Permit . CITY OF TIGARD MECHANICAL PERMIT
1111 - -' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00526
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2011
Parcel: 2S101AB00600
Jurisdiction: Tigard
Site address: 12260 SW 72ND AVE
Project: Guilleux Subdivision:CONDO SUPPLEMENTAL PLAT NO.1: Lot: 22858 -2
Project Description: Replace oil with gas furnace.
Contractor: CARSON OIL COMPANY INC Owner: GUILLEUX, REMY
3125 NW 35TH 12260 SW 72ND AVE
PORTLAND, OR 97210 PORTLAND, OR 97223
PHONE: 503 - 471 -4365 PHONE: 503 - 526 -9311
FAX: 503 - 227 -8521
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/18/2011 $46.75
Type of Use: SF Fuel Piping 11/18/2011 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/18/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/18/2011 $29.10
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 /ttoo OUNC by calling 503.232.1987 or 1.800.332.2344.
/ �1 /� V
Issued By: " Permittee Signature: e )^7 ���L r j / 0 /\/
` 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.
.N .
Mechanical Permit cat
Appliic 1
. . 4, • •CEIVED
m
NOV 1 8 2011 • it oFFIcE USL ()Nis
City of Tigard 1 . . .
Date(By: 7/ /, // 40 Permit No.- -6.—r _ 1;1e s: a
l , . 13125 SW Hall Blvd., Tigard, OR 97223
' S Phone: 503.639.4171 Fax: 503.5981/f rinie/By: Plan Review • Mo.-Pn:
eLit
. 1 ,... i A ' RI) Inspection Line: 503.639.4175 OF TIGARD Dale Ready/By: Fa See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION N'ifi'dimath°°: y z Supplemental Information
'''': :'',':''''',.!' '■• : • . '
Mechanical permit fees* are based on the value of the work
0 New construction ri Addition/alteratiordreplacernent
performed, Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead. and profit,
Value: S
V!,',::',:;V.' i::: ,..• ,: :'.': :'f.: :'.:'>., cgIWO4Y:: 9 ., ;:'1'f;04!4; , : , <:::;: , :t: , • '''''''' Itki iii 4k6i
g!Fp. .:....„. : . . — :,...,... „..... .. „..
ff, 1 - and 2-family dwelling 0 Commercial/industrial 0 Accessory building
.;;;A.§. s . a/ infonnatioa use checklist.
0 Multi-family D Master builder 0 Other; Description 1 Qty. Ea. Total
:JOik.:§tit., „,. Heating,kooling
Air conditioning
Job site address! /22 • ;2 • • 40 4
NouireS site plan Showing placement) 46,75
_.
— _
1=11MIRMIERMMI' Furnace 100,000 BTU (ducts/vents) I
Suite/bldg./apt. no.: Project name: ONIWIJIMMMIll Furnace 100,000+ BTU (ductsfvents)
Heat pump 54,91 _
61.06
Cross street/directions to job site: Duct work 23.32
Hvdronic hot water system 23.32
Residential boiler (radiator or
ydronic) 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other. 23.32
Tax map/parcel no.: Other fuel appliances
"'''' '''': '. ': • :: :;'' , :: . '• : : :: '•-•: , ::•:'.: 1, !...tikgdliiiiirk:e6k,*ojik;..;4,:aZ':; : "::,3>::,5,.i: : :::::. : : , .?,;:::,: . Water heater _ 23.32
33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
. Wood/pellet stove 33.39
Wood fireplace/insert 23.32
.. Chimney/liner/flue/vent 23.32
it •:.. . i t: ', :. : . :.':N . .s ; :;..4 :.1"1 • 1 !' . Other: 23.32
instaimmummimmmo Environmental exhaust and ventilation
. - Range hood/other kitchen
Address; , i.tn A
• equipment
-. 33.39
=Mr& R k v
• e., q ' 3 Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: (50 ) 52b . Fax: ( ) toilet compartments, utility rooms) 23,32
23.32
ESSIIIMMMI, EVIM qig0ST3*t Attic/crawls k ace fans
23.32
J. _ .
Business narne: A • ‘ 1 ; i la ft tli! ? s 1/ jelpipirii
Contact name; 6 Au $14.15 for first four; $4.03 for each additional
,._ LIPIRMI o.IPMIMMIIIIIM — .
Furnace, etc. 1 1,5
Address! 12 ,-''
... ;.—rg.
. Oas heat urn
City/State/ZIP: fra t 0 1 : . - ' alb Wall/suspended/unit heater ..
Phone: (03) 7 /.. 365
IMIEMMIMI Water heater
Fireplace
E-mail: ... r. ' .4 • k 4 1 a • yl Range _
',':5 ' ' '': '• .' ':'''. • ' '''''' ' ':': " 'i' rciriiiiktoii4;0:4%;::*:2.;;:::', ,..: Barbecue
°.•;:•fi'' : :: ':::•:',..,::':',' . , ,.;- ..;•:. i•A:::':' ,-•,:- — ., -: ---- ' ''.; '''."''''' ... '' .."' Clothes dryer (gas)
Business name: A R,SO ,_,.. 1' _ # • " :.. Other: , ,.
Address: 5 1. _ IA 51} x ;.::
rn Subtotal
112:1
Minimum permit fee ($90.00)
Phone; (0 ) 4366" Fax: (503127-852 I Plan review (25% of permit fee) --- C10, — op
, k • State surcharge (12% of permit fee) /6 86
4.
i• TOTAL PERMIT FEE 160, 86 7
Thu permit application expires if • permit is not obtained within 100
Authorized Signature; ./ 1 ' days after it bas been accepted as complete-
)
Print name! . . Date - ' Paa methminlogy act by Tri-ceuntv Building! Tedusev Service Board
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