Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00173
Date Issued: 04/05/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 25103DA02500
Jurisdiction: Tigard
Site address: 10790 SW DERRY DELL CT
Project: Bronte Subdivision: DERRY -DELL NO.2 Lot: 27 & PT
. Project Description: Oil to gas furnace conversion, gas piping
Contractor: PORTLAND HEATING INC. Owner: BRONTE, DENISE
PO BOX 828 10790 SW DERRY DELL CT
LAKE OSWEGO, OR 97034 TIGARD, OR 97223
PHONE: 503 -697 -5047 PHONE:
FAX: 503 - 697 -0675
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/05/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/05/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/05/2012 $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.
Issued By: 11 A Permittee Signature: nN r
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. •
Apr 0412 09:28a PORTLAND HEATING INC 503 697 0675 p.1
•
Mechanical Permit Appli lation FOR OFFICE t SE O\1.I"
City of Tigard so M ED D ,: v ispird aJ Permit /sip.: N te R /A -eWP) j .
13125 SW Hall Blvd, Tigard,i. • • P 3 Plan Ravi
Phone: 503.718.2439 Fax: 503 98.1960 4 2012 Date/By. Other Permit
TI G A R D Inspection Line: 503.639 APR Date Readyl ly. Jam: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Metbod: Supplemental Information
1TY OF TIGARD
TYPB
eisairISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees' are based on the value of the work
❑ New construction
Z Additi alteration/ lacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit.
Value: $
CATEGORY Ot CONSTRUCTION
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commefcialriindustrial ❑ Accessory building For special irfor radon use checklist.
❑ Multi - family ❑ Master builder ❑ Other. Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 10790 sw derry deli court I (requires site plan showing placement) 46.75
City /State/ZIP: Tigard, Oregon 97223 I Furnace 100,000 BTU (duets'vaus) 1 46.75
Furnace 100,000+ BTU (durctslveats) 54.91
Suite/bldg, /apt. no.: I Project matte: f.-e G i- Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: west on ark, off 99E, . on wilkins, Duct work 23.32
then : • onto deny dell, .61 e o • i ;� o Reside c. S 1 r y e T is hot water system 23.32
Residential boiler (radiator or
R> I Unit heaters 23.32 -
� I /Miff i Unit hea (fuel-type, sus not electric), 46.75 ectric),
in-wall, in -duct, suspended, etc.
Flue/vent for an y of above 2332
Subdi . ion: I i Lot no.:
Other: _ 2332
Tax map /p • —I no.: Other fuel appliances:
• x CR1PTO N OF WORK Water heater 2332
e 14.1 Gas fireplace/insert 3339
Oil to gas furnace 96% Tempstar — C P i F (N G Flue vent for water heater or gas
fireplace 2332
Log lighter (gas) 23.32
Wood/pelletstove 33.39
Wood fireplace/insert 2332
PROPERTY OWNER I ❑ TENANT Chimney /iner/tluelvent 23.32
Other: _ 23.32
Name: Denise Bronze Environmental exhaust and ventilation:
Address: 10790 SW Berri Dell Court Range hood/other kitchen
equipment 33.39
City/State/ZIP: Tigard, 97223 Clothes dryer exhaust 3339
Phone ( ) Fax ( )
Single-duct exhaust (bathrooms,
toilet commitments, utility rooms) 23.32
❑ APPLICANT i dri ❑ CONTACT PERSON Attic%rawlspacefans 23.32
Business name: Portlandne. I Other. 23.32
Fuel piping:
Contact name: J. Paul Cessaro $14.15 for first four, $4.03 for each additional
Address: PO Box 828 Furnace, etc. I I
Gas heat pump
City/State/ZIP: Lake Oswego, Oregon 97034 Wall /w
spendu:d /unit heater
Phone: (503) 697 5047 1 Fax: : (503) 697 0675 Water heater
E-mail: portlandheatiaginsn.eom I Fireplace
Range
CONTI#ACTOR Barbecue
iness name: Same Clothes dryer (gas)
Other.
Address
MECHANICAL PERMIT FEES*
City/State/ZIP: i I Subtotal
Minimum permit fee ($90.00) 90
Phone: (503) 830 9403 I Fax: ( I ) Plan review (25% of permit fee) 5°
CCB lic.: 62886 6,figfh 3 State surcharge (12% of permit fee) 10.80
Ov I
r 6 TOT_4i PERMS E 133t3' Authorized signature: This permit application expires pines if f not permit is not t obtained within 1811
days after it has been accepted as completes /AD •
Print name: J. Paul Cess . I Date: 4/1/12. 1 • Fee methodology set by Tri- County Building Indusuy Service B i
T: V3�7douglPr hsl�CPermuAppdac 111107/12 I aaoabtyl ot/ozreoM,WEB) 6)4