Permit CITY OF TIGARD MECHANICAL PERMIT
• 2 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00533
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/09/2009
Parcel: 2S102CCO3600
Jurisdiction: Tigard
•
Site address: 13995 SW 102ND AVE
Subdivision: FRELEON HEIGHTS Lot: 4
Project: Peck
Project Description: Replace furnace
Owner: FEES
PECK, ALAN W & Description Date Amount
13995 SW 102ND AVE Furnaces < 100K BTU 10/09/2009 $46.75
TIGARD, OR 97223 FlueNent For Any of Above 10/09/2009 $23.32
PHONE: 503 - 968 -8140 12% State Surcharge - Mechanical 10/09/2009 $10.80
Minimum Fee Adjustment - Mechanical 10/09/2009 $19.93
Contractor:
TRI- COUNTY TEMP CONTROL
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 557 -2220
FAX: 503 - 557 -0919
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: )ji/UAIN Permittee Signature: Qx_ aid t / � .ca17 n'L�
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
N
•OCT "82009 01:07P FROM: TO:5035991960 P.1
Mechanical Permit Application rOli m41( 1: t 5f. ()Nil
City of Tigard RECEIVED Received astray; Permit No' Ee j ,xp 1 �y
- 0533
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date/By:
Other Permit:
11 i i I(1 Inspection Line: 503.639.4175 Q C T 8 2009 Date Ready /By: lurk 65 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental information
CITY OF TIGARD
TYPE OF Wg3eJ1LDLNG DIVISION COMMERCIAL FEE" SCHEDULE — .USECRECKLIST
Mechanical permit fees' are based on the value of the work
New construction
❑ ®Add ition /alteration/ replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: S
® 1- and 2- family dwelling ❑ Commercial/industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
❑ Accessory building
❑ Multi- family ❑Master builder ❑Other: . For special. information use checklist.
Description I Qty. 1 fa. I Total
. .IOR SITE INFORMATION AND LOCATION Heating/cooling
Jab site address: I a qq S v v toznd 4\tortu -c) Air conditioning
(requires silo plan showing placement) 46.75
City /State/ZIP: to . q1 J Furnace 100.000 BTU (ducts/vents) I 46.75
\`�,'J Furnace 100,000+ BTU (ducal/vents) 54.91
Suite/bldg. /apt. no.: I Project name: Heat pump 61.06
Cross streeUdirections 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: I Lot no.: Flue/vent for any of above 1 23.32
Other: • _ 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
• R _ l � ^ - . -„ Flue fireplace fe 33.39
,�"f F �`.^I "r �' l 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
PROPERTY OWNER I ❑ TENANT Ot yninermue/vent 23.32
p^ � 23.32
Name: ,A4� r �]rf--) . , Other: Environmental exhaust and ventilation
Address: , Range hood/other kitchen
equipment 33.39
City /State/ZIP: - Clothes dryer exhaust 33,39
�^ Single -duct exhaust (bathrooms,
f0
Phone: 6 c168—C46 Fax: ( ) toilet compartments. utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 ,
Other: 23.32
Business name: Same as contractor
Fuel piping
Contact name: Diane Mason $14.15 for first four; S4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall /suspended/unit heater
Phone: ( ) Fax:: ( )
Water
Fireplace
E -mail: Range
CONTRACTOR , Barbecue
Business name: in Tri County Temp Control Clothes dryer (gas)
Other:
. Address: 13150 S Clackamas River. Drive MECHANICAL PERMIT FEES'
City/State/ZIP: Oregon City, OR 97045 Subtotal
Minimum permit fee (S90:00)
Phone: (503) 557.2220 I Fax: (503) 557.0919
Plan review (25% of permit fee)
CCB lie.: 72623 State surcharge (12% of permit fee) Q
TOTAL PERMIT FEE 100 • VO
Authorized sl ature: This permit application mires If a permit is not obtained within 180
days after it has been accepted as complete.
Print name: VI I, moon I Date: f , / FJ"1 • Fee methodology net by Tri- Cormty Building Industry Service Hoard
I: \ Building \PermilAMEC .Permit Ape doe 10/01/09 440-4617r (I IN2/COM/WPtD)