 10/01/09 -040- Ar,17T(II /cmcOMnu9513)