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Permit CITY OF TIGARD MECHANICAL PERMIT ''1 s COMMUNITY DEVELOPMENT Permit# MEC2012 -00478 Date Issued 09/19/2012 TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S110DD10600 Jurisdiction Tigard Site address 10940 SW HIGHLAND DR Project Hix Subdivision SUMMERFIELD NO 6 Lot 322 Project Description (1) furnace replacement Contractor CHASE HEATING CO Owner HIX, KAREN 2236 NE 82ND AVENUE 10940 SW HIGHLAND DR PORTLAND, OR 97220 TIGARD, OR 97224 PHONE 503 - 254 -1274 PHONE 503 - 626 -7629 FAX 503 - 254 -1816 FEES Specifics: Description Date Amount Furnaces < 100K BTU 09/19/2012 $46 75 Type of Use SF 12% State Surcharge - Mechanical 09/19/2012 $10 80 Class of Work ALT Type of Const Minimum Fee Adjustment - Mechanical 09/19/2012 $43 25 Occupancy Grp Stories Fuel Fuel Types Gas Pressure Total $100 80 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344 /� Issued By k1 - /� At Permittee Signature ©J " PP[rt c,a -flo/L Call 503 639 4175 by 7 00 a m for the next available inspection date This permit card shall be kept in a conspicuous place on the job site until completion of the project Approved plans are required on the job site at the time of each inspection I - - — — - -- - - -- Mechanical Permit Applic.i t si F F OR Off t F O\L'l City of Tigard D Resumed Date/13v Permit No AA Ce- Iv 0DLf1 Ili 13125 SW Hal] Blvd , Tigard, OR '7 ' Plan Review Phone 503 71112439 Fax 503 5981 e/gy n�, Other Punta Inspection Line 503 639 4175 P 19 2012 Date Ready /By Juni ® See Page 2 for Internet www.ttgard or.gov Nonded/Method Supple ncotai Intormavon CITY OF TIGARD TYPE (13UI L$G 1 )1t1810i'; COMMERCIAL FEE* SCHEDULE — USE CHECKLIST Mechanical permit fees' are based on the value of the work ❑ New construction &Addis ton /alteration/replacement performed Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit. Value S CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES g I- and 2- family dwelling ❑ CommerciaVtndustnal ❑ Accessory building For special Information use che klisi. ❑ Multi - family ❑ Master builder ❑ Other. Descnption I Qty I Ea_ I Total JOB SITE INFORMATION AND LOCATION Air conditioning Job site address: 1 043 460 Sl.6 14,1•4111 I 4.n d T (requires site plan Allowing placement) 46 75 �. Furnace 100,000 BTU (ducts/vents) ( 4675 di`r • --7} • / j4 City/State/ZIP Tgarzl< q 12 -4 Furnace 100,000+ BTU(dunvveins) 5491 Suite/bldg./apt. Project /a t. no J ect name: Heat pump P (requires site plan showine placement) 61 06 Cross street/directions to job site Duct work 23 32 , Hydronic hot water system 123 32 Residential boiler (radiator or hydromc) 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 23 32 Tax map /parcel no - Other fuel appliances: DESCRIPTION OF WORK _ Water heater 23 32 Gas fireplace/insert 39 •. b � /�j'�a�'� Flue vent for waler heater or gas ^'1 fireplace 23 32 Log lighter (gas) 2332 Wood/pellet stove 3339 Wood ftreplacelinsert 23.32 Chimney/liner/flue/vent 23.32 11240PERTY OWNER I ❑ TENANT Other 23 32 Name ,..ear.e.r) )4--i X Environmental exhaust and ventilation: D 9 6 60 ' I a � ei Range hood/other ther kitchen Address. equipment 33 39 City/State/ZIP: I l d.rx ( kJ r 17 ,p..-4 Clothes dryer exhaust 33 39 Phone' (�31 (kb, . 162_9 to ile comp exhaust tments, (bathrooms, coo Fax ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspacc fans 2332 Other 2332 Business name: Fuel piping: Contact name: $14.15 for first four. $4.03 for each additional Furnace, etc Address Gas heat pump , Ctty/StaterZIP• Wall /suspended/unit heater Phone ( ) I Fax: - ( ) Water heater Fireplace E-mail: Range _ � CONTRACTOR /+ Barbecue Business name: C 1v� �a w � C+ ? W � (�M tr1!w B "` l ! 1 Clothes dryer (gas) Other /� �'" Address �l _ i \e. —" ` w MECHANICAL PERMIT FEES* City!State/ZIP � + �� Oj'1'Z2,0 Subtotal ^ �3) a5� Ili � � 1+7mumtim permit fee 00) C 7 d Phone: 3 c 294' I o� 1 4. Fax: Pl an review (25 % of permit fee) I CCB he : k tJ"• 3 343 O State surcharge (12% of permit foe) /0. SV TOTAL PERMIT FEE 1 010 • $A Authorized signature `f7 81 - _ ,• A /" This permit applrcotioo expires it a permit u not obtained within 190 A"O a — J ' •K days after it has been accepted as complete. Print name 11 e. s'L & rk / Date: 9 .* 1 g--12.._. • Foe methodology set by Tn -County Bwldrng Industry Ser see Board I \BuildingiPerm u, MEC - iApp dot o]07112 440.46i7T (I1/o2/COAt'WEB) L d 9l8 L duedwoO 6uReeH ese43 e61. 01. Z L 61. deg