Permit CITY OF TIGARD MECHANICAL PERMIT
II r! Permit #: MEC2011 00530
COMMUNITY DEVELOPMENT
Date Issued: 11/23/2011
IIGARU 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S134BD10500
Jurisdiction: Tigard
Site address: 10882 SW 118TH CT
Project: Kaess Subdivision: PENN LAWN ESTATES NO.2 Lot: 33
Project Description: Replace gas furnace.
Contractor: A TEMP HEATING & COOLING INC Owner: KAESS, DOUGLAS L
16000 SE EVELYN ST 10882 SW 118TH CT
CLACKAMAS, OR 97015 -9519 TIGARD, OR 97223
PHONE: 503 - 650 -5014 PHONE:
FAX: 503 - 557 -2990
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/23/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/23/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/23/2011 $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 1.800.332.2344.
Issued By: Permittee Signature: iN / e, - -7 7f /./
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.
Mechanical Permit Applicat CEIVED Fclf:.(Frl( i: IlSVONIS
City of Tigard Received .r .; h tag. 1/..... Jy 5
•J a mute riy " \ /�� ./ J C 4i 30
• 13125 SW Hall Blvd,. Tigard. OR 97223 NOV 21 2011 Il ii Reyicw
II. Phone: 503.719.2439 Fax: 503.5981960 Other Permit.
Date/13y:
'1" CU:'l l { .I) Inspection Lint: 593.639.41 75 CITY OF TIGARD Date Read)' /By: Juris: RI yer Page 2 for
InRlnet. www.tigard BUILDING DIVISION Not itled /M "' °d: _/� S Information
• TYPE OF WORK COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
" ° - Mechanical permit fees'" are based on the value oft he value
❑ New construction ' Add ilion /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other; mechanical materials. equipment lab °r,,lwerh_tad, antd profit.
- .... -_ _ -- Value: S
CATEGORY OF CONSTRUCTION REylnlNi 'IALEQUIPMENT /SYSTEMS
1 - and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building _ For special infarrnationusechaelt1lsr.
❑ Multi - family ❑ Master builder ❑ Other: Description I t)ty. La. Total
-- JOE SITE INFORMATION AND LOCATION Heating /cuuliug:
Air conditioning
Job site address: 0 q 4 - ilyiv (r, JyN (requites site_plati sli wiug placcntanri 46.75
City /State /ZIT': 'T _, l QI a Z3 Furnace 10 BTU (ducts/vents) 1 46.75 y6'
,,,..c Furnace 1.00,000+ BTU (ducts /v9oh.t
Suite /bldg. /apt. no.: Project name: <_ '-' _. ^ Heat pump
re wires site 'Ion ihowial loremenil 61.06
Cross street/directions to job site: Duct work ,... 23.37
" "" "' Hydronic hot water system 23.32
L2esidential boiler (radiator or
h dronic) 23 . 3 2
-- - .... - •• Unit heaters (fuel -type. nut electric).
in - wall, in -duct, sus>ended, etc. 4675
Fl
Subdivision: Lot no,;
LIe /vent i'orsay of above 23.32 ,
Other: 23.32
Tax map /parcel no.: Other fuel appliances: --.
DESCRIPTION � 'oflu_ OF WORK Water heater ,�,• 23 .32 �„__..
ht,.c�� � I F f ((.5+0 , n u l v e n t fo r 33,39
Plug vent for water ITCater or gas
fireplace 23.32
Lo_ lWb[er(gas) 23.32 ,
Wood /pellet stove - 33.39
Wood fre.laealinsert 23 -
- Chimp /liner /flue /vent 23.32
(2 PROPk R'1'Y OWNER ❑ TENANT' Other - _
23.32
Name: Di, U , X ,e ` S Environmental exhaust and vtntilution:
Range hood/other kitchen
Address: 1 0 i Ig / � L w 11 _ e 33.39 „
City /StutL&Z1P: ' r I j 2 _3 Clothes dryer exhaust 33.39
- — Single -duct exhaust (bathrooms, .
Phone: ( ) Fax: _ - • toilet cons artments, utility rooms) 2332 .._,^
i APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23 , ; 32 ,. „,
�. Other: ._ 23.32 ,,,
Business name: . Fuel piping:
Contact name: --- A - -y yE G AND CObLING, lNC 5 14.15 for first Nur: $1.03 For such additional ...
f=urnac etc.
—
Address: Clackarnot, OR 97015 Ga s heat )um _
City/State/ZIP: ,- 503.650 -5014 - T .7 y
hone: ( ) Wall /suspended/unitheater
l > f=ax:: (SOS ) S � - _ ` 1 , 0 Water healer
.. .., _ ,. - --_.
, Fireplace . --
E -mail: .,_ Ranee —...-
.... CONTRACTOR Barbecue
-
” C lothes drvei (las)
BusutesS name: Other - °A- 7E1virl EATTNt 11ND COOLING, iTVC
Address; MECHANICAL PERM i �cESQ _
T Subtotal
t'it)' /State /'l.11' N. ClL�i ":: +.I11S 97015 -- Minimurnpermit (J,'
PI nc. ( ) Fax: ( � ) Plan review (25% DC perm N it fee _
■ r CCB firs: � f . � State surcharge (l2 %ofptn tee) r ., .
, f�Q
2 TO7 ALI'kRMITFEE (Q t�.�()�
Phis Lpermit fIJ)pli[atlall CMpireS ira permit is not obtained within ISU
Authorized signature: W �� +' tr
J days after it hug bes11 accepted as cua splititt,
�'] r p a � tNi- ee utrihodoluny se , by 1 ri- Courtly Bulldln( tudustt Sel'yace &lard
�Nrint. fl a me: I ! , AIM). �' , 1} . {t _.r, Dalel
Z0 39dd ONIld3H dW31 V 066ZL99609 6b :ZT TTOZ /TZ /TT