Permit CITY OF TIGARD MECHANICAL PERMIT
'''! ss COMMUNITY DEVELOPMENT Permit #: MEC2011 00188
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/03/2011
Parcel: 1 S133DB01500
Jurisdiction: Tigard
Site address: 11665 SW SHEFFIELD CIR
Project: Ruffin Subdivision: BRITTANY SQUARE NO.2 Lot: 39
Project Description: Replace existing gas furnace.
Contractor: LYONS HEATING & COOLING, INC. Owner: RUFFIN, KARLA
PO BOX 849 11665 SW SHEFFIELD CIR
LYONS, OR 97358 TIGARD, OR 97223
PHONE: 503 - 859 -2325 PHONE: 503 -475 -5419
FAX: 503 - 859 -2655
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/03/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 05/03/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/03/2011 $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: D/v ,774/:'4 /9-770A/
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.
04/29/2011 12:20 5038592655 LYONS HEATING PAGE 01/02
Mecha Pe rmit A licatdon . t( l � 1. (l 1 l( I 1 - (1■1,1
III City of Tigard W Reee+ved
• 13125 s W Hall Blvd, Tigard, OR 9 �� 4 �� DateBy: _3 // . <<_- Permit No.. e #1 / , if,
5 Phone: 503.718.2439 Fax: 503.598, 1 �� Plan Review tither Permit:
Q Date4By:
. 1 i .: , 1 I, i m Inspection Line: 503,639.4175 S Q,r 1 e R
Internet: www,tigard- or.gav ',C1 1G_1 �� d/M th S ee Pa a for
� � \ v`� Notified/Method;
O Sapplct f l o e; Edon
tlfl'11. a W \ CQl fltl '+ It04: 'Ek" : 5 ` itittintocusf
[l New eonstructitmAddition / alto • ' , . laecfnentMechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mccbanical materials
equipment, labor, Overhead, and profit,
Master builder
y +A❑ Commer C Nt 1tilel (ir4 ndu value: $
'1`1C"tt 9t OP
CKI 1 - and 2- farxtil dwelling al�strial 0 building For , a on a ss c1 1 E I�.$ a ..
❑ Multi- family [] .. 9>rd information ePP. checklist.
❑ Other: Description 1 Qty - I -Ea, I Total
. don sin An ° 1 * AND'
l ND t °cAr t'v �. t#catlncondiWeowtioning
ling: -
1 Air
Job site address: I I 1 1Q s sup . she c..1 d j r , L l C t� � ( ires ails plan showing placement) 46.75
City/State/ZIP: 1 (� a C‘--T �. ` � Pomace 100,000 BTU (ducca/venla) I 46.75 1 410 iS
.] Furnace 100,000+ BTU (duets/venis) 54.91
Suite/bldg./apt. no.: I Project name: Heat pump
- (requires site plan showingplacement) 61.06
Cross street/directions to job site: Duct work 23.32
Iiydronie hot wager system - l 23.32
Residential boiler (radiator or
_ydronic) 2132
- -- Unit heaters (fuel type, not electric),
in -wall, in -duct, suspended, etc. 46,75
Subdivision: Lot Fluclvcnt for any of above _ 2332
Tax map/parcel no.: Other: 2132
Other fuel appliances:
)111i1Elliilt'PYDIV IVY R'b1tE / Water heater 23.32
• D- .-:l / e IG t ��n f l • - Q. �t, r n O.CR. uo l I' ek e F fireplace
for water heater or gas 33.39
�rcL e... Gas rnaC.Q,.. fireplace 23,32
Lo Iii li ter (Ras) 23.32
Wood /pellet stove 33,39
Wood fireplace/insert - 23,32
>a a 'ILltliklVlh . Chimney/liner /flue/vent 23.32
NaC0. r_lk Other: - 23.32
me: ,
_ Environmental exhaust and ventilation:
Addt ass. 11(p(ns C , _� t i { I a C equipRsngc m o kitchen 3.
W X1 "1 t 33.39
City /State/ZIP: '� d DQ . CA-� •D-- . Clothes dryer exhaust — 33.39 ^ —
Phone: (303) �i S - 51 -k-ICI - Fax: ( ) Single -duct exhaust (bathrooms
toilet compartrncnty utility rooms) 23,32
:[ PPLIiI,`',+IiTi{'11 I' '+CVI+ T PERSON Attickrawispaoe fans
23.32
Business name: Other: 23.32
Contact name:
514.1.51W first four; S4.03 fbr
—
Address: Furnace. etc.
—
City/State/ZIP: — '
Wall/suspendedAmit heater
,—
Phone: ( ) I Fax:: ( ) Water heater
E-mail:
Ran
C ItAiC Barbecue
Bossiness name: . • •A 1 L • , vc r j� Clothes dryer (gas) •
Address: 0 - '?}C g t%q _ Other:
t'
City/State/ZIP: -
City/State/ Art'p t?�
1.1,�C)f ( 'R 9 - 35 c Subtotal ` (45, 75"
Phones ( ) 5�5q - a `a 5 Fa't: ( 3) g5cj • a( - '"` Minimum p fcc ( 590.00) alP� ___..
Plan review (25°✓u of permit fee)
4, /"CCB lie.: WOO. A
U ( state surchar (12% of permit fee) jp, go
��
�� ' TOTAL PERMIT FEE LOD. go
Authorized signature: ,, J ti(_ _ V--
� This pcnnk application expires if a permit to not obtained within 180
` C'�" (/ �{ � � days after it hiss been accepted as compkt
Pri nt name: ttirl l e_____% J Date :,', za . i ' • Foe methodology set by Tri -County Building lnduatry Service Board
1: 18 ultdiampermitAMFt;FeneitApp.dec n9/n9/10
44( (I t/011bOM/N'L8)