Permit n CITY OF TIGARD MECHANICAL PERMIT
a ` COMMUNITY DEVELOPMENT Permit #: MEC2013 -00063
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/29/2013
Parcel: 1 S134DC09700
Jurisdiction: Tigard
Site address: 11523 SW CORNELL PL
Project: Benassu Subdivision: TIGARD PARK Lot: 13
Project Description: Replace gas furnace
Contractor: ABLE HEATING & COOLING LLC Owner: BENASSU, DEBORAH T
16285 SW 85TH AVE #105 11523 SW CORNELL PL
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 579 -2250 PHONE: 503 - 620 -5607
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/29/2013 $46.75
Type of Use: SF . 12% State Surcharge - Mechanical 01/29/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/29/2013 $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: � C
Permittee Signature:
fir ���
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.
Jan 2513 01:49p Able Heating & Cooling 5036203980
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Mechanical Permit A I Ili t , 7 i FOR OFFICE USE U L1
iii City of Tigard CEI o BY % R •4 Q Pe"°it d s 1312 5 SW H all Blv d., Tigar OR ' Plan Review
e Phone: 503.718.2439 Fax: 503.598.1960 paterg, Other Permit:
T t G A l D Inspection Line: 501639.4175 JAN 2 8 2013 Date Ready/By: Eris: H Sce Page 2 for
- Internet: www.tigard or.gov Notified/Method: Supplemental Information
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CITY TIIGARD
TYPE O tfG DIVISION COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
117! New construction ® A ddition /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*
® 1 - and 2- family dwelling ❑ Cornmercialindustrial ❑ Accessory building For speckd lnformationuseckeeJ&
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning
Job site address: 11523 SW Cornell Place (require_ site plan showing placement) 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000 BTU (duets/vents) 1 46.75
Furnace 100,000+ BTU (ductsivents) _ 54.91
Suite/bldgJapt. no.: Project name: BENASSU Heat pump
. - (requires site plan showing placement) _ 61.06
Cross street /directions to job site: That work 23.32
Hydronic hot water system 2332
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:
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace/insert 33.39
replace existing gas furnace
Flue vent for water healer or gas
fireplace , 23.32
- Log lighter (gas) _ 2332
Wood/pellet stove 3339
Wood fireplaceJinsert 23.32
® PROPERTY OWNER 1 ❑ TENANT Chimney/liner /due/vent 23.32
Other: 23.32
Name: Debra Benassu Environmental exhaust and ventilation:
Address: 11523 SW Cornell Place Range hood/other kitchen
equipment _ 33.39
City/State/ZIP: Tigard, OR 97223 Clothes dryer exhaust , 33.39
- Single -duct exhaust (bathrooms,
Phone: (503)620-5607 Fax:
( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspacc fans 2332
Business name: Other: 23.32
Fuel piping:
Contact name: $14.15 for first four, $4.03 for each additional
Address: Furnace, etc.
I
Gas heatptunp
City /State/ZIP: Wallisuspe nded/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E- mail:
Range
CONTRACTOR Barbecue
Business name: Able Heating & Cooling, LLC -
Clothes dryer (gas)
- Other.
Address: 16285 SW 85` Avenue MECHANICAL PERMIT FEES*
City/State/ZIP: Tina rd, OR 97224 Subtotal
Phone: (503) 579 -2250 Fax (503) 620 -3980 Minimum permit fee ($90.00) 90.00
Plan review (25% of permit fee)
CCB lie.: 184392 State surrhnrge (12% of permit See) 10.80
- TOTAL PERMIT FEE 100.80
This permit application expires if a permit is not obtained within 180
Authorized Si
gnature v�fire:&y days after it has been accepted as complete.
Print name: Kelly Wilhite Date: 01 -25 -13 I ` Fee methodology set:by Tel- County Building Industry Service Board
1: 12uildiag \Pemils\MEC- PeneitApp.doc 03/07/12 440- 4617rp1/02fCOM/WEBt