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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2012 00661 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/17/2012 TIGARD Parcel: 1 S 135AD04000 Jurisdiction: Tigard Site address: 8579 SW LUCILLE CT Project: Oliver Subdivision: LUCILLE ESTATES Lot: 2 Project Description: Replace gas furnace. Contractor: SUN GLOW INC Owner: OLIVER, MOLLY 2428 SE 105TH 8579 SW LUCILLE CT PORTLAND, OR 97216 TIGARD, OR 97223 PHONE: 503 - 253 -7789 PHONE: 503 - 314 -7318 FAX: 503 - 253 -7693 FEES Specifics: Description Date Amount Furnaces < 100K BTU 12/17/2012 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 12/17/2012 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/17/2012 $43.25 Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas 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: , 1 . Permittee Signature: v/ --/0/°z-/ C , 7-70 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. Mechanical Permit Aaalication 1 FOR OFFICE USE ONLY City of Tigard Received /� / 7 /jam Permit N �,. ` N. 13125 SW Hall Blvd., Tigard. OR 9722 Date/By: o��°� �D�y/ ' Phone 503,7182439 Fax; 503,598.19 1 EC R i tci low Other Permit: y: I n s ction Lfnc: 503.639.4175 uatc/By: T 1 G n 12 f 7 lx Dote Rattly Iffy: hrrlr: ® See Page 2 for i Internet: www.tigard- or.gov Notified /Method: DEC 13 2012 1 _ f Suyplerrrentsr Information t 6+' R,a a . ? 11a :t" a .., tr' . l•�. .s hl� 4 » � f � v (''' :,,t' ( f p�ii r Mechanical permit fees* arc based on the value of the work CI New construction Addition /alters ': -..� VISION performed. Indicate the value (rounded to the nearest dollar) of all 0 Demolition ❑ Other: mechanical materials. equipment, labor. overhead, and profit Value $ dwelling v.J t•., re 1- and 2-family g ❑Commercial /industrial ❑ Accessory building FOP use c %eckli a: ❑ Multi- fancily ❑ Master builder © Other: Description i Qty. J_ Ea. I Total rrikt�a '� a 1 t#{' ' nyya *N' Ho tig/coolitt t1 Air conditioning Job gitc a d d ress. u `� C,-,� (requires site plan showing placement) 46.75 — � L -- _ Furnace 100,000 BTU (duets/wilts) i 46.75 c,i(p City/State/7.1P: —r V. I P 'D-a-3 Furnace 100,000+ BTU (ducwvcnta) 54.91 Suite/bldg. /apt no.; , Project name: Heat pump (requires site plan ghowing placcmct) 61.06 Cross street/directions to jnh site; _Duct work 23.32 13ydronie hot water system 23.32 . Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, 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: M 4t ws 'Ili a* ;r ry f r # i, * .i:ir e ":.. Water heater 23,32 y j1 Ir r (}as fireplace/insert 33.39 __G IZA-A.- Flue vent for water heater or gas fireplace 23.32 Log_I'Ighter (gas) 23,32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 r + , #� i .. ", jtm mik Chimney /liner /flue/vent 23.32 Other: 23,32 Name: m r' , t � Environmental exhanat and ventilation: Address: S-1 5 u. �—t -tLi L� c_--- Range hood/other kitchen 33.39 City/State /71P: .-- r R GI i a.•D73 clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone (50 13 %' Fax ( ) toilet compartments, utility rooms) 23.32 I r f + V + W,'' , riiii,V f ; ) ^'e tyyt, k, M !,+ Attic/crawlspace fans 23,32 ban Business name: .. . Other. 23.32 SUN GLOW, INC. Fuel pipbny` Contact name: t*,,.r HEATING & AiR CONDITIONING $14.15 for first four; 84.03 for each additional Address; LOW 2428 SE 105th Avenue Furnace, etc. Portland, Oregon 97216 Gas heat pump City/State/7Z): (503) 253-7789 FAX (503) 253-7693 Wall /suspended/unit heater Phone: ( ) Fax; ; ( ) Water heater //�� Fireplace Email C.-�■ r 1 SAO rp1 s Lt. y QW t n c_ [dove (4 Range � ` zt, *i.iz i D 4.4 k,' }.,: . a " •: R� , i } r1. , R n , BQI'hci uc Business name: Clothes dryer (gas) SUN GLOW, INC. Other; Address: *UN HEATING & AIR CONDITIONING �+ � ' r *LOW SE 105th Avenue ( 5 :. Ciry /State/ZTP 'W Portland, Oregon 97216 Subtotal 4b.1 S ( (503) 253.7789 FAX (503) 253.7693 Minimum permit fee ($90.00) i l / Kone: ) Plan review (25% of permit fcc) CCB lie.: 4 V6 I State surcharge (12% of permit fee) 10. $ 0 TOTAL PERMIT FEE j PO _ TO i,/ ert Authorized signature: (� Yu�-� -- Je U _ (Q da This permit application r altos been permit h not obtained wiHtin tA0 gn y . l:r it had t�+ accept as complete. Print nam tl� + Date: _a 1 (a a: " fee mothedololty set by Trl..rnmty Building Industry Service Board 1,■anlldinowermhslM5C- PorntitApp.doe 03/07/12 140 4017T (11 /72/COM/Wl:0)