Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00407
1 3125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 09/13/2011
TIGARD 13125 2S112CA13200
Jurisdiction: Tigard
Site address: 15508 SW 76TH AVE
Project: Holzang Subdivision: RENAISSANCE WOODS NO 2 Lot: 56
Project Description: Replace furnace and A/C Unit must meet 5' minimum rear and side yard setbacks
Contractor: FIRST CALL INSTALLATION COMPANY Owner: HOLZGANG, MARY ANN
13150 S CLACKAMAS RIVER DR 15508 SW 76TH AVE
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE 503 - 231 -3311 PHONE. 503 - 968 -2076
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Air Conditioning 09/13/2011 $46 75
Type of Use: SF Furnaces < 100K BTU 09/13/2011 $46 75
Class of Work: ALT Type of Const: FlueNent For Any of Above 09/13/2011 $23 32
Occupancy Grp: 12% State Surcharge - Mechanical 09/13/2011 $14 02
Stories:
Fuel
Fuel Types Natural Gas
Gas Pressure
Total $130.84
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: /"4115 Permittee Permittee Signature: 4—p L / (,��0A/
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.
Mechanical Permit t)\
1 1 i
A nlicat !] �, t)R 01 I!t ,1% ,1% 1 S
P U �E l ED Received .p 1 ��
City of Tigard Date/By: C � / � PermitNol���, / — Q® �0
13125 SW Hall Blvd., Tigard, OR 97223 1 2011 Plan Review
Phone: 503,639.4171 Fax 503.598.1.960 S E Date/By: Other Permit.
1 I i'i A It L) Inspection Line: 503.639.4175 .� Date Ready/By. NZ 65 See Page 2 for
Internet- www.tigard- or.gov CITY OF TIGR�'gD Natitied/Methad Supplemental Information
Pi fi nImP, DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ®Addition/aiteration /replacement performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. En. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: ' 55o g ow fue- .' Air conditioning
(requites site plan showing placement) 1 46.75
City /State /ZIP: WI) 0 4 Furnace 100,000 BTU (ducts/vents) I 46.75
�J
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 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- walk -duct, suspended, etc. 46.75
Subdivision Lot no.: Flue/vent for any of above 1 23.32
. Other: 2332
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater _ 23.32
Rcp1-t Gas fireplace 33.39
1 + Vf Fl for water heater or gas
Qt CU fireplace
23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39 _
Wood fireplace/insert 23.32
23.32
Chinntey /I iner /fue/vent
PROPERTY OWNER 1' - I ❑ TENANT Other. 23.32
Name: )4 2/A-nn l / i 11z �] r f j Environmental exhaust and ventilation
FF �� .�" vJ- Range hood /other kitchen
Address: equipment 33.39
City /State/ZIP: Clothes dryer exhaust 33 39
/ Single -duct exhaust (bathrooms,
Phone: ( m) q(Q$ L /� V7(Q Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Business rne: Tri County Temp Control Other: 23.32
na
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 beater
Fireplace
E -mail: Mange
CONTRACTOR Barbecue
Business name: First Call Installation Clothes dryer (gas)
Other: _
Address: 13150 S Clackamas River Drive MECHANICAL -PERMIT -FEES*
City /State /ZIP: Oregon City, OR 97045 Subtotal
Minimum permit fee ($90.00)
hone: (503) 557.0230 Fax: (503) 557.0919 Plan review (25% of permit fee)
CCB lic.: 182714 � State surcharge (12% of permit Fee) 1 / fJ
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TOTAL, Pe mM IT obtained ri/v
This permit application expires if a permit is not t ohtaiaed within 180
Authorized signature: CCCC days after it has been accepted as complete.
Print name: Diane Mason Date: q I, I * Fee methodology set by Tri -Cowny Building Industry Service Board
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