Permit CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00186
Date Issued: 04/13/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S111CD01200
Jurisdiction: Tigard
Site address: 9500 SW SUMMERFIELD DR
Project: Miller Subdivision: SUMMERFIELD NO.7 Lot: 362
Project Description: Gas furnace conversion, tankless water heater, gas fireplace and gas piping for furnace, water heater, fireplace
and range.
Contractor: REX HEATING & A/C Owner: MILLER, SCOTT
14015 SE STARK 9500 SW SUMMERFIELD DRIVE
PORTLAND, OR 97233 TIGARD, OR 97224
PHONE: 503 - 255 -7233 PHONE: 503 - 560 -2951
FAX: 503 - 257 -6317
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/13/2012 $46.75
Type of Use: SF Water Heater 04 /13/2012 $23.32
Class of Work: ALT Type of Const: Gas Fireplace 04 /13/2012 $33.39
Occupancy Grp: Fuel Piping 04/13/2012 $14.15
Stories: 12% State Surcharge - Mechanical 04 /13/2012 $14.11
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $131.72
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 direr uestions to UNC by calling 503.232.1987 or 1.800.332.2344.
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C C
Issue By: Permittee Signat e: i - ,
•ii:1 ( II left.
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.
' • CEIVED
Mechanical permit Application p t'1 rl( OFFICE I('f: I itil•; (hvl.v
City of Tigard A " 1 R 1 20 .• .owed
• 13125 SW Hall Blvd., Tigard. OR 97223 Date/By; , L. - :,:- b /7• Permit No.:
Phone: 503.718.2439 Fax: 503,598.1960 CI OFTIGA ty '
i Other Permit:
t 1 , ;,� , i ) Inspection Lino: 503.639.4175 BUIL I1 ING DIVI r
Internet: www.tigard•or.gov ' eedyBy: Lot: la fire Pane for
Notified/Method: Supplemental I Information
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TYPE OF WORK • CO G RCIAL ' EEo SCHEDULE - USE CHECKLIST
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•
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❑ New construction ddiltoNaltcration/replaccm�nt Y Mechanm `= I permit fees* are based on the value of the work
performed Indicate t 1c value (rounded to the nearest dollar) of all
[] Demolition ❑Other: `ecmtaniet I materials equipment, later, overhead, and profit.
CATEGORY OF CONSTRUCTION , Value: $
! dwelling ' .:IUEN'mnfJ /SYSTEMS FEES.'
- and 2-family
Y g ❑ Commercial /industrial ❑ 'Accessory building Par xpr b(/arrmNan ore rhec.t1ivR
❑ Multi- family ❑ Master builder
❑ U lher: Descriptio �. L a. Total
JOB sin: INFORMATION AND LOCH ON Iieating/c ltlin ;
]uh site address; Air coedit Y ring -
9 Sw Si r net . i- l E 'x �� — _ re. afro sit- . Ian ahowl.: rlucement 46.75
City/State/ZIP: 77 / `, 7 • Z Furnace 1.0 000 WI' ducts/vents 1 MUll
v Furnace I 0,0001 B U dee:events) _ 54.91
Suite/bldg./apt. no.: Project name: I lint porn — —
Cross street/directions to job site: I (requires sit plan showi r. placement) 61,06
Duct work 23.32
H dronic I nt water a ,. tem 23.32
— Residentia boiler (ra boor or �-
It dronic 23.32
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Unit heater: (flrel•typ ,not electric),
• - . - -- _ — in •wall, in -•uct, susp•nded, etc, 46.75 _
Subdivision; T of Flue/vent ran of ove 23.32
Other: 23.32
Tax map /parcel no.: I Other fuel a .
(lance :
A_w r DESCRIPTION OF WORK Water heat - r 23.32 Ram
�'� 7 ' S LF!>p r+, �/Q11S� � ] Cos fir ' Ia e �MI 33.39 likl
( Flue vent 1.r water It. stem or gas
77W4C `65 S t rn-i 1 0 /14ZAW S '1 firepl - 23.32 --
, I Lo :li: htcr :as 23.32
1el
$ 6i4 )e �t
7Q WuN•cil- stove En 33.39
Wood tire. sec/insert 23,32
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ROPERTY OWNER TENANT Chimney/liner/flue/ye 23,32
Namc: Sl //C L
Other; 23.32 L st; Environmental exhat st and ventilation:
Address: /MO s w S wsis Wed /, p Range hoot /other kitchen
e•uipment _ 33.3
City /State/ZTP:17;9 ) ___/..0/2_ Ql 2,2
U Clothes d ry r Walling _ _ 33.39 -
Phone: (�3) I// ��� _al
( ) Single -duct exhaust (b ithrooms, -
toilet coin rtmcnts, u ilit rooms 23.32
• ' ' (CANT • i a CON�FA(.T PERSON Attic/crawl ace fans _ 23.32 _
Business name: h�FX � J
� I Other: 23.32
Contact name: & [ � Fuel Lrtpin
9 $114.16 for li . 1 four $4.1.13 for each nddlllona
Address: / Liar S C f Mg r ] 1 - Sr, Furnace etc, 1
City/State/ZIP: l e14') Mgr( nl r gq 7 23 3 ass hoar • o
V Wall /suspe dcd/unit h : ter _
P
via
hrnc: (1Zi'3) 2 Si ii . 7Z 3 3 I Fox:: ( ))2-51-, C3 I ? _ Watcr hate -
r
E-mail: I Fire •lace
CONTRACTOR Ran:e _ _ I
_ Barbecue
Business name: • Clothes dryer (gas)
Address: - -- I Other; 1
City/State/ZIP: - i -' - •-
MItCH NICAL PERMIT FEES*
Subtotal • ,
Phone: ( ) Fax: ( ) M.i imum permit fee ($90.00)
C(:D lie � / - ( -- _ Plan eview (25%ofpermit fee) ^ t-•-
GC c � f.... �� State sur c(12 %of permit fcc) (Li. II
• OTAI, PERMIT ITF;F „7 _
Authorized signiitttrc:
"7 ( .--__ Thle permit , ppllcellon spires If a permit le not obtained within can
r _
aye after I lute been accepted u complete.
Print name:
/I.asf � •• - , De ^ (r --i'.11 • Nee meth.. )logy act 6 Tri•Counly Building Industry Service Board
I: Wuildin9lPermae\M C- Permilna .doe 09/09/10 I 140 -del Tr (II/02/(:OM/wpa)
Z000 /Z000l1 9NIIV3H X38 LLE9L9ZC09 XV3 WdOI:Z 31.0Z /ll /b0