Permit CITY OF TIGARD MECHANICAL PERMIT
NI COMMUNITY DEVELOPMENT Permit #: MEC2011 -00497
Date Issued: 11/03/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 2S111AD16300
Jurisdiction: Tigard
Site address: 15048 SW 91ST AVE
Project: HAWKES Subdivision: MALLARD LAKES Lot: 29
Project Description: Gas furnace replacement
Contractor: SPECIALTY HEATING & COOLING INC Owner: HAWKES, JUDITH L
7500 SW TECH CENTER DR #130 13949 BEAVERCREEK RD #121
TIGARD, OR 97223 OREGON CITY, OR 97045
PHONE: 503 - 620 -5643 PHONE
FAX. 503 - 681 -0793
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 questions to OUNC by calling 503.232.1987 or 1 800.332.2. 44
Issued By: c..-^ / Permittee Signature:
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.
NOV/03/2011/THU 01:02 PM FAX No. P. 001
_. .
Mechanical Permit Applicatio FOR oriFic IT USE ONLY
City of Tigard ‘- ) CV■11441E4X) Rzccived Brieggi
Date/By 1
q SW H
Permit No : ryi ) 1 7 ........ C . a j 1F... tr) 116. 7
'Inv
1325 all Blvd , Tigard, OR 97223 .7 i
1111 Nan Review
' I - Phone: 503.718.2439 Fax 503.598.1960 1/4‘ 3 70\ aste/BY; Other Permit;
'TIGARD
inspection Line: 503,639.4175
Date Ready/By. . hum El See Page 2 for
• Internet; www tigard o n N otified/Method: ifled/Method: ) —... Supplemental Information
CIV AlCiP"-(1-14 _
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Mechanical permit fees* are based on the value of the work
Ill New construction 1(Addition/alteration/replaccinent performed, Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other' mechanical materials, equipment, labor, overhead, and profit.
Value: $
,;; ,,„ 0,?,;TEOZ)C,P1S.:03P911.671'N''.::"P';'
MI- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist:
Multi-family 0 Master builder 0 Other: Descnption Qty. I Ea I Total
i. ,1 , 6 H
Job site address; i 5c) 4 7' 5-u) i1 A-oe-- _(requires site plan showing placement) 46,75
Furnace 100,000 BTU (ducts/vents) I 46.75 t itp..1
City/State/ZIP, *SA di — 1 aaq U Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: P roj e c t name. ,.i Heat pump ._
...A. i (requires site plan showing placement) 61.06
Cross street/directions to job site; Duct work 23.32
Hydronic hot water system 23 32
• Residential boiler (radiator or
hxdronic) 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-duct, J etc 46.75
Flue/vent for any of above 23.32
SUbclivision; Lot no.;
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
' " ' i:' ' "', ' ': ' '. ' ‘: Water I eater
"/, ::;:;',:;,,,',`,. i ,,,:„ "'' ::..", `"•'; 'EC 0 7 " , 1 1 P 10 4'.'; -:". ''';': ; ''' . r i" 'ti;Y' ' ''''': ''. i 23 32
Gas fireplace 33 39
Flue vent for water heater or gas
g.k1:21101,C_L (36,a.44,Alana4-42-, fireplace , 23.32
Log lighter (gas) 23.32
t\ 10 itery49 Wood/pellet stove __. 33.39
Wood fireplace/insert 23.32
''' 0 ' ii : : " .. I . .", .. , . ,, ri li
4 , - z......, „. Othe ; .•,,,„, ,;,‘ „,• ; , ,,,, „ ,: Chimney/liner/flue/vent 23.32
% s P4OPP,' "" ,• ,, , ' .
Judy Hawkes R11306 23 32
Name: Environmental exhaust and ventilat
15048 SW 91st Ave Range hood/other kitchen - —
Address; Tigard, OR 97224 equipment 33.39
City/State/ZIP: 503 Clothes dryer exhaust 33,39
Single-duct exhaust (bathrooms,
Phone; ( ) toilet compartments, utility rooms) 23.32
Li k4LIC kV T " ' ' , '" ' ,.' ',I:I, OSI`i,Ai, rtsopi ..'• .,, ; Attic/crawlspace fans 23.32
'---:-."' Other: 23 32
Business name:
..... Fuel pining:
Contact name: $14.15 for first four; $4.03 for each additional
Furnace, etc,
Address: -
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
.
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail: • , , , - Range
, (01■17CRACTOR Barbecue _
Business name: Specialty Heating & Cooling Inc Clothes dryer (gas)
— Other
Address: 7500 SW Tech Center Dr Suite #130 '' '' ", NItClIANICAL PERMIT FEES.
_
City/State/Za Tigard, OR 97223 Subtotal
Minimum permit fee (590.00) 90.00
Phone: (503) 620-5643 Fax; (503) 598-0718
Plan review (25% of permit fee)
CCB lic.: 66578 State surcharge (12% of pennit fee) 16 • 50
..,„
TOTAL PERMIT FEE ( ger,
This ernsit application expires If a permit is not obtained 'within 180
Authorized signature: uacry) ofir4.0--- .--,n As: th be accepted as compiet.
Print name: SuSan Date: 1::1 Building Industry bcrvicc Board
1A1a1 09/09(10 440-4617T 11 l/02/COM/WEB)