Permit CITY OF TIGARD MECHANICAL PERMIT
,1111
'• COMMUNITY DEVELOPMENT Permit #: MEC2012 -00150
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date issued: 03/22/2012
Parcel: 1 S133CD10100
Jurisdiction: Tigard
Site address: 11856 SW WILTON AVE
Project: Huynh Subdivision: COTSWALD MEADOWS NO.3 Lot: 133
Project Description: Replace gas furnace
Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: HUYNH, QUYNH -HOA T
PO BOX 80607 11856 SW WILTON AVE
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE: 503 - 233 -1779 PHONE:
FAX: 503 - 651 -3345
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/22/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/22/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/22/2012 $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 N• ' - • enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir- questions to a (ling 503.232.1987 or 1.800.332.2344.
Issu =d By: 1 01 4 Permittee Signat re:
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.
04/17/2007 01:50 FAX 5036513345 BENS - HEATING&AIR 0002 /003
Mechanical Permit Application
Received n. / � )}
~ City of Tigard Date/By: 7 iv � i Permit No.: ,riL �
's 13125 SW Hall Blvd., Tigard, OR 972;4 ►►►► \ ` Plan Review
R Phone: 503.639.4171 Fax: 503. . tt60o l \‘;\ Date/By: • Other Permit:
• t t. t , Inspection Lino; 503.639.417 Date Ready/By;
- El See Page 2 fur
•
Internet: www.tigard•or.gov Ni..; �/ , � `` Notified/Method: Supplemental lnformatIon •,
TYPE OF WO OF Q ) ` , COMMERCIAL FEE* SCHEDULE •- USE CHECKLIST
❑
New construction Addition /alterati�' neat Mechanical permit tees* arc based on the value of the work
performed, Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: �� mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: $ —
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
K1- and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use chv.ckNrr.
❑ Multi•family ❑ Master builder ❑ Other: Description Qty. I :a. 'loud _
JOB SITE INFORMATION AND LOCATION 'leafing/cooling
Job site address: 1\ 1r5-( S I .- , • \ Air conditioning w � -y
y�J ( re q uire s 9de plan chewing placement) 46.75
City /State / /..iP"1 t�N ` ()51... �, LZ 3 Furnace 100,000 BTU (dnctn/ventx) i 46.75
`, Furnace 100,000+ BTU (ducts/vents) 54.91
Suite /bldg. /apt. no Project name: �"'V f v Heal pump 61.06 ___-
C'ross street/directions to job site: / f Duct work _ -- _ 7.3.37.
• 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
Flue /vent for any of above 23.32
Subdivision: Lot no.: Other: 2 3.32 ' • -
Tux ttttip /purcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32 ,
�o Gas ti j,lace 31.39
•(�1(°ic P c' g FU PN 4Ct Flue vent for water heater nr gas
fireplace 23.32
_ " —
-_ Lug lighter (gas) 23.12
Wood/pullet stove 33.39
Wood fireplace/insert 23.32 __
Chimny/lincr /flue /vent 23.32
PROPERTY OWNER I ❑TENANT
Other: 23.32
Nature: f io.e, a yN,/ Environmental exhaust and ventilation
I Range hood/other kitchen
Addrens: / / 7(.a to ei110✓[ equipment 33.39
_._...
('it)'Itit ;rte( /.11'_ l� /� q •z _ ZZ _ 33 • 39 Clothes dryer exhaust _33.39 -
- t --•-- Single -duct exhaust (bathrooms, - - 1
Phone: (V ) s ' _ G 705 Fax: ( ) toilet compartments, utility rooms) 23.32
g APPLICANT ❑ CONTACT PERSON Altic /crawlspace fans 23 .32
Itusincss panto: °...'.. °._..- --
■ - � — J_... - --
Fuel piping .. ____
Contact tu Si ' 1.1‘,,r o $14.15 ror first four; 54,03 for each additional
Address: Furnace, etc.
$14.15
Gas heat pump _
<'ity /Suns / /.IP; ' Walllsuspended/unit heater
Phone: ('.J f
-3 ' gg 0 Fax:; ( ) Wafer heater . - - -- - -
Fireplace
l i -nisi l; Range • _ _..
CONTRA OR Barbecue
Business name: .......... ' N S / f i hIC �' r'T G O ther:
Address: ! 0 lti a � / „ � j ' 7 MECHANICAL PERMIT FEES*
C
city/slate/ZIP: iC cr /triAm. 0I- C t7Z g:0 --- Subtotal
( '�G ) - � ) 3.s' ' 1 ? Fax: (� (�yS! '�S r• • Minimum permit fee (390.00) - Va :lJt�
....... ._._�___ ,,._ _, _•_ • '� Plan review (25% of permit fee) _--
A. a lie.: , 1 js--(i •7 State surcharge (I2% of permit fee) ' _ /p. 2 •-'
TOTAL PER,N1t'I' FEE /Do . $'n
Au Uiorizcd signatur :
This permit application expires if a permit Is nut obtained within Ian .
days after it has been accepted as complete. (\ l
P rins name: Dule:3� Z I — ( 'L • Fee men,udningy set by Tri- ('minty Building Industry Service n•
I 'Jtuildina'Permits.\ILC.PermnAp .doc 1IN1/09 440 4oi7r(I 1/02/COM/WIR)