Permit ,� CITY OF TIG ARD MECHANICAL PERMIT
,1 COMMUNITY DEVELOP Permit #: MEC2011 -00492
Date Issued: 11/03/2011
TIGARD. 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 1 S136CA01100
Jurisdiction: Tigard
Site address: 11250 SW 78TH AVE
Project: DeLance Subdivision: FAIRVALE Lot: 6
Project Description: Install new gas furnace.
Contractor: COMFORT SOLUTIONS HEATING & COOLING Owner: DELANCE, JOHN M
PO BOX 1233 1355 SW MAPLECREST DR
CLACKAMAS, OR 97015 PORTLAND, OR 97219
PHONE: 503 - 698 -2665 PHONE' 503 - 704 -2583
FAX• 503 - 658 -4011
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/03/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/03/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/03/2011 $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 quests. • - • .0 by calling 503.232.1987 or 1.800.332 2344
Issued By: J / .40a■frfrIA2—kp Permittee Signat re:
Call 503.639.4175 by 7:00 a.m. for the next available inspectio • ate.
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 Application R.ECE, 1 l 0, -.,CF; 1 SE ONE
City of Tigard A atenay_ if Z Permit No. F e _// 2.
1 1 1 , . - ,• 13125 SW Hall Blvd., Tigard, OR 97223 i ` ' 0 2 Ian Rc w
I ' Phone, 503.718.2439 Fax 503.598.1960 ! Date/By: Other Permit:
T ' c; . i• r inspection Line: 503.639 n ri ' a : to Rea dyBy: mils. Ell
see Page 2 for
Internet: www.tigard -or.gov l lti onficd/Method; Supplemental Information
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-`' ` •h. � \• �•• ^` • Mechanical perrrrit fees° are based on the value of the work
0 New construction % ddition/alteration/replaoement performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit.
❑ Demolition ❑ O ther: . ;, ..,
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value: $ •i,: c.. 7 , i � - i .. . C 77- 7,7'e:I l K� + ;7i*i` :. a ; .777�F' r0 ig ;:"= M rt,SSJ ^'S5 , \.r c . „ t . , ..,4t , R
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11- and 2- family dwelling ❑ Comrnercial/indust ial 0 Accessory building FOP special information use checklist.
0 Multi- family 0 Master builder ❑ Other: Description _____I Qty. J Ea, I Total
T ,err , .:7 h a;73 ml 6 i 7 ,r 7 Heating/coolioh:
. . .., , t, :, .' , 7,7, °ttw .!.. .'....,". 5 t.o 3s° .. ,,^ A con — �
Job site address: / / a 50 7g i/„� (requires site plan showing placement) 46.75 7 5
•� Furnace 100,000 BTU (duets/vents) 46.75
/ I
City /State/ZIP: a/ / 0 � Furnace 100 BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: • a Heat pump
(requires site plan :hewing placement) 61.06
Cross sereet/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: I Lot mo.; Flue/vent for any of above 23,32 ,
l Other' 23 32
Tax map /parcel no.: Other fuel appliances: '
, y, \ ti { 3 , . ' \ci r7y r ;' " / V i41.i \ir 7.T , r i:i: l+ �l µ + '. f
� 7: Water heater 23.32
rn \».\ �, ^ a '{ 'a�,. 5t.n>. ti`t4 • 1 \u :»'• ,,: k
..;.;,,, .,.,.? iv.r.u`, ,l,.tj!a.."t cAlit; ; l ‘,"_44.,:..4
Gas fireplace 33.39
`r r s—F' F lue vent for water heater or gas •
f fireplace 23.32
Log lighter (gas) 23.32 -
Wood/pellet stove 33.39
Wood fireplace/insert 23.32 • .., t Z t i ' : " " '� ,, t r ;;7 r t 7 :7 7 , 5 ` ; t , � P 7 f,Ft k v.; ,j.;, ,, a h. r1 . Chunneynlner /flue/vent 23.32
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f.. •`, -\•. ,;r.. : AC.r..., .•.\.
: •1 • •, « r,_ 1 :r.M.t. \i.,:s. iv'. ......, : ",
Qthtr: 1 --- 23,32
Name: JO () , - 4 14re Environmental exhaust and ventilation:
Address: i ' . e Range hood /other kitchen
4 �`- ' equipment 33 39
City/State/ZIP: � J / 0 • '' r Clothes dryer exhaust - 33 39
Single -duct exhaust (bathrooms,
Phone: (5 , - Fax: ( ) toilet compartments, utility rooms) , 23.32
w. z^m n^rc:y 1 ^ Cy - .•"h i r :' 1 . ,� "+ter. ° ��P'r' � T {"r 5 ,} r �i ' , � "'. / n.7,"" Attic /crawls a.Ce fans 23 -32
D.,`,.',.. 1 3 " t •.v..v ;,\ c .' ..e : t 4f ;;:l:i �,:u9tt,,;`\:.n.i '1�45.ih. t.,!. M +.l TZ ;1'4Y9,AN: N,..31 r.. +�n ; , , n ,...,,.a, p
Business name: 23.32
Fuel piping:
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
-. i Gas heat pump
Cily /5tate/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax :: ( ) Water heater
— Fireplace
E-mail: Range
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BuSbiess name: ./ //I I ; t13 tt „a._ Clothes dryer (gas)
Other:
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Address: i_ �. 1a o r�wr >wre=wn.•, M h na t • z �, r � tt
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City/State/ZIP: ,,, , d I / 70/5 Subtotal / 01, 7
Phone: ( i,� (� a -- — Fax: +p ' Minimum permit fee ($90.00) CO
/ M / Plan review (25% of permit fee)
ISEIWA IZWIIIIIYAYL State surcharge (12% of permit fee) /0 - W
TOTAL PERMIT FEE /op . fro
This permit application expires it a permit is not obtained within 180
Authorized signature: ( / days after it bag been accepted as complete.
Print name: i, A' ' ri / Date: • Fee methodology set by Tri- County Building Industry Service Board
I'1 Budding \PermitsOMEC- PermitApp.doc 09/09/10 440 -4617T(I1 /02/COM/WEB)