Permit 71 , CITY OF TIGARD MECHANICAL PERMIT
; COMMUNITY DEVELOPMENT Permit #: MEC2011 -00454
Date Issued: 10/13/2011
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Parcel: 1 S133DB04500
Jurisdiction: Tigard
Site address: 11369 SW WINTER LAKE DR
Project: Kragh Subdivision: BRITTANY SQUARE NO 4 Lot: 73
Project Description: Replace gas furnace
Contractor: SPECIALTY HEATING & COOLING INC Owner: KRAGH, WILLIAM D
7500 SW TECH CENTER DR #130 DE MARA, CHERYL
TIGARD, OR 97223 11369 SW WINTERLAKE DR
TIGARD, OR 97223
PHONE 503 - 620 -5643 PHONE' 503 - 524 -7022
FAX. 503 - 681 -0793
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/13/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/13/2011 $10 80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/13/2011 $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 "cation 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 . ect questions to OUNC by - n 503 232 1987 or 1 800 332.2344.
I ued By: \ ', Permittee Signatur• ,.
Call 503.639.4175 by 7:00 a.m. for the next available inspection da - .
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.
OCT /13/2011/THU 01:10 PM FAX No, P,001
•
Mechanical Permit App1i i,„,i r clff?1(r'u r ONLY . . .
14 J
e �
Ci} of Tigard ' Received ®I ��
Permit No : geh lllciC f/5 �,
i
.. 13125 SW Hall Blvd., Tigard, Ok 97223 Date/By: i O Plan Review
Phone' 503.718,2439 Fax: 503 598.10E1. 1 2011 Date/By: Other Permit:
'TT E All D Inspection Line: 503.639,4175 bate Ready/By n lri
Internet: www.tigard -or gov r�` / y See Page for
CITY TIGARD Notified/Method: Supplemental Information
• ., , �,' `f ' ,
CITY 4ti t , , ,, �i , ham per t'
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' } :n' ^q /1 ,i ^.. '" :\,•. rr' O�fA:�i;tJU+,'��,vey�
Mechanical permit fees* are based on the value of the work
El New construction Addition /alteration/replacement performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
y �y �� �y Value: $
' 1 • ''„ \'a• „, tC tEhk Y�01 ON, 1JCflO11 f " ;:!;; r,.Vie, ''.,,,,4•,a .,,`�� 6AUV; i , „„,
1 - and 2- family dwelling ❑ Commercial /industrial [] Accessory building
0 Forspeclad Information use ekec ILsY
Multi family �c.hh.�r�� Master builder Other: Description I Qry Ea Total
; •J,. • :' " +TO$;SI E O TJQNe ' iQ,•,,,,, �� ^• .. Heating/cooling.,:
S r� �! , Air conditiotung
lob site address: 1 1 6 q sY 0 3 W �iri a e , � „ (requires site plan showing placement) _ 46 75
/ 4bxc° W J �� Furnace 100,000 BTU (ducts/vents) 1 46 75 412.14
City /State /ZIP: .. C? 0 6 7 c) 3 Furnace 100 Heat 000+ BTU (ducts /vent;) 54.91
Suite/bldg. /apt. no.; Project name: Pu m P
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydtonic 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:
„�x,- aun)ES,.1R R 'OF, *�4 "" , r , ', ,,t. >r' Water heater 2332
Gas fireplace 33.39
:` I .. P % t 0 it iii... ' i 1 IS ._ ° Rue vent for water heater or gas
i fireplace 23.32
Log lighter (gas) 23 32
Wood/pellet stove 33 39
Wood fireplace/insert 23 32
• l , >PR,OrE t'!�'Y_',0 .', , ...... , , ',;>,, : , , r .. OAls ' ;,; , • ,, ° Chimney /liner /ftue/vent 23 32
- - Other: 23.32
Name: Environmental exhaust and ventilation:
Address: ( ('I l,„ \ ( - Range hood /other kitchen
''��1! C w equipment 33,39
City /State /ZIP: b CO n 8 ( La ) ®(�, Q 1 n Clothes dryer exhaust 33.39
1 Single -duct exhaust (bathrooms,
Phone: ) y � Pax: ( ) toilet compartments, utility rooms) 23.32 _
” Attic /crawl ace fans ,. , , l, , .; ❑ i C(r!��?i.SC,T' , � �� sP ns 23.32
Business name: Other: 23.32
. Fuet,liping:
Contact name: $14.15 for tint four; 54,03 for each additional
Address: Furnace etc.
, Gas heat pump
City /State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: -
', "CQN'FRAC1COR : F, , y ,. - /' , ; •,; Barbecue .,
ecue w
Business name: Specialty Rearing & Cooling Inc Clothes dryer (gas)
Other
Address: 7500 SW Tech Center Dr Suite #130 ,11041i pl •
City /State /ZIP, Tigard, OR 97223 Subtotal
Mimmutn permit fee ($90.00) CZ ,1 ('q
Phone: (503) 620 -5643 Fax: (503) 598 -0718 Plan review (25% of permit fee)
CCB he : 66578 State surcharge (12% of permit fee) 1 6 . 80
w — TOTAL PERMIT FEE I (j 0 O
Authorized signature:
i This permit application expires if a permit is not obtained within 180
;: days after It has been accepted as complete.
Print name; ms.$ �. ` 6 , y /G ja11F,
- Date; i1 Fee methodology Set by Tn- County Building Industry Service Board
I \ auiidaog '?•rmrts\RPC- Ptnm ;App,doc 09/09(10 440 - 4617T (I uo2 /COivwE )