Permit CITY OF TIGARD MECHANICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: MEC2011 -00183
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04!27/2011
Parcel: 1 S134AD00800
Jurisdiction: Tigard
Site address: 11366 SW IRONWOOD LP
Project: Katz Subdivision: ENGLEWOOD Lot: 27
Project Description: New gas furnace with flue & gas line.
Contractor: SYSTEM AIRE INC Owner: KATZ, HOWARD
14444 SW FERN ST 11366 SW IRONWOOD LP
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 524 -5927 PHONE: 503 - 968 -0761
FAX: 503 - 590 -8357
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/27/2011 $46.75
Type of Use: SF FlueNent For Any of Above 04/27/2011 $23.32
Class of Work: ALT Type of Const: Fuel Piping 04 /27/2011 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 04/27/2011 $10.80
Stories: Minimum Fee Adjustment - Mechanical 04/27/2011 $5.78
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 No on Center. - •se rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir questions to OUNC by cal • : I .232.1987 or 1.800.332.2344.
Iss ed By: , t /11t . _ -- Permittee Sig , ��
i
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.
Apr 27 11 04:47p Systemaire 503 - 590 -8357 p.1
Mechanical Permit Application RECEIVE FO12 OFF1( E 1 SE O` t.\
Ci of Tigard Re a eA ! f `irl� MII
Permit No.. � �0��� del g3
iiii i ■ 13125 SW Hall Blvd - ,'Tigard, OR 97223 APR 2 7 y Lffi
Phone: 503.718.2439 Fax: 5 03 . 598 . 1 %0 Q f Man Review
DateBy: Other Permit:
T 1 G A 1 u Inspection Line: 503.639 CITY OF TIGARD Date Ready/n . >a Sec PaEe 2 for
Internet: www.tigard- or.gov BUILDING DIVISIO Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEET SCHEDULE - USE CRECICLI.CT
Mechanical permit fees' arc based on the value of the work
❑ Ncw construction [ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials. equipment. labor. overhead, and ofit.
CATEGORY OF CONSTRUCTION Value: $ I � (
RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
V I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building Fur speciall information use checklist
❑ Multi- family ❑ Master builder ❑ Other Description f Qty 1 Ea. Total
JOB SITE INFORMATION AND LOCATION Heatirtg/rnnlir►g:
�) Air conditioning
Joh site address: i t 3, LE Lt 3( Z '� LOO (manes site plan showing placement) 46.75
1 1 J Z � � Furnace 100,000 BTU (ducts/vents) .4, 46.75
City/State/ZIP: ` C:, f v ft�L t7� Furnace 100,000+ BTU (ducts/vents) 54.91
Suitc/bldg. /apt. no.: Project name: Heat pump
(requires site plan shoama placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duet suspended, etc. 46.75
Subdivision: Lot no.: Flue/vent for any of above yj 23.32
Other. 23.32
Tax map/parcel no.: Other fuel appliances:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
o CA A\. 1 - t t k J ( I\ C i SSt. - Mli c f cl - yss Flue vent for water heater or gas
r fireplace 23.32
11.1 z X i i.......) G. Y11. V Ct. .N L A ✓Lk.� Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert , 23.32
❑ PROPERTY OWNER l ❑ TENANT Chimney /liner /flue /vent 23.32
V 1 Other 23.32
Name: i..1- 44 , Environmental exhaust and ventilation:
Address: 1 l Le � �.t .) U ��� o UJ � - equip hood /other kitchen
I equipment 33.39
City /State/ZIP: C ��1 f 7 Z- Z- 3 dr
Clothes yer exhaust 33.39
3 Singlo -duet exhaust (bathrooms,
Phone: ( ) C,t,,,._ nj G I Fax: ( ) toilet compartments, utility rooms) _ 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other
Business name: 23.32
Fuel piping:
Contact name: $14.15 for first four, $3.03 for each additional
Address: Furnace, etc. ( / '/r( .
Gas heatpump
City/State/ZIP: Wall/suspendedhmit heater
Phone: ( ) I Fax:: ( ) Water heater
fi mail: Fireplace '
Range
CONTRACTOR Barbecue
Business name: Sy S 1.-rL a Js, Teti Clothes dryer (gas)
_ Other:
Address: i t.? Y 1./v. Sl...j k n .5T ME(3IANICAL PERMIT FEES'
City /Statc/ZIP:T. Q d VZ- Subtotal �,
Phone: 1 4 Fax: (93) 6 - p 3 e? t Minimum permit fee (590.00) q O
�� ) S 1 Z 3 Plan review (25 %of permit fee)
CCB �CQ
lie.: 3� / /? / State surcharge (l2 %ofpermitfee) /p.gJ
f TOTAL PERMIT FEE (/��/��� so
/ Thi permit applicataa expires it a permit is not obtain 180
Authorized signature: days after it Pas been accepted as complete.
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