Permit Irr CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00337
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011
Parcel: 2S112BC09200
Jurisdiction: Tigard
Site address: 14791 SW 80TH AVE
Project: Haynes Subdivision: Lot:
Project Description: Replace gas furnace.
Contractor: FIRST CALL INSTALLATION COMPANY Owner: HAYNES, DONALD
13150 S CLACKAMAS RIVER DR 14791 SW 80TH AVE
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 231 -3311 PHONE: 503 - 803 -4299
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 07/15/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 07/15/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 07/15/2011 $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: ��,lll1 Permittee Signature: a )9/ z /ei _ a ` /
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. �9 / / �
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.
JUL -15 -2011 06:548 FROM: TO:5035981960 P.1 cn
M ec h a n ica l P ermit.Ap p tlea > tI q L `c a.r.. , t 1Z01 i If f t,l. ONI.N
City of Tigard Recei Permit
• 13125 SW Hail Blvd., Tigard, OR 97223 J U L 1 5 2011 Date/By: '7 5 / :A 6f�0� - 0., 033 4
g Plan Review
Phone: 503,639.417.1 Fax:. 503.598.1960 Date/By: - Other Permit:
t i A it 1) Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: EI it See Page 2 for
Internet www.tigard-or.gov BUILDING [NOW' Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE •••-• USE CHECKLIST ECKI,IST
❑ New construction ® Addition/alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF .CONSTRUCTION Value: $
l -and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES.
® y g ❑ Commercial /industrial ❑ Accessory building
El Multi -family ❑ Master builder For special information use checklist.
❑ O ther: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION -Heating/cooling
Job site address: 14 W sow,j Awned conditioning
y (requires site plan showing placement) 46.75
City /State/Z1P: Tt ar grj2^L�. Furnace 100,000 BTU(ducts/vents) 1 46.75
�LJJ Furnace 100.000+ BTU (duas/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
I-Iydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fiiel -type, not electric),
-imwall, in -duct, suspended, etc. 46:15
Subdivision: Lot no.: Flue /vent for any of above 23.32
Other: 23.32 •
Tax map /parcel no.: Other filet appliances
DESCRIPTION OF WORK Water heater 23:32
iI t Gas fireplace 33.39
[r, ) �) Flue-vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
-Wood fireplaoe/insert 23.32
Chimney/liner/flue/vent 23.32
XPROPERTY OWNER ❑ TENANT Other: 23.32
Name: Io - 4.1 MB Environmental exhaust and ventilation
Address: CJti l f`t Range hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
r Phone: (� 6F1.-42/01 Fax: ( ) toilet compartments, utility mums) 23.32
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: Tri County Temp Control -
Fuel piping
Contact name: Diane Mason $14.15 for first four; $4.03 for each additional
Address: 13150 S Clackamas River Drive Furnace, etc.
Gas heat pump
City/State/ZIP: Oregon City, OR 97045 Wall /suspended/unit heater ,
Phone: (503) 557.2220 Fax: : (503) 557.0919 Water healer
- Fireplace
E -mail: _ age
CONTRACTOR Barbecue
Business name: First Call Installation Clothes dryer (gas)
- , Other:
Address: 13150 S Clackamas River Drive h4ECHANICAL3'ERMITfEES*
City/State /ZIP: Oregon City, OR 97045 Subtotal
Minimum permit fee ($90:00)
P one: (503) 557.0230 Fax: (503) 557.0912 plan review (25% of permit. fee)
i + CCB lic.1182 ?14 State surcharge (12% of permit - fee)
TOTAL PERMIT FEE r OO bV
This permit application expires if a permit is not obtained within ISO
Authorized signature: ! days ufter it has been accepted as complete.
l Print name: Diane Mason Date: r l J 15'i I • Fee methodology set by Tri- County Building Industry Service Hoard
r\ nnileina \ Permits \MEC- PermitAao.doc 10/01/09 440. 46171(11 /02/COM/WLa)