Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00263
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/08/2011
Parcel: 1 S135DC01801
Jurisdiction: Tigard
Site address: 11890 SW 91ST AVE
Project: HUBBARD Subdivision: TIGARDVILLE PARK Lot: 9
Project Description: Gas furnace replacement.
Contractor: CLAWSON HEATING Owner: HUBBARD, JUNE D REVOCABLE LIVING
PO BOX 899 BY HUBBARD, JUNE D TR
GRESHAM, OR 97030 504 NW DENTON AVE
DALLAS, OR 97338
PHONE: 503 - 618 -9646 PHONE:
FAX: 503 - 665 -2375
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 06/08/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 06/08/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/08/2011 $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._ .
Issued By: 1 ✓���i Permittee Signature: —
//
Cal 13.639.4175 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.
JUN -8 -2011 08:56A FROM :CLAWSON HEATING 5036652375 TO:5035981960 P.2
Mechanical Permit Application FOB OFF IW E f S ONIA
P h * City of Tigard lie Re Re c ceive Received ! �
13125 SW Hall Blvd., Tigard, OR 972 3, �, Plan Review � • �
14 .. Phone: 503.718.2439 Fax: 503. 98Af960 O \ e\ Date/By. Other Permit:
`i I G A RD Inspection Line: 503.639
and -or. ov Date ed /Metho S See Page for
Internet: www,ti
g 6 °�® v Notified/Method:
EN
Supplemental Information
TYPE OF WORK v q � \`t V , . COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
K l• t....0,-.4-- Mechanical permit fees* are based on the value of the work
❑ New construction dition /alteration//rreplaeement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: V mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
and 2- family dwelling 0 Commercial/industrial El Accessory building For special Information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
\. CI f (s � k r
Air conditioning
Job site address: 1 �, (requires site plan showing placement) 46.75
City /State/ZIP: 6 f T Dr Cl -7 2 2- S Furnace 100,000 BTU (ducts/vents) ` 46.75 .75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump
(requires site plan showing 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 -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:
DESCRIPTION OF WORK Water heater 23.32
cbc_AD1 `'L- �, Gas fireplace 33.39
clap Flue vent for water heater or gas
-€ I �(' (� fireplace 23.32
"�-�' v� Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
' 15-PROPERTY OWNER ' ❑ TENANT Chimney /liner /flue/vent 23.32
Other: 23.32
Name: , . kA A A.01 Environmental exhaust and ventilation:
Address: Range hood /other kitchen
equipment 3339
City /State /ZIP: n0.At 02�.Z� • Clothes dryer exhaust 33.39
E - Single-duct exhaust (bathrooms,
Phone: 6 ` ) C J 5€- O Z 3 Fax; ( )
toilet compartments, utility rooms) 23.32
APPLICANT ❑ CONTACT PERSON Attic /crawlspacc fans 23.32
•
Business name: _ Div ]- Ad ,` &.`., Fuel 23.32
Fuel piping:
Contact name: iCN{ 1
$14.15 for first four; $4.03 for each additional
Address: p O ED Eq - I Furnace, etc.
City /State /ZIP: //��� C iNr O 9 � � Gas heat pump
�1iV kY T (l v Wall /suspended /unit heater
Phone: E 1_8 - q �(,� 44, ^ c. ( Fax: : 5y ( - Water heater
f - snail:
G4 `� AX)J1 ` U1�1 L�CJ �V 1 I l ,S i X Rang
Range e
CONTRACTO Barbecue
Business name: v A 3 /\ e e /�� Clothes dryer (gas)
Address p . ' . J ` Other:
MECHANICAL PERMIT FEES*
City /State /7_IP: - / 0 1 r l r>,Q 9 t E, Subtotal
Phone: W l e l C
3 f -9 � 4r l Fax ` : - ()tj 2375 Minimum permit fee 0) 9D 2 Plan review (25% of permit rmit fee)
GCB lie.: 11 t ) 2,, • i ilkIlix. State surcharge (12% of permit fee) I 0 ,
TOTAL PERMIT FEE I 00 ,80
Authorized signature: - This permit application expires if a permit is not obtained within 180
Sas days after it has been accepted as complete.
Print name: A . / y A 4 Date: p 4 t Fee methodology set by Tri -County Building Industry Service Board
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