Permit ' CITY p ® MECHANICAL PERMIT
q OF TIGARD
1 - 2 • -• COMMUNITY DEVELOPMENT Permit #: MEC2013 -00277
TIGARD 13125 SW Hall Blvd -, Tigard OR 97223 503. 718.2439 Date Issued: 05/23/2013
Parcel: 1 S133DC11300
• - Jurisdiction: Tigard
Site address: 13401 SW LAURMONT CT
Project: Edmondson Subdivision: ARI GREEN Lot: 4
Project Description: Replace gas furnace.
Contractor: BEN'S HEATING & AIR CONDITIONING LLC Owner: EDMONDSON, JEFF
PO BOX 80607 13.401 SW LAURMONT CT
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE: 503 - 233 -1779 PHONE:
FAX: 503 - 651 -3345
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 05/23/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 05/23/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 05/23/2013 $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.
Issued By: Permlttee Signature: /
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.
05/23/2013. 13:03 FAX 5036513345 BENS - HEATING &AIR L 004
NOISING JNiU iii it3
Mechlanic11 Permit Applicatio88y911A0 in n l oR Omer, 1154: °NIA
Received , Permit N • 0� �7
Cih' of Tigard �c Date/By: .i •r. C= i _5-DO
" 1312 SW Hall Blvd., Tigard. OR 2 OZ ti )dW Plan Review Other Permit
Phon : 503.639,4171 Fax: 503.598.1960 \ mt./B
I . l ,.. , It t . 1 lnspctinn line: 503.639.4175 1 ' Date Ready /By: See Page 2 for
Inter et: www.tigard 03t Ho(ifie/Melhod: ® Supplemental Information
TYPE OF WORK u COMMERCIAL FEE" SCHEDULE - USE CHECKLIST
._..._. ...... .._ _.__..._...,
0 New construt ion girAdd it ionlaltcrut ion/replacement Mechanical permit fees* arc based on the value of th work
performed. Indicate the value (rounded to the nearest dollar) orall
Demolition Cl Other: mechanical materials, equipment, labor. overhead, and profit
CATEGORY OF CONSTRUCTION Value. $
�,( RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
`l I - and 2 - fnm ,y dwelling ❑ Commereial/industrial ❑ Accessory building
Fnr special in rornralion use checklist. I I _
❑ Multi - family ❑ Master builder ❑ Other: Description QY t .. - Tii. ^r _ offal
JOB SITE INFORMATION AND LOCATION Heating/cooling
1 L Air conditioning
loft site address:
l SLIQ 1 monk Qic (requires site plan showing placement) 46.75
City /State /ZIP: Q oa... cn Furnace 100,000 BTU (ducts /vents) _ 1 46.75
"' Furnace 100,000+ BTU (ducts/vents) 1 54,91
Suite/bldg./opt. n .: 1 Project name: --- ' - " " "'
Heat pump 61.06
Cross strect/direc tons to job site: Duct work 7 .3.31 .
- - — .- .dronic hot water system 23.32
Residential boiler (radiator or
hydronle) 23.32
-- Unit heaters (fuel -type, not electric),
. in -wall, in-duct, suspended, etc. 46.75
Subdivision I Lot no.: Flue/vent for any of above 23,32
- ... .. Other: 223;32
fax map /parcel rm.: • Other fuel appliances __ .-. ..... .....
-- DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
- 4._ p,c;1[;1...„ Cc ■-•.-JC'hl;a (p, Flue vent for water heater or gas
fireplace 23.32
- Log lighter (gas) _ „ _ 23.32
_ Wood /pellet stove 33.39
Wood fireplace /insert 23.32
Chimney /liner /flue /vent 23.32
❑ PR JPERTY OWNER ❑ TENANT - .._...
_ ._ Other: 23.32
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
dres s:
A ......:. - .., equipment 33,39
city/Suue/'/ IP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23..12
('zi APPLICANT ❑ CONTACT PERSON Attic /crawispacc tans — 23.32
Other: i 23.32 i
Rosiness name, (-.. t' / _— ._._,,......,..
('cooler name: SIJ.IS for first four; 54.03 or each additional
Furnace, etc.
- -- Gas heat pump _
City /State /ZIP: Wall /suspended/unit heater -- .-
Plicate: (S-0.3 r' . 3 (� Fax: : r ae � �
� s j e7 �rJr Water heater
_fireplace
"-nu" ' Phased roe. (k) th .r s +-ef • G U iM Ran •c --- ._....
CONTRAFTOR Barbecue
Business name: ' e
• N / I 4„ Clothes dryer (gas)
-- Other:
Other
CO I•.;
Address: L b 10 6� 7 MECHANICAL. PERMIT FEES*
City/State/ZIP: 007--
0� - lYi , rrt d �• q 7 Z C,'] Subtotal -- ..._._
-;---- Minimum puma fee (590,00)
-- c SC►3) a, 3 : -) - '7 7 C� tax (Sir 3
l Pla review ( 25 %of permit fee)
tic.: S 7 State surcharge (12% of permit Ice)
L_. ^ TOTAL PERMIT FEE /On
'I'hih permit application expires If a permit is not obtained within NO
Authorized signu ur � days after It has been accepted as complete.
( Print (lame, (, V V .l. �Date6" ^ I ' ' Fee methodology tel by Tri County Building Industry Service noatd
I U4u,i.i i i•,i , \M+et Perm■+Ap dnc. 1nim too .140-4617T (I
05/23/2013 13:02 FAX 5036513345 BENS - HEATING &AIR 0001
FAX -
- (BEN'S))---
HEATING & AIR CONDITIONING LLC
PO BOX 80607
PORTLAND, OR 97280
503 - 233 -1779 * FAX# 503 - 651 -3345
E -MAIL bensheating @web- ster.com
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