Permit CITY OF TIGARD MECHANICAL PERMIT
N . . , COMMUNITY DEVELOPMENT Permit#: MEC2013-00620
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2013
Parcel: 1S134DC00900
Jurisdiction: Tigard
Site address: 11635 SW 114TH PL
Project: DALTON, Subdivision: 114TH PLACE Lot: 2
Project Description: Furnace replacement.
Contractor: CLEAN ENERGY COMFORT Owner: DALTON, LOREN G&ANNETTE N
7287 BROOKSLAKE RD NE 4188 GREY STONE DR
SALEM,OR 97305 YORBA LINDA,CA 92886
PHONE: 503-982-5927 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 10/16/2013 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 10/16/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 10/16/2013 $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! Permi ee 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.
Mechanical Permit Applicatio,i - ir , , ; --: I h1-:01E1(41 I SIl .)\L1
City of Tigard . :,___,r ;--=,1, ;-:i 0!) i'..-...7 ; Received ,,_ / i ,
1 ■11 ',,, '3 ' " 1 ' '.. ' DatelBy: 10 Permit No.:
l- I -Od s w• ti
• • 13125 SW Hall Blvd.,Tigard,OR 9722 '
71
Plan Review ....w.
• . Phone: 501718.2439 Fax: 503.598.1960 OCT 114 2013 DateeBy: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: 121 See Page 2 for
Internet: www.tigard-or.goy ' Notified/Method: Supplemental Information
0 i V& ' l-c,Htl_,: 11111
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. Vil.5FM`FirnrIer-Ck.(IlarttlaTI :,,,t,,,
'' ' ' '-'" ..'"' " 'Ili(''- n---'i.1%'''' "...!1929"ilt'.s:,''Fi=r3iggaini.17,:4.L14.,T1,i:i..i.giiliv,-;:., =':.i..-':."14i,kilei;;•; 6 ..as,,... ,..44,.... ,, ,,,,,k.. .,....-.-:
= - Mechanical permit fees*are based on the value of the work
0 New construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
0 Demolition 0 Other: mechanical materials,equipment,labor,overhead,and profit.
Value:$
4140.Mtli6i4v,"11,fr:s!..-44itt#10~iiiir.witioi„ ,,.. gig,,t„iki-r.9,1H-4',1-:,*,.1.711411` .alrazrz
.5(1_and 2-family dwelling 0 Commercial/industrial 0 Accessory building For spedal ittforntailon use checklist.
0 Multi-family 0 Master builder 0 Other: Description I Qty. I Ea. I Total
Ottiftiffiliglirll**10.4414:040440147::'.3i:;.:'i. :X#t*.f.ltl .''.45,,--,;:.-*MU Air conditioning 46.75
Job site address: tr (j 3...s-- s L) fici Pi. Furnace 100,000 BTU(dects/vents) 1 46.75 t
City/State/ZIP: 7{ k C) K' Furnace 100.000+BTU(ducts/vents) 54.91
Heat pump 61.06
Suite/bldg/apt,no.: Project name: Ketre„. Do, 140,,,
Duct work 23.32
Cross street/directions to job site; _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
Flue/vent for any of above 23.32
Other: i 23.32
Subdivision: Lot no.:
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
:44f.''it •I':"I144'111.1T: "Ij:..1*41rkii*It&ald'Aiiii"*.1414Pi':4WIrInI*47411111 Zsc fivreenPtiacforelinsertwater heater or gas
33.39
Rep 4
/c..,‘(„9._ vr Kc .Cse____.
fireplace 23.32
Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney!liner/flue/vent 23.32
Other.
Environmental exhaust and ventilation: 2332
,.. liliA:;TAAMEOlikftiliAliiiNtitt ,Wilfain'Qn.$1.NV131197:4*00kirtrillit*' ,
Name: Range hood/other kitchen
equipment _ 33.39
Address:
Clothes dryer exhaust 33.39
Cit Single-duct exhaust(bathrooms.
y/State/ZIP:
, toilet compartments.utility rooms) 23.32
Phone:( ) Fax:( ) .Attic/crawlspace fans 23.32
Mar 23.32
fil!:P.O.M. linft.ii*Oltafkliik:Wii.7.1rAli?i.411:titirtilktC44.04, 101. -414-, Fuel piping:
Business name:
$14.15 for first four;$4.03 for each additional
Contact name: Furnace,etc.
Gas heat pump
Address:
Wall/suspended/unit heater
City/State/ZIP: Water heater
Phone:( ) I Fax::( ) Fireplace
Range
E-mail:
Barbecue
Clothes dryer(gas)
-74:1,444:101gr trrERAC1404#41401n4gati-kl'-:-niaMN+II:Iltiltij.T„,.:' - drY
---...
Business name: C... .ec.„..t,..,_ fr,e_.--9y Copi.„- ..,it- J__t,,k C__s
Other.
.,;t11j:31,.1,: i.1:7' j47.1..
Address: 7-ad, er ,,„k, RA kic Subtotal 1-40 5
Minimum permit fee($90.00) 0•es0
City/State/ZIP: too kls 0e 9 7,30..S
Plan review(25%of permit fee)
Phone:(_ ...13,) 47K2 -5-ci 2 7 Fax:(5b=4>36 24-2._9 2,/ State surcharge(12°/0 of permit fee) /08°C
CCB lic.: • i 93c) 6 TOTAL PERMIT FEE (0(). $0
_f,t's permit application expires If a permit is not obtained within 180
__.
Pc....41riC45 cl)( 'll"it days after it has been accepted as maiplete.
Authorized si A _„Apr_ i, Le ' • Fee methodology set by Tri.County Building Industry Service Board
Print name: pip-gm-0m.y IIPPP" .`•" Date: f(,,-(l/ -(3
1:1BuildinePermi NMEC_PertnilApp_0401 I 3.clac 400.4617T(11/02JCOM'WES)
I .CI 126240E60S A983W3W13310 WdLb. : . 8IO2 .17.1 400