Permit CITY OF TIGARD MECHANICAL PERMIT
1111 11- COMMUNITY DEVELOPMENT Permit #: MEC2011 -00579
Date Issued: 12/15/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 1S136CB02000
Jurisdiction: Tigard
Site address: 8175 SW PFAFFLE ST
Project: RUIZ -PRADO Subdivision: RANCH VALLEY Lot: 1
Project Description: furnace replacement.
Contractor: NW SUNDANCE SERVICES INC Owner: RUIZ - PRADO, CUAUHTEMOC
10117 SE SUNNYSIDE RD STE F1201 8175 SW PFAFFLE ST
CLACKAMAS, OR 97015 TIGARD, OR 97223
•
PHONE: 503 - 750 -7442 PHONE:
FAX: 503 - 655 -3347
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/15/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/15/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/15/2011 $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 1.800.332.2344.
_ c
Issued By: Permittee Signature:
Call 0 .• 9.4175 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.
Mecha Permit Application 101 .:clrr ic. t SI. (i \l:''
CI Of Tigard RoeE • l _ ®A pona,cNo.. � i
s
City g � � � nate /s s" . � J — c.t1S7 y
v 13125 SW Mall Blvd., Tigard, OR 971.23 (` Plan Review
Phone: 503.718.2439 Fmt 503.59 < 1
'� Date/13y; Other Permit:
t1 i i ,,\ t�:t> Inspection Line: 503,639.4175 J 49 1:, pate keAdyJ y: rods: PI See Page 2 for
Internet: www.ttgurd- or.go'V O < , � r j� \() Notified/Method: ' - _ p Supplemental lorormaaon - -
TYPE W .., - 0 - OF ORK � ` 0` .. • COMMERCIAL F E`E SCHEDULE -USE CHECKLIST
Mechanical permit fees" are based on the value of the work
0 New t oi»3truetion FI Additionialtcration/ performed. indicate the value (rounded to the nearest dollar) offal)
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION `
..' 'RESIDENTIAL EQUIpt NT / SYSTEMS FEES' :
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special iri/brmat/on use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty- Ba. Total
. JOB . SITE INFORMATION AND LOCATION Heativicooling:
r „, Air conditioning
.. .Job site address: , p 9 o vp i
"" ' (requires site plan showing placement) 46.75
City/State/ZIP: Furnace 100,000 11T1.1 (duets/vents) % 46.75 442 ,1-,
t) / Sta te/ZIP: ll � � 9(�► - Furnace 100,000+ BTU (ducts /vents 54.91
Suite /bldg. /apt. no.: Project name: t Z — P Heat pump
— . .� _. ( requires site plan showintplacement) 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 r
Su - Other: 23
Tax reap /parcel no.: Other fuel appliances;
DESCRIPTION • OF WORK •. . Water heater 23.32 .
' eras fireplace 33,39 --
- t 11 - II . • . L ;�
lj 4 Mr.. Flue vent for water heater or gas
t 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 2332
. Chimney/liner /flue/vent _ 23.32
0 PROPERTY OWNER ' • 0 :TENANT Other. 23.32
Name; Environmental exhaust and ventilation:
Address: �. Range hood/other kitchen I 33.39
equipment
. City /State/ZIP: Clothes dryer exhaust 33.39
Singlc -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) . toilet compartments, utility rooms) 23.32
APPLICANT . . . . ' 0 CONTACT' PEIYSON' Attic/crawlspace fans 23.32
e� Other: 23,32
Business name: ✓ �1(� a ! _ F uel piping: -
Contact name: f 1 c , , m t` e T M - $14.15 for first four; $4,03 for each additional
Address: tQti 1 , U,r t ck e F I. G1 - lE ] , rttace , ...
Gas heat pump
City/ State /ZIP: G l a Qy ctei or 910 % 5 wawsus. ended/unit heater
Phone: (_ a ) ilr : ' , , Fax:: ( ,� Water heater 0. Fireplace
E- mail :AW A r ti IA.1 - y - ?* s. t. ..v . a 7e
Barbecue •
Business name: Clothes dryer (was)
Other:
Address: P , . MECHANICAL PERMIT FEES*
CiCity/State/ZIP: • r Subtotal lam/ Cr
-- - —
� , Minimum permit fee ($90.00)
Phone: ( ) I - x: ( ) _ Plan review (25% of permit fee)
CCB lie.; t 9 3 i q e State surcharge (12% of permit fee)
I________' `OTAL PERMIT FEE y e
This permit application expires it a permit is not obtained within 180
Authorized signet T► �• days after it has been accepted as complete.
Print name: D 1Sm — (1 t(1 - Pate: 14 at t1T 1 1 /02/COM/WEa) i5 1 1 , Fee methodology set by Tri-County Building industry Service Board
L' �Buildinglp9rn5itslMSC- PdmitApp.doc 091010 �
E0 /E0 39tid NflSMN LPEEgS9E05 ZZ :60 ITOZ /5I /Z1;