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Permit CITY OF TIGARD MECHANICAL PERMIT 11 COMMUNITY DEVELOPMENT Permit #: MEC2012 -00280 T [GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/30/2012 Parcel: 2S103DC06200 Jurisdiction: Tigard Site address: 11200 SW FAIRHAVEN ST Project: Strealy Subdivision: EXODUS Lot: 3 Project Description: Install furnace Contractor: SPECIALTY HEATING & COOLING INC Owner: STREALY, GARY C 7500 SW TECH CENTER DR SUITE 130 11200 SW FAIRHAVEN ST TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503 -620 -5643 PHONE: 503 - 887 -4002 FAX: 503 - 681 -0793 FEES Specifics: Description Date Amount Furnaces < 100K BTU 05/30/2012 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 05/30/2012 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/30/2012 $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: Permittee Signature: fbk a pPt/ r fplb 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. MAY /29/2012/TUE 09:55 AM FAX No, P, 002 c ' Mechanical Permit Application FOR OFFICE USE ONL,' ,�j/ City of Tigard Received • B^ I y Pennit .� ,n9 - DI , . I b � ' A 13125 SW Hall Blvd., Tigard, OR 9 i3� -E ED Daie -B : W/ a Phone: 503.718.2439 Fax: 503.59 6 t C �I Plan Review Other Permit: Date By: 'l' I G A R D Inspection Lint: 503.619.4175 Date Reedy'9y: lb See Page 2 for Internet: www.tigard or.gov SAY 2 9 2312 Notifled'Method: M Supplemental Information TYPE OF i ' ! OF TIGkI COMMERCIAL FEE* SCHEDULE - USE CHECKLIST t la 1 tl ���y Mechanical permit fees* are based on the value of the work ❑ New construction ddition /that ktie n l• ce performed. Indicate the value (rounded to the nearest dollar) of all • ❑ Demolition ❑ Other: mechanical materials, equipment. labor, overhead, and profit. Value: $ CATEGORY O): CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* Et and 2- family dwelling ❑ Commercial /industrial 0 Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description J Qty, Ea. I Total • JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: (requires site plan Showing placement) 46.75 City/State/ZIP: Strealy, Gary R12172 Furnace 100.000 BTU(ducts:venls) I 46.75 - 11200 SW Fairhaven St Furnace 100.000+ BTU (ducts'vents) $4.91 Suite/bldg. /apt. no.: Heat pump Tigard, Or. 97223 (requires site plan showing placement) 61.06 Cross street /directions to (503 - 4002 Duct work , 23.32 Hydranic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, induct, 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; _ __ DESCRIPTION OF WORK • Water heater 23.32 Gas fireplace 33.39 Flue vent for water heater or gas I AA-A-Wit- ,b)..A-Pel4e-e-, fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23,32 PROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 23.32 Other 23.32 , Name; �/. Environmental exhaust and ventilation: Address: Range hood/other kitchen equipment 33.39 City /State /ZIP: Clothes dryer exhaust 33.39 Single - duct exhaust (bathrooms, Phone: ( ) Fax: ( ) toilet compartments. utility rooms) 23.32_ ❑ APPLICANT . ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Business name: Other: - 23.32 - - Fuel piping: Contact name: $14.15 for first four; $4.03 for_eaeb additional Address: Furnace, etc. Gas heat pump City /State/ZIP: Wall/suspended/unit heater - Phone: ( ) Fax:: ( ) Water heater r Fireplace E -mail: Range CONTRACTOR Barbecue . Business name: Specialty Heating & Cooling Inc Clothes dryer (gas) Other: Address: 7500 SW Tech Center Dr Suite #130 MECHANICAL PEI2MITFEES* City /State /ZIP: Tigard, OR 97223 Subtotal Phone: (503) 620 -$643 Fax: (503) 598 -0718 Minimum permit fee (590.00) Plan review (25% of permit fee) CCB lit.: 66578 State surcharge (12% of permit fee) TOTAL PERMIT FEE -- /oD•$V ' Authorized si ature: This permit application expires If a permit is nut obtained within ISO days after it has been accepted as Complete. Print name: 4/4-1/S2,_ (fl/1. Date: 2 L- • Pee methodology sal by 76-County ©uikling Industry Service Board I: nuildint Pci mit6 NIEC- ParaliApp.doc 00 09 10 +10-1617111 02 CO)-1 w'l=-111