Permit CITY OF TIGARD MECHANICAL PERMIT
11 11. COMMUNITY DEVELOPMENT Permit #: MEC2011 -00523
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2011
Parcel: 2S110BA07700
Jurisdiction: Tigard
Site address: 11591 SW COLE LN
Project: BLOUIN Subdivision: EVERGREEN SPRINGS Lot: 2
Project Description: Gas furnace replacement with gas piping.
Contractor: A- ACTION HEATING Owner: BLOUIN, PAUL F
18245 SW TV HWY SULLIVAN, SHELLEY S
ALOHA, OR 97006 11591 SW COLE LN
TIGARD, OR 97224
PHONE: 503 - 649 -3524 PHONE:
FAX: 503 - 649 -6095
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 $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.33. 344 --
•
Issued By: . — Permittee Signature: C/—Y�
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
03/05/2017 13:29 FAX 2] 001/002 -
Mechanical Permit A licit' _
D Received � FQR orrice us,. ONLY
City of Tigard Re e / Permit No.: e i
• 13 125 SW Hall Blvd., Tigard, OR 97223 1 Plan Review
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Phone: 503.639.4171 Fax: 503.598.1 1 7 2011 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: EIS ri See Page 2 for
Internet: www.tigard-or.gov
CM. OF TIGARD Notified/Method: Supplemental Information
:It ti ,, '.'at`: DIVISIO
TYPE OF WORK COM FEE* SCIITEDIILE:: =; USE C$EEKt.r;ST ,
• Mechanical permit fees* are based on the value of the work
❑ New construction ddition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ther: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
For special i ormation use checklist.
1 - aSIDENTIA,L »QUIP I SXSTE IS FEE$*
- and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building
❑ Multi - family ❑ Master builder ❑ Other: p klist.
Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 Q i . f /� Air conditioning
1 1 � '7 t "�� (requires site plan showing placement) 46.75 e
City/State/ZIP: ' j sQ (i C Z23 Furnace 100,000 BTU (ducts/vents) ' 46.75
1 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 -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
DESCRIPTION OF WORK Water heater 23.32
l
Gas / � Flue vent or water heater or gas
fireplace 23.32
�- Flue vent for
^a C r . t
s T Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
ROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 23.32
`-'� i O Other: 23.32
Name: Environmental exhaust and ventilation
Range hood /other kitchen
Address: �' �I equipment 33.39
City / State/ZIP: , I �d C7 , 3 Clothes dryer exhaust 33.39
Phone _, 8 5 S Fax: ° '�C:J toilet Single-duct compartments, (bathrooms,
) OD ` G J � Fax: ( ) t comparhnente, utility rooms) 23.32
❑ APPLICANT ❑ CONTA 'PERSON " . • Attic/crawlspace fans _ 23.32
TI Fuel 23.32
Business name: A- AC?1ON HEATING INO,1 8l A/C Fuel piping
Contact name: t 18245 S.W. T.U. HWY $14.15 for first four; $4.03 for each additional I G' j
ALOHA, OREGUN 97006 Furnace, etc. i 1 �"
Address:
Gas heat pump
City/State/ZIP: WalUsuspended/unitheater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Business name:
A- ACTION HEATING & A/C Clothes dryer (gas)
-p �, Other:
Address: 1 H� `' 'rr' .:MEGHANICAL.PER1y1IT:F.EKSw .
ALOHA, OREGON N 970 97006 _ . .
City/State /ZIP: Subtotal
Phone ] )Logq - s`✓ (4 Fax :. (0 — (D 0 9� Minimum permit fee (590.00)
.J �' 1 ] Plan review (25% of permit fee)
-V CCB lie.: ( 4 C '� g State surcharge (12% of permit fee)
\ (( TOTAL PERMIT FEE ) C
This permit application expires if a permit is not obtained within 180
Authorized signa e:
days after it has been accepted as complete.
Print name: „ r --- a ____ • V p Date: 1 r 11 I1 * Fee methodology set by Tri-County Building Industry Service Board
1\Aui Win o \Pnm�ir�\MPC`_PmnitAnn gin, INMI /n0 44 7T III/ /C:f1M/WP.RI