Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00584
IS 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2011
T
Parcel: 1 S133CD16700
Jurisdiction: Tigard
Site address: 13845 SW ASHBURY LN
Project: HUDSON Subdivision: PEBBLECREEK NO.3 Lot: 57
Project Description: Furnace replacement.
Contractor: SPECIALTY HEATING & COOLING INC Owner: HUDSON, MARTIN L & H SUE
7500 SW TECH CENTER DR #130 13845 SW ASHBURY LN
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 - 620 -5643 PHONE:
FAX: 503 -681 -0793
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/16/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/16/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/16/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 1.800.337 .4
Issued By: Permittee Signature: ,
-�
_ _!ice i
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.
DEC/16/2011/FRI 10:41 AM FAX Ni, P. 002
Mechanical Permit Application -s4
,S) FOR OFFICE USE ONI A'
City of Tigard - ck.
. q SW Ball Blvd., Tigard, OR iC-i'')
e (1. Received i ..,
Date/By: i i , ilMill Pemiit No.: to -...., . — .• .
7 1312 gt....,- A DPlan te/BReview y: r
' • '
• Phone: 503.7182439 Fax: 503,59 8. 960 , c N- Other Permit:
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Inspection Line: 503.639.4175
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TICARII, -.•". eCN.k. +S-P Date Ready/By: El See Page 2 for
• Internet: www.tigard-orgov (* %.0% Notified/Method: M, Supplemental Information
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Mechanical permit fees* are based on the value of the work
E New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition Other; mechanical materials, equipment, labor, overhead, and profit.
Value $
.;•';:.:/:;•;....:;:''', :: CO ',1;:,(;' , .,..:, ...... ••••• - • • . •• • . • • • ••• ••, •• • , • .• . -.. • •••• • • •• . .
:•• : .. - ' •-• ••••,•••,.; • `;''' •-• •••• • '•-• :':' • •-•, '; • •••• •;,-- --•,• ,•,•• • • •-• • • •• ■-••• ''; ••'• ''' " • ' ' • ' 40 ••• •" 'Y •''•'''' •'4,./.WPP1,3:1.410.'.-90,1•WiT;10:§TPREPM'7'1';:4.1.'.':.'
I
I - and 2-family dwelling 111 Commercial/industrial 1:1 Accessory building
Multi Master builder 0 Other: Description For special Information use checklist.
0
I Qty. I Ea. I Total
''''''••: Jt:WON4ti.c*rviXtyi*..,ii,:4660.i..04.,.xik,,77777,777 Heating/cocain:
'.;''''•‘':' Y.' - .!.' '.....:' ''' ',- 1..-- . ' l'• " :''''''''''''''''':.;' : '''''.;:: 4 Air conditioning
Job site address: (requires site plan showing placement) 46.75
City/state/ZIP: Hudson, Sue & Martin R11389 Furnace 100,000 BTU (ducts/vents) 1 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
13845 SW Ashbury Lane
Suite/bldg./apt. no.: Heat pump
Tigard, Or. 97223 (requires site plan showing placement) 61.06
Cross street/directions t (503)524-8754 Duct work 23.32
Hydronic hot water system 23,32
Residential boiler (radiator or
hydronic) 23.32
Unit heateis (fuel-type, not electric),
in-wall, in-duct, suspended, MO. 46.75
. —
Flue/vent for any of above 23.32
Subdivision: Lt no,:
Other: 23.32
Tax map/parcel no.: Other fuel appliances:
. '
)Ci ;',.4.ffR;:-; ., ::•,n:.'j Water heater 23.32
Gas fireplace 33.39
_ Flue vent for water heater or gas
fireplace 23,32
—6T/L4 Log lighter (gas) 23.32
. ..
_
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
23.32
. . i . ,:' :.. : ; : .!‘„:: . ":•'::., Akt70001r,*,'0.V., l'''..; :;17 ;:.-:':,,:;:. ":'
' Other: 23.32 .
Name: „SG-4 - Environmental exhaust and ventilation:
Address: . Range hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.34
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility moms) 23.32
'...:.. 'C l:1,:APIIICNI.:.‘ 2. ''.,: , : . :',: .,,„; . : Attic/crawlspace fans 23.32
Other. _ 23,32
Business name:
Fuel plptng:
Contact name: 514.15 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
CQNFRACTOR Barbecue
.. .
Business name: Specialty Clothes dryer (gas)
ialty Heating & Cooling Inc
., Other:
Address: 7500 SW Tech Center Dr Suite #130 .... ,•••.:,:,:. , .' ..::. NEC,73,01,ICAt PEI •YEEs!..,.,„ . ;.: , .....,:Y,:.,,.:
City/StateJZIP: Tigard, OR 97223 Subtotal `1.4 , Yr
Minimum permit fee ($90.00) qi),...4
Phone: (503) 620 Fax: (503) 598
Plan review (25% of permit fee)
CCB lie.: 66578 State surcharge (12% of permit fee) i (0.)
..,
u....s TOTAL PERMIT FEE / 00 ,
12-------. This permit application expires If a permit is not obtained within 180
Authorized signature:
days after it has been accepted as complete.
Print name: 11,11,41/4/..e....,
_ _6601'1 Date: W II(40/// • Fee methodology set by Tri-County &Odin Industry Service Board
I: \Building dot 00/09/10 440,4617T(11/01/COWIVRE)