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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2011 -00592 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2011 Parcel: 2S112CB06200 Jurisdiction: Tigard Site address: 15436 SW 82ND PL Project: Lloyd Subdivision: ASHFORD OAKS NO.2 Lot: 76 Project Description: Replace furnace Contractor: AMERICAN CONTRACTING Owner: LLOYD, KRISTINE D 7855 SW OLESON RD 15436 SW 82ND PL PORTLAND, OR 97223 TIGARD, OR 97224 PHONE: 503 - 407 -8538 PHONE: 503 - 279 -5241 FAX: 503 - 244 -9556 FEES Specifics: Description Date Amount Furnaces < 100K BTU 12/21/2011 $46.75 Type of Use: SF Flue/Vent For Any of Above 12/21/2011 $23.32 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/21/2011 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/21/2011 $19.93 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 Notifi . •• - 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 q -stions to •UNC by calling 503.232.1987 or 1.800.332.2344. Issued B Permittee Signatu /41111I - 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. 2011 -12 -19 19:06 AMERICAN CONTRACTING 5032449556» 5035981960 P 2/3 Mechanical Permit Application 1.()R OI'I'1( is 1 tit: Um.) City of Ti and REZO' ��E j� J�� D� � N...._ q j Prmit No.:�L' a - A 1SW Hell Blvd., Tii,ard, OR 97 2 d/ Pw Y Phonc: 503.718. 2439 Fax: 503 Other Permit: Ins ection Line; 503.639.4175 Date/By: I I t.; ;\ R 1 r p D E C 2 Date Ready /By', luny el See Page 2 for Internet: www.tigard- or.gov 2 011 Notified/Method: Supplemental Information . „� 1 u t ,- � vi H' d . r , "N 4 + } I r' V ,�.It_)b"99.1, ai,' , � ! ?: .i w ;` hr' YTr ��MN I .,� Y � , El New construction Addition /altcratirnr /re lOCemCnl ii " Mechanical permit fees' are based on the value of the work p performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. �., :.ryS Pa aarda'��P"PrfpA .�C!tlur la M , Val !, , I I A I Z') I� ti�� 7 4 c II 1"rr ll .I , a I ' ' � ' .' ,, � 4e; � , , U' 1 e l i ° �' 1i 1�. 4:Urvlr„4.4. y j i.,, I I tia,, Ai6 N ,. .nu , ., 4, w ,, I . e.. :w x.,ir` t " ' *, s rr ^ y , ;-9 •2 I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family 0 Master builder ❑ Other: Description I Qty, I Ea. 1 Total ,. i �, 1 , '] ,• t ,. l �A; "'' T. , I 'i 1! 1 , Beating/tooling: - Air conditioning Job site address: /sy.3d S F .2 KA ce , re uircs site . Ian showin' lacernent 46,75 City/State/ZIP: j I UdG / + Furnace 100.000 u l cls /vents) 46.75 �. • / Furnace 100,000+ BTU (ducts/vents) 54.91 e Suite/bldg./apt. no.: Projectna e: ,1(/'I � /� .�oc��[ Heat pump - (requires site elan showing placement) 61.06 Cross street/directions to job site: Duct work 23.32 s D _RA °� , Hydronic hot water system 23.32 ' h T A �, t dc7�r Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -typc, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: Lot no.: Flue /vent for any of above / 23.32 23 ' 32. Tux map /parcel no Other: 23,32 � `""'P�" a Other fuel appliances: - • y , r ' « I ' romnrtrw: :.,10 n,'dpl L. u,a k riu w v� � 1 ''rrm, ,.,; '4 — .... h eater 23.32 " Gas fireplace 33.39 Flue vent for water heater or gas Ae Impvr�� fireplace 23.32 • Log lighter (gas) 23.32 - Wood/pellet stove 33.39 . — Wood fireplace /insert 23.32 ..:{ ,�e .71.,! F I 1. ,, .. 'i;i$,,,., , " c;i! :'..;1 e u ,,- 4 , : n,h °6,:. .„.,,‘,,,,,'„,„,,,:,E,:.41..,1, ,t . , Chi /liner /flue /vent 23.32 Other: 23.32 Name: .4,Ir . # 44 _ n Environmental exhaust and ventilation: Address: / 6 / __5C.t) a P� a� � ., equipment boo /other kitchen 33.39 City /State /ZIP: i� CI • & J A © _Clothes dryer exhaust V 33,39 Phone: (03) ;z.71 .. s-- 4/ r Fax; ( ) - Single -duct xhaust (bathrooms, i. t -du e � 4N I ,, � T wild compartments, utility oo . y com art enu 23 32 „ p rooms) e xit I 1 as r Tai` ry !,; i ,d r �! i,� k, i• ` „ A ttic /crawlspace fans :. ;. 23.32 Business name: /� J e Other: 23,32 -' Fuel piping: Contact name: ,s./ 514.15 for first four; $4,03 for each additional Address: g - 1 ,! orV -1 Furnace, etc. City /State /LIP: ,i /,, �� Q Gas heat pump °r-ry ~' _; ~g a 9 7c2 Wall/suspended/unit heater - Phone: (a3) 407- SS06 Fax: : ( 13) ay 1 � 9 --6 . Watcrheater E-mail: /�CP�/� ed. Jf w _ � Fireplace . i Co . ��- '(�/2r Coate Range .. • "� i!:7: r' , ; . 'i , ewn ,itt'al,,.,„ a(l: 'iw :4' ,. 'e a, A, ,,FI .. Vb'. n . . + „ivf stt ,,k.;.ti: "l; ' ,,: 7., 4 ; ... ' � : I w,.. w m. ,,, . .. „ , '�9z d .,�•�W�bx• r .,. ry , y'i .q:;,.' ; � i. � :� .:� . ,, ., Barbecue Business name: Clothes dryer (gas) Address: L/ Ocher: . VGily /State %L[P: GLPOZl� ,_ .: !'' ., ': :ii. "'.J `;51 ' • 891 ' x,' ., ,..:;:•'". - Subtotal ? 67 Phone: t� 7.. �s• Fax _ _ ermit $9 fee (1,00) ° 38 x _ 3) 2- 41 v — 9 S � Minimum p (. 9Jt� 4�<J' CCB lie,: �� L� 7 - Plan review (25% of permit fee) r _ State surcharge (12% of permit fee) r eV — TOTAI. PERMIT FEE f Authorized signature: This permit application *spirts if a permit is not obtained within ISU days after it has been accepted as complete. Print name: l`s , er Date: j2 — / ? 1/ • Fee Methodology set by 'Uri-County Building Industry service Board I :\Building \Perntlte A Aoe (19/00/10 445- 4617TT ill /Q2 /CCM/WEB)