Permit CITY OF TIGARD MECHANICAL PERMIT
II q
II COMMUNITY DEVELOPMENT Permit #: MEC2013 -00179
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/02/2013
Parcel: 1 S134CD10500
Jurisdiction: Tigard
Site address: 11730 SW 116TH AVE
Project: Davis Subdivision: BURLWOOD NO.4 Lot: 6
Project Description: Replace gas furnace
Contractor: ABLE HEATING & COOLING LLC Owner: DAVIS, JEROME M
16285 SW 85TH AVE #105 11730 SW 116TH AVE
TIGARD, OR 97224 TIGARD, OR 97223
PHONE: 503 - 579 -2250 PHONE: 503 - 348 -4359
FAX: 503 - 620 -3980
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/02/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/02/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/02/2013 $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 qu UNC byy calling 503.232.1987 or 1.800.332.2344.
Issued B . . (' �^axGQ�li1� --/t I Permittee Signat re: �, j / , , /
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 Applicatio ECEIVED USE OFFICE l L Os.L
City of Tigard Received a
. t APR 0 2013 t> 9 / 3 Permit No.: N( o/ - OV/ 7�
• 13 125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
n� 1' DateBy:
Ti C, It D Inspection Line: 501639.4175 ITY l! TIGARD Dace Ready /By mils la See Page 2 for
Internet: www- tiggrd- or. gov BUILDING DIVISION vot+fediMe d Supplemental information
•
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
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, equipment, labor, overhead, and profit.
Value: $
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
® 1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist
—
❑ Multi- family ❑ Master builder
❑ Other: Description Qty. I Ea, I Total
I -
JOB SITE INFORMATION AND LOCATION HeatleP/cooling:
-- Air conditioning '
Job site address: 11730 SW 116 AVE. (requires site plan showing placement) 46
CityiState2IP: TIGARD, OR. 9'7223 Furnace 100,000 BTU (duets/vents) I 46.75 , 46.75 1
Furnace 100,000+ BTU I:du s/ventsl 54.91
Suite/bldg./apt. no.: Project name: DAVIS Heat pump
(requires site plan showing placement) 6 L06
Cross street/directions to job site: Duct work 23.32
Hydronic 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:
DESCRIPTION OF WORK Water beater 23.32
REPLACE EXISTING GAS FURNACE Gas fireplace/insert 3339
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood 6replacelinsert 1 23.32
® PROPERTY OWNER l ❑ TENANT Chimney/liner/flue/vent 23.32 ■ Other: 23.32
Name: JEROME DAVIS Environmental exhaust and ventilation:
Address: 11730 SW 116 AYE. Range hoodiodter kitchen
equipment 33.39
City/State/ZIP: TIGARD, OR 97223 Clothes dryer exhaust 3339
Phone: (503)348 - 4359 Fax: ( ) Single -duct exhaust (bathrooms,
toilet compartments, utility rooms) 23.32
0 APPLICANT ❑ CONTACT PERSON Atlic/crawlspace fans 23.32
Business name:
Other: , 23.32
Fuel piping:
Contact n ` a 514,15 for first tour, 54.03 for each additional
Address:
Furnace, etc.
Gas heat pump 1 +
City /State/ZIP: Wall /suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: ABLE HEATING & COOLING LLC Clothes dryer (gas)
Other.
Address: 16285 SW 85 AVE. SUITE 105 1ECHANICAL PERMIT FEES*
City /State/ZIP: TIGARD, OR 97224 Subtotal - 46.75
Phone: (503) 579 -2250 Minimum permit fee (S90.00) 90.00
( ) Fax: (503) 620 3480 Plan review (25% of permit fee)
CCB lie.: 184392 State surcharge (12% of permit feel 10.80
l. TOTAL PERMIT FEE 100.80
Authorized signature: r 0.44 This permit application expires if a permit is sot obtained within 18n
days after it has been accepted as complete.
Print name: KELLY WIL I Date: 4 -01 -13 • Fee methodology set by Tri- County Building Industry Service Board
r:tBUtd ng\PormhsNEC-PermhApp.doe 03:07112 440 (1 umacownvcs)
L 086£0Z9£09 6uli000 v 6uiieeH env d6Z:£0 £ L 1.0 adV
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11730 SW 116TH AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
04/05/2013 00:00
MEC2013-00179
PASS - No C of O
347040 ml
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11730 SW 116TH AVE, TIGARD, OR, 97223
Residential - Mechanical
699 Mechanical final
04/05/2013 00:00
MEC2013-00179
PASS - No C of O
347040 ml
Violation Summary:
Inspector Contractor