Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00364
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/03/2011
Parcel: 1 S133CD01300
Jurisdiction: Tigard
Site address: 11760 SW SWENDON LP
Project: FORSTER Subdivision: Lot:
Project Description: Furnace replacement.
Contractor: NW SUNDANCE SERVICES INC Owner: FORSTER, JOSEPH D
10117 SE SUNNYSIDE RD STE F1201 11760 SW SWENDON LOOP
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 750 -7442 PHONE:
FAX: 503 - 655 -3347
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 08/03/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 08/03/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 08/03/2011 $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 501232.7 nr 1 800.332.2344.
Issued By: ` -errriittee Signature:
1.
Call 51 .63•.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.
Mechanical Permit 1 11 %. ation� �,
, 1kt,
1<<)R O I t� E USE ONLY
City of T and
\ Received
g mammy: off i PermitNo.: --
1 / 4 13125 SW Hall Blvd„ g egl, s e•fi9' rAJ /1AD �_�. _� 11 ' _ •
Plan ReVieW
Phone: 503.718.2439 Fax: 50 '514930 Q� ;° 4 /Ety; Other Pennit:
711, 1:.8.1? Inspection Line 503.6 ' t\ 1 }a� Dt v &." Date Ready /By: purls: ra See P 2 for
Internet: www.tigard- oi r C ' �� 5\ - d Notified/Method: 7 7 i Suppteme Ynferm8tion
1Ello ' WORk \,V`' - •, COMMERCIA .* *: SCI: :uSE.C,RECAMST ".
V — Mcchatucal permit free are based on the value of the work
❑ New construction ®IAdditi�� alteration /r place r performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials equipment, labor, overhead, and profit.
0 Demolition Q Other: _. t
Value: $
M ORY i • • CONSTR CTIO
N RESTllIENTl4iL 'f;Q(fI.PAI1uNT / SYSTEMS FEES*
►1 I- and 2- family dwelling 0 Comm ! rcial /industri- ■ , cessory building For special information use cilecklist.
❑ Multi- family ] Maste l.allder U � er: Description � Qty. J Ea. j Total
. . ... • :JOB S ITE I FOR I T •ION A ► :INtOC - t1 fieatiup/cooling: . -.._..
Air conditioning
Job site address: ' i l�J .. - .. ♦. ' a il. 6 (renuires ittIan showing placement) 46.75
Furnace 100.000 BTU (ducts/veins) y 46.75
City/State/21P: i, e r a • r « M INIM t
Furnace 100,000* BTU (ducts/vents) 54, 31
Suite/bldgJapt. no.: 'i'r �� float Dump
1 �� 1ti�tl�J1 re. uiressite Ian showin_ .laoemcnt 63.06
Cross sircot/dirootions to job site; 11.1® Duct work . ._, , . 23,32 _ ._
-® . Hydronic hot water sstem h,d 23.32
Xd r oenttal boiler (raliiatar or
IIIIIIMIMMIIIII 11111.111111 ,. ttronic) 23.32
111.11110 i -, in-duct, (fuel-type, sus p, electric). .
in-wall, l-t e not p not l c. 46,75
Subdivision: M Lot no.: Flue /vent'for any of above. . 23.32
Other: 23.32
Tax map /parcel no_: !-® Otlter fud appllaaces:
D ? ETON O)' 1)? � � Water heater 23.32
I_-� Pin fireplace
nt 33.39
�. 1 4. Flue vent for water heater or gas
IIIIIIMIIIIIIMIMIIIIIIII fireplace 23,32
-I� Lod lighter (gas) 33.32
wood /pellet stove 33.34
IIIIIIIIIMIMMIMMMIIIIIIIIMIMI Wood fireplacc/inscrt • 2332
I t ' - . PROPERT OWN • mu� L u Chimney /liner /flue/ve 2332
Other: 23.32
Name: I - ,
Q'" ` , Environmental exhaust and ventilation:
Address: ' Range hood /other kitchen
.. ♦i� ♦ ♦.�:� equipment 33.39
M My-� Clothes dryer exhaust 33.39
Phone: ( ) I HEIM ) Single-duct exhaust (bathrooms.
i -�
toil
�(
C ACT:•PERSON utility rooms) 23,32
i
toilet compartments, ',
" � . • Atl �' ace fan $ 23.32
Business name: - Other: ,i _ — [ 23.32_
A � ' il Fuel i i
Contact name: A: +i t �' i - � �'T -� ► � � . „ Si4,15 for flryt four; $4.03 for each additional
Address; • "� �, 1 t I " ` ` Furnace, etc,
' Gas heat um
City /State/ZIP: ` g o • . • $ ;MI Wall /sus +ended/unithcater _
i Water heater
phone' • ., r`+ j, r•1 Ali , ii 01:117M. . T "
Fire .lace
IEIIIIIIIIIIIIIIIIIIIIII CON.; CTOR. B arbecue 111111111111111
1211 Clothes d cr a.,
. NUM �-I Om er. • •, --
Address: � � . MIEC>EIAI�TICAi:.PElibfi:T )fiEES"
f ;-� j Subtotal I{(; 75
Minimum permit fee ($90,00) qo QQ
Phone: ( ) �I� Fax: ( ) Plan review (25 %of permit fee) .rte
CCS3 lic.: t 4 I • !EM. /11111•111•11111111111111 State surcharge (12% of permit fee) 4 ' .`
TOTAL 'PERMIT FEE t ; '
a T'his perhtt Application expires if a permit is not obtained width, 180
Authorized si i Q � , Merillp
l • days otter It has been accepted as complete.
Print name is , iremiiiii=1 cominum i s Fee methodology sat by Tri- County Building Industry Service Board
ria„ii,rn,AP.r.irAhA r'.Nrmlr.Am.dno 04/09 0 440.46171'0 I/02/COM.4VE'a)