Permit 14 MI C ITY OF TIGARD MECHANICAL PERMIT
a COM MUNITY DEVELOPMENT Pe rmit #: MEC2012 00553
T L G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/24/2012
Parcel: 1S133DC16500
Jurisdiction: Tigard
Site address: 13078 SW LAURMONT DR •
Project: Walters Subdivision: VILLAGE AT SUMMER LAKE PARK Lot: 20
Project Description: (1) furnace installation
1
Contractor: WOLFER'S, INC Owner: WALTERS, JAMES B & CHRISTINE L
290 YOUNG ST 13078 SW LAURMONT DR
WOODBURN, OR 97071 TIGARD, OR 97223
PHONE: 503 -981 -4511 PHONE: 503 - 702 -3014 _'
FAX: 503 - 981 -0801
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 10/24/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 10/24/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 10/24/2012 $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.
' � A Issued By: �� Permittee Signature: Ot ' � Vv
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.
s. Approved plans are required on the job site at the time of each inspection.
OCT /23 /2012 /TUE 02:32 PM MOLFERS HEATING FAX No, 5039810801 P. 001
•
Mechanical Permit A lication FOR OFFICE USE ONLY
CEIVE ecev
Re er () a- u P�rnstlan.t f6C ma.. Co CO
74 'r 13125 SW Hall Blvd., Tigard, OR 9 Plan R
g Phone: 503.718.2439 Fax 503.59 .19 Date/By: Other Permit:
T 1 GARn Ins Line: 503.639.4175 OCT 2 3 2012 D at e Read y/By. r BI See Page 2 for
Internet: www.tigard- or.gov Notified/Method: -r, c Supplemental lotarmadon
4';'I ". \ 9 1 7•° i i ,, ,- 5. • • • �. i arw� Y? rt � ., ° : ° o t • C -• a = ____ aka -f:
� .EERSe .•. � 1 � '✓ .�n i - ,- � +�,.����c; a - °a.,o.�,.. —r
' j. if- Mechanical permit fees are based on the value of the work
0 New construction Addition/alteration /rep , e - performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other. mechanical materials, equipment, labor, overhead, and profit.
.t .M `� ° 4 '"+ � ,� Value:
F" to w „4W MAW c -"� " "« y � 0 6i' ¢. B 5 ''s ,
1 :11 I- and 2- family dwelling ❑ Commercial/Industrial ❑ Accessory building 14/14700..„
For special Information use checklist
❑ Multi family ❑ Master builder ❑ Other:. Description . Qty. I Be. 1 Total
a: gin �M "K � er R , a ; . F Heating /cooling:
its "s pat 4, t:4!4!..'P u i ,'° L ! r 1 ,- t Ot$ a ,�F, ��a ° Air conditioning
Job site address: /30 7e ilfirin 1 (requires site p lan slwwing p laeement l 46.75
Furnace 100,000 BTU (duos/vents) t 46.75
��/ �/ i '' r i Furnace 100,000+ BTUjductslventa) 54.91
/ Heat pump
Suite/bldg./apt. no.; Project name: requites sitestan showing placcmentL 61.06
—
Cross street/directions to job site: Duct work 2332
- Hydronic hot water system 2332
• Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
_, •- - ---in -wally in -duct, suspended; etc.— -- -- - 46 -75- —
• Subdivision: Lot no.: Flue/vent for any of above 23.32
Other. 2332
Tax map /parcel no.: Other fuel appliances:
2332
rat . • 7 " ! c a �'i�-��^ ---.-,•-).....;"-,; y 4,-:- 7c..,,_=.1.,---,-....-7,.. -� - :. Gas fireplace/insert 3339
Flue vent fbr water heater or gas
fireplace 2332
M // 'L Log lighter (Ras) 23.32
Wood/pellet stove 33.39
Wood BreplaceTmsert _ 23.32
.� ° Chimney/linertflue/vent . 23.32
''A^' rh- •1'X q : .:24.11.4.,,, , � �� 'J�" - r`� w = - , r y a r�� -�L - ia, w.
® - � u
� E'' f::... / - Other: 23.32
/ �L � .1 / �A Environmental exhaust and ventilation:
Range hood/other kitchen
Address: '� ` � . I) , equipment 33.39
City /State/ZIP 9 Clothes dryer exhaust • 33.39
'r - Single -duct exhaust (bathrooms,
Phone: "'":4;" 7/ • Q/ Fax: ( ) toilet compartments. utility rooms) 23.32
�' "'^' �� '' ,•. ''f' 1 , ,,.'.', T. f �. ° ,, Attic/crawlspace fans 2332
f
M , , a „ , t ' �O, �'""` �,u �t+a� .Q �{!" ,�.�!�t,�.. -
Other 23.32
Business name: ` =Air r , / piping:
Fuel •
Contact name: / . C F i $14.15 for first four, $4.03 for each a dditional
r`
Address: di U I / • Furnace, etc
Gas heatyumy •
City/State/ZIP: TOM 1,/1 I .� I Wall/suspended/unitireater
—
Phone: (tJ3) G.l g l- i.4. 1 r 1 f `[� � , , • b Fax; ; ( 3) q L - o RD I Water heater .
S.I. L 0 y�►� 1' J 1tC ah17d . e Range Firep
E -mail: r
, - 1 R: iii > "I t it C '"" RY lY , w« ."..',41:.V41,4 ° *�. r:`.'k Barbecue
Business name: , I1JGGI�3i1.r d / Clothes dryer (gas)
Address: /� .s �.l C - ."'dye,, er iI iO z E-F4P INSIViV
City /State/ZIP: i i ��' a � , I Subtotal
Minimum permit fee ($90.00) 6 1)
Phone: (t3) 421- 1 -4511 . Fax: ( PIA ) 9O ( J i ` DC1 p D I Plan review (25% of permit fee)
CCB lic.: I* 1 r 1 State surcharge (12% of perrnit fee) /D• •
TOTAL PERMIT FEE 1 (ib'
_ - I ' pryntr npplicntio ne nesnire$ if n permit is not obtained within 180
Authorized' signature: days after it has been accepted as complete. .
Print name: , ' C,( : A TJ Date 0 93 / • Fee methodology set by Tri- County Building Industry Service Board