Permit CITY OF TIGARD MECHANICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit #: MEC2012 -00521
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/10/2012
Parcel: 2S102CA00904
Jurisdiction: Tigard
Site address: 13320 SW ASH AVE
Project: Burgess Subdivision: VILLAGE GLENN Lot: 4
Project Description: Installation of gas furnace and a/c Placement of a/c unit must maintain 5' side and approved rear yard setbacks
Contractor: WOLFER'S, INC Owner: BURGESS, ROBERT
290 YOUNG ST 13320 SW ASH AVE
WOODBURN, OR 97071 TIGARD, OR 97223
PHONE 503 - 981 -4511 PHONE 503 - 449 -8771
FAX: 503 - 981 -0801
FEES
Specifics: Description Date Amount
Air Conditioning 10/10/2012 $46 75
Type of Use: SF Furnaces < 100K BTU 10/10/2012 $46 75
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 10/10/2012 $11.22
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
Total $104 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 Notificatio r. 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 que 'ons to OUNC calling 503.232.1987 or 1.800.332.2344.
c
Issued B : / Permittee Sig ure: i , { �__
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.
OCT /09 /2012 /TUE 02:02 PM MOLFERS HEEATING FAX No. 5039810801 P. 001
Mechanical licatioi IECEIV : OR • F OFFICE USE ONLY
cal Permit Ap P
`J Tigard OCT 0 9 2 01 2 d p Permit lyfL
Cx of Ti and D aterer. /O / ' �o / - o � ,
- ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 M p� Date/By: Other Permit:
TIt:Ar Inspection Line: 503.639.4175 V8� T RallflU Date Ready/By. .ham: 91 See Page 2for
Internet www.tigard.ar.gov BUILDING DIVISb oti6ed/Metbod �w� ORI �; Supplemental Information
.__ : 1v \" a K MvE,1 ;._,-- h ' . 1 ,V N'I 7-01b�'� •.'.� t'
+ "7.'n '-� �r-r` "r1` .:c F�„I''t.�' F•: 1.y . `.' y _ �i,..� •^
e Mechanical permit fees are based on the value of the work
['New construction Addition /alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials. equip ent, labor. overhead, and profit
° .i ,,-�fia. ,� . a u ,i a e ' l &370 d�w< .-. = ± _ .. o,.�nslb' l , i �f�i'7 " ' ' _ .
0 1 - and 2- family dwelling ❑ CommerciaVindUStrial ❑ Accessory building w For speclol information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description . I Qty- I Ea I Total •
Heating/cooling:
n -. °,; 1 1!-4. ' "l?�' ".� ") --i-- <bid ,-- --a �.t� ; i Air conditioning
Job site address: ( 332. %SW (requires site plan showing placement) 1 46.75 4fo%
Furnace 100,000 BTU (ducta/vents) I 46.75 -'2S
City /State/ZIP: u L j. . Q� 91 2 Furnace 100,000+BTIJ (ducta/venta) 54.91
Suite/bldg. /apt no.; Project name: Heat pump
(requires site plan slowing placement) 61.06
Cross street/directions to job site: , Duct work 2332
Hydronic hot waterystem 2332
Residential boiler (radiator or
—
hydronic) 2332
Unit heaters (fuel -type, not electric),
• in -wall, in -duct, suspended. etc. 46.75
- I no.: Flue/vent for any of above 23.32
Subdivision: — Other: 23.32,
Tax map/parcel no.; Other fuel appliances:
m ^,M+ w µ ,� `","• r (- ...,, ; e i vtia cc z ,N Water heater 2332
i � � ;1:T�u '" � , .at " . ' Gas freplace/insert 3339
,ec - " 04,1 Q , Flue vent for water heater or gas
fir -lace 23.32
Log lighter (:r 23.32
. _ Wood/pellet stove 33.39
• Wood fireplace/insert 2132
• C-4. J i v � j �4 W "��` T , ` 4 pt F Chimney/liner/flue/vent 23.32
,� .,r,,, ._,. - ..,.-..,: �=F - .:rir-- ---4,T w. -zt Other. 23.32
,., �. r. n:-... •cx^......, •. -
Name: , � d .. - teIr Environmental exhaust and ventilation:
Address: /3 3 zo s2„,/ Ark 11.-" Range hood /other kitchen
equipment 33.39
City/State/ZIP: T t J ' , i 9 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: l ) r ^ • Fax ( ) toilet compartments, utility rooms) 23.32
P rl•r y 4.' 61 L 4.;" ' s3 ..$7, A t ,1. +k hL _ . Lg Eel' _ Y fro :e•I 17 Artic/crawlspace fans 2332
Other. 23.32
P / -/, S d Fuel pipi g:
• Contact name: ... / . sic, &a - 514.15 for first four; $4.03 for each additional
/� Furnace, etc -
Address: /v U 1 / '
Gas heat pump
1 I.G I._ 1 i V. ' 1 Q I Wall/suspended/unit heater
��
Phone: (IS3) Gig 1 4s I i ` Fax : (�j) q gJ _ p � l heater
Wreater er 'lace
he he
E -mail: / tea, 111 Y ) 01 -' r r e a_11,11,0 - / )1' ' " - -- -- -- - Range • - • .. • • • _
.7 k. — t :• a aye; R v a „ " ^ M- ^, ? Barbecue ..
Business name: 1,rif 1 ( � g � N r / Ctheres d (gas)
Address: /� i J i ....,1 / a't l , _ _ c :4•r'il.' TAVAI4,44.41agtrAtgi
City /State/ZIP: ` ralEdi ` / 1101 f Subtotal gs•se
�� Minimum permit fee ($90.00)
" t
Phone: (603) if I I - J 11 Fax: (tj) 9g - D; S f _ Plan review (25% of permit fee)
CCB tic.: State surcharge (12% of permit fee) 1 i • ZZ
J ,
& g ���� TOTAL PERMIT FEE ►nLl -• z..
This permit application expires If a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete
Print name:. ' CC I / 4411- Date: ( e q, ( / � ' Fee methodology set by Tri -County Building Industry Service Board
OCT /09 /2012 /TUE 02:02 PM IIOLFERS HEATING FAX No. 5039810801 P. 002
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