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Permit ` CITY OF TIGARD MECHANICAL PERMIT 14 s- COMMUNITY DEVELOPMENT Permit #: MEC2012 -00085 TIGA 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2012 Parcel: 2S103BB11800 Jurisdiction: Tigard Site address: 12140 SW ANN PL Project: Borman Subdivision: YE -OLDE WINDMILL Lot: 37 Project Description: Replace gas furnace. Contractor: ROSE CITY REFRIGERATION HEATING & AIR LLC Owner: BORMAN, NANCY F PO BOX 19207 12140 SW ANN PL PORTLAND, OR 97280 TIGARD, OR 97223 PHONE: 503 - 636 -5371 PHONE: FAX: 503 - 655 -4669 FEES Specifics: Description Date Amount Furnaces < 100K BTU 02/14/2012 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 02/14/2012 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/14/2012 $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: P , , i Permittee Signature: 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 Application FOR,OFFICE USE ONLY CI Of Tigard Received - ` Blvd., 3 V DJ Date /By' or rmtt N E / 13125 SW Hall lvd., Tigard, OR Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date /B• Other Permit. - TIGARD Inspection Line: 503.639.4175 FFR 1 4 7012 Date Ready/By: H See Page 2 for Internet: www.tigard- or.gov pygr�� Notified /Method. Supplemental Information r ^t r-' "GARD -„ o: .: f •_ "} ,%' COMMERCIA i iF.EE* SCHEDULE CIIEG ,,, . ; . <:: �', u;W q tr,::,:: y� °::..,: > .:_;.. ..,. „ ,., ,,,•i � YPE, F4't �;4 , , .- ,., .._ , >,..,,... „ ,,.,x�,.,_, ,.. - . -�,,,. - Mechanical permit fees* are based on the value of the work ❑ New construction ,...0 1 Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. ., ,..:: _ . . : , ; -- CATEGORY`: OF CON ' ''; , sK ,;. , z . air' .-, ,.,' <, � . -. - _:... ,:; > -_:.. � :. " RESIDE I\ " T I Ati`EQ[;T[PIVIEN T /:SYSTEMS * ° " .':x....._.._,�, Al" and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total „'' �. , : .. Heating/cooling: ts,'11:, J9 ITE.;INFORMATION.x;AND, LOCATION. ,,,.;_ Fes..:., ,,.. -.� � .. . �: F., _ ,, -�. '.,.: � ,. -x , ° - °� - Air conditioning Job site address: 'Z ( [.t • S w ' er.,.. , (requires site plan showing placement) 46.75 Furnace 100,000 BTU (ducts /vents) ( 46.75 y L.7( City /State /ZIP: /7y 4„.-W ©� ''f 2 2-21 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite /bldg. /apt- no.: 1 Project name: Heat pump (requires site plan showing placement) 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: ,, : ; : , t x.y >: ; , w. F»° ;•,;, , Water hea ; i '- , , SCRIPTION " OF WORK v ,,' ` ; v , ,' , t " 23.32 ,.( ,.. �- ,,,- s��.:T� .,..,,..- ..•r6L ✓iota. -�- , ,. �' rs ..� �i , • ° -.. - .. ::Y i,�'','f. , % ✓,: -, --- L Aril ay Gas firepla 33.39 ( e �s GL f � / _ Flue vent for water heater or gas t/ fireplace 23.32 Log lighter (gas) 23.32 Wood /pellet stove 33.39 Wood fireplace /insert 23.32 „PROPERTY`•OWNER ; "° Chimney/liner/flue/vent 23.32 > :•(�"' ” ry ® ` TENANT ,. 3 x . -. „`': •, ... '.ry > °' :-;; 1 .; y " .: Other: 2 32 . Name: A ,) A A G , , 0 v a 0 Environmental exhaust and ventilation: Address: S.4N"�L gsLC 3% l, Range hood /other kitchen equipment 33.39 City /State /ZIP: Clothes dryer exhaust 33.39 Phone: ( ) Fax: ( ) Single -duct exhaust (bathrooms, toilet compartments, utility rooms) 23.32 s; APPLICANT- '4,;•;',' ' rE:';`° ,;x ,;. , -_.- -' : ;� , i x ' . ❑ � � Attic /crawlspace fans 23.32 CONTACT.,;PERSON ' ' .. Business name: Other: 23.32 Fuel piping: Contact name: $14.15 for first four; $4.03 for each additional Address: Furnace, etc. Gas heat pump City /State /ZIP: Wall /suspended/unit heater Phone: ( ) I Fax: : ( ) Water heater E -mail: Fireplace Range ��„ CONTRAC�?T,QR" ; '�, � ;_;; . . �; <'S' = :x..;;,;o z,,,� ^'� ��� Barbecue _ Business name: e,),/,.. e4 �/, _ , Clothes dryer (gas) �? �� Other: Address: ? v ? O " / `7 2 _ 0 ,.,,,,. '�' � "` MEC *max ' "av ERM1T °,ET;�S,. m City /State /ZIP: '? 0 4-...A, 04 C 7 z -c Subtotal t-f . 7 S� _ Minimum permit fee ($90.00) / (� ,, _ _ Plan review- (25 %.of- permit- fee) - - Phone: (Sa 3) (0 3 (o — 3 7 / Fax: (S i 3) C S C —�� -VB lic.: l6 � 3 ZS State surcharge (12% of permit fee) CCCC TOTAL PERMIT FEE / r ro This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: GZ,t..0 / �, , Uw Date: Z/`c / 2 * Fee methodology set by Tri- County Building Industry Service Board t. \Buildi \Perm its \MEC- PermitApp.doe 09/09/10 440 -4617T (11/02 /COM/WEB)