Permit •
'CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2012 -00602
• T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/21/2012
Parcel: 2S114BB14700
Jurisdiction: Tigard
Site address: 10477 SW RIVERWOOD LN
Project: Slater Subdivision: SWANSON'S GLEN NO.2 Lot: 88
Project Description: (1) gas furnace installation
Contractor: PIONEER GAS FURNACE Owner: SLATER, MISTY M
2636 NE SANDY BLVD 10477 SW RIVERWOOD LN
PORTLAND, OR 97232 TIGARD, OR 97224
PHONE: 503 - 249 -5000 PHONE: 503 - 679 -8539
FAX: 503 - 249 -8260
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 11/21/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 11/21/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/21/2012 $43.25
Occupancy Grp:
Stories:
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Fuel
Fuel Types: •
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Gas Pressure:
Total $100.80
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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: i ' "v1.C�[ •k=f(/1 Permittee Signature: Dk A PPLI C A TI Ma
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.
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Nov 20 2012 11: 48AM HP LASERJET FAX p . 2
Mechanical Permit Applies II r.1- s
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City of Tigard D Rweised
Date/By: Oa.' , s %mit N.: 4 i 6 € , .201.2- oc , • -1--
11 ..- 13125 SW Hall Blvd., Tigard, OR 97223 NOV 2 0 2012 Plan Review
" 111 Phone: 503.718.2439 Far 503.598.1960
Date/By: Other Permit
I 1 , , \ 1 ,, , 1 , lospecticm Line: 503.639.4175 CITY OF TIGARD Date Ready/By: II See Page 2 far
Internet www.figard
BUILDING DI Notified/Metbod: Eigl Supplements! Istonmstion
VISION
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Mechanical permit fees' are based on the be of the vvork
0 New construction leAddition/alteration/replacement performe d. indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhaid, and profit
Value: S
).. ..'.‘/Plt,--3t*•:,IiR „ . -- -.N - 1:=t.:-.atw , :.i... , ,A.=..,:;--cuFkc;w.Kr.r.x:r , _,.x.,:;,, , 4 4 %,..,qt,,,r.,N; ; .!,,,,,,.,..-::, ,t. 0., ; 24 4 0 ,. ;, ; , , , A ,., „., . , ,:.,....„ . ...... ..,
PM 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building For *pedal brformation we thealisi.
El Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
gagiON MAW, 41 # 1 0.;***C4 01 0*~O.nind l agei'g Air Reatingie1344 . 11W
Job site address: I 0(41 1 Stiti ki rot l e-Pawed LA _ (requires We Oen showing Wm:mart) 46.75
Furnace 100,000 BTU (ducts/vems) i 46.75 1 /10 47
City/State/21P: 0 (2. 0, 12_2_.q Furnace 100,000+ BTU (dectelvents) 54.9l
Suite/bldg./apt. no.: Project name: S Li} - Head pump
, (requires site plan Mown's( placement) 61.06
Cross street/directions to job site:
Ductwork 2332
Hydronie hot water system 23.32
Residential boiler (radiator or
hydronie) 23.32
Unit heaters (fird-type, not ehxtric),
in-wall, in-duct, suspended, etc. 46.75
Subdivision: Lot no.:
Fluelvan for any of above 23.32
1
Other 23.32
Tax map/parcel no.:
°ther hid sPigiantes
M-5104.1?4:KaNitrig004-#0,ft***tit'6,41tis0.004,AM Winer heater 23_32
Gas fireplacefmsert 3339
t n "tik. ir5 furnac.ar Flue va'd for water heater re gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
-
Wood fireplaodinsert 23.32
. P:f444 M70*.Cre.0: .. ktift*Wi 7 ailtalte t Matk r i.' .tii "a4KOZ.%`ei' C oe hMin eYnilicriflue/vent 2332
23.32
Name: t?.1 isrki S LM Envirron.td eslasust and ventilation:
Range hood/other kitchen
Address: 5 Lt.-me, o1/4.s a.lvo Of equiPminil 33.39
City/State/ZIP: Clothes dryer Wisest 33.39 .
Single-duct exhaust (bathrooms,
Phone: ( A ■ • •
.0.- Fax: ( )
toilet =apartments, utility rooms) 23.32
!:' 1-.' • - .11161 . AnicicrawisPace flins 2332
...-- Other. 23.32
Business name: P . 1 O
0 0 e.- r... c9-ft-s FLA- MPCCA's Feel pIplreis _
Contact name: VIA.° 814356er first four; S4.413 for earls addldonal
Address: 2-6t(a. `?•.3e 5andl glucL ,. Furnace, etc.
Gas heat pump
CitY/StatelZIP: P-or-f-lan d 0 A_ ' el '7 2- 3 2__ Wall/suspended/mit heater .
Phone: 503) 2_.*G1 - 5 0 0 0 I Fax : 6 2 .....ig 2400 Water heater
Fireplace
B-mail: 5 &II SID. P_ 10 rl!.:g.i4° eOlvkl 4.. oleN . _ i c Range
Business name: Clothes dryer (gas)
Other:
Address: 7.;:iig%4V4ailiit000.404-10010fiti*A;V:::T.J:4':
City/StatetZIP:
Subtotal
Minimal pamit fee ($90.00)
7e) ' 445
Phone: ( ) I Farr ( )
- NM review (25% of permit fee)
CCB tic.: I i "S till) \
1,-.." State =draw (1294. of permit fee) /0. 8 0
TOTAL pcamrr FEE l 00 . 80
Authothed ....,.,404 41 'Mb permit application expires its permit is sat obtained within 180
days after it be been accepted as complete.
Print name: isirmimairammt Date: • Fee methodology set by Tri-County Building Industry Semice Board
1:1BuildineemsitAMEC-PartritApp doc . , /12 44046 I (I I/02/COM/WEB)
Nov 20 2012 11:48AM HP LASERJET FAX p.1
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FACSIMILE TRANSMITTAL SHEET
Private and confidential. Intended for addressee only.
To. 8 FRom•
al-i of- t(troL
COMPANY: DATE:
IL 2J I 2_.
FAX NUMBER: NO. OF PAGES: .
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PHONE NUMBER:
56 Z-41, 7 Molt ti
RE:
URGliNT 0 FOR REVIEW 0 PLEASE COMMENT OPUASE REPLY 0 PLEASE R•CYLE
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2636 NI SANDY BLVD PORTI AND_ OR 97232
PH.S03-249-5000 FAX 51'3 • CCIB#1731R1
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