Permit
i
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2010-00007
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/07/2010
Parcel: 2S 104AA08300
Jurisdiction: Tigard
Site address: 12610 SW KATHERINE ST
Subdivision: Lot: 0
Project: Bukowatz-Grill
Project Description: Install furnace.
Owner: FEES
BUKOWATZ-GRILL, ROBYN Description Date Amount
12610 SW KATHERINE ST Mechanical Permit Fee - RES 01/07/2010 $90.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 01/07/2010 $10.80
PHONE: (manual)
Contractor:
OREGON HEATING & AC
PO BOX 397
DUNDEE, OR 97115
PHONE: 503-691-9699
FAX: 503-691-8556
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 N a io nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules
or din t questions to OVNC_Uy calling 503.246.6699 or 1.800.332.2344.
i
Iss ed By: Permittee Signature: ~
Call 503.639.4175 by 7:00 a.m. for an inspection that bu Hess 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.
Mechanical Permit_Ao ication pgor
City of Tigard IXECEIVE
Permit NU,:
ba 0404
y
13125 SW Hall Blvd., Tigard, OR 97223 plan Review
Phone: 503,639,4171 Fax: 503.598.1960 JAN 04 2010 Date/33,: OtbciFenu" _
lnspection Line: 503.639.4175 Date Readv/k3 yuris: &1 See Page 2 for
rmemet: www.iitard-0r.gov CITY OF TIGARD rlotifcd/Melhod: Supplemental Infennafion
84 Iff DING wIfIR10AIT
❑ New oonstruction dition/alteration/replaceinent Mechanical permit fees' are based on dic value of the work
perfnrmcd. Indiento the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, a ui ntcnt. labor. overhead, and mfit.
1 r ? ~h t 1 , t br " t' 4L q Value $
tttb';
A1- and 2-fntnily dwelling ❑ Cormercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi-family ❑ Master builder ❑ Other: Description _ Qty, 133. Total
I ,~t I nly~k ter, {~1~,30~ S1'>~la:;~1~1pyyy~~~~~". x~Nr ~~itQ~ it pn fl,,~~,~„aSi I~Qatln COOItn
Airconditioning
Job site address: taw 6 tuo Ka_4 ty A , (requires site plan showia Placement) 46.75
City/state/Zlp: C 'I Furnace 100,000 BTU (ck~crs/yenta) 46.75
Furnace 100,000
Sriifc/bldg./apt, no.: Project name: + BTU (ducts/venW 54,91
Heat um - 61.06
Cross street/directions to,job site., Duct work 23.32
hI dronie hot taster S +etem 23.32
_ Residential boiler (radiator or
hydronic) 23.32
Unit heaters (facl-type, not electric),
in-wall in-duct suspended, etc. 46.75
Subdivision: Lot no., Flue/vent for an of above 23.32
Otlrcr: „M 23.32
Tax snap/parcel no.: Other fuel anti lianccs
f i {~'R1r "~llh' - yt t pi}xr Water heater 23.32
1)h.' t,,:;~4 fa -..,w„ a ,1, Y,n r'• ~,~~,r.„77r~~J~{ .A,.n y:Rf
Gas fireplace 33.39
Flue vent for water heater or gas
fireplace 23.32
Lo lighter (gas) 2132
Wood/pellet stove 33.39
Wood ftrc lacc/inscrt 23A
r r f Chunn /liner/flue/vent 23.32
t r Other: 23.32
Nettie: C~tlC3 Y- Environmental exhaust and ventilation
Address Range hood/other kitchen
~Gt d L ~ 'f l~d1I' 1S,f! ~---o uy ipzruztt 33.39
City/Stace/Zlp: CA t_X,~ Clothes dryer exhaust 33.39 _
Single-ducat exhnuSt (bathroom's,
Phone ~ Farx ( ) toilet compartments, utility rooms) 23.3_2
'emu' Y r y Attic/crawls acc fans 23,32
4 c i : 2pa; l~ +."It.O ).,y~i yp1 t 1 F, [F~11'y#r.,,Y 1i~~ti,
J Othet• 23,32
Business narne:
{ ontact Heart: $14.15 for first four; 54.03 for each additional
Furnace, etc.
Address:
Gas heat um
City/ State/Z1I': r l Wall/sus cndcd/wtitheater
Phone: (bZ Fax: )kq Water- hearer
Fireplace
E-mail: Range
Business name; Clothes dryer
Othef
(Ij
P< °,S r C y 3
Address:
,4 e.`, 7' 'kCt CSI .:t`t`+~•> ,.t { 7~. i(.
Cityr/State/Zip: Subtotal
! _ Minimum permit fee ($90.00) t
Phone: Fax:„ Plan review (25°1° of permit ace)
CCB lic.: + State surcharge (12°,b of permit fee) t
TOTAL PERMIT FEE
AuthoriLed signature, This permit appliiceitioa etpires if a permit is not obtain within raQ
_ days after it has bee- accreted as comptctc.
Date: Fee methodology set by Tri-Caunty Building Industry Service Board
F rint name:
Vxb'
t:lea;laine~PermiL•1tvlFC-FermitMa.6oc torouo9 aao-a6t-~x(I t1ovC4MnvEn)
Ze/Te 3Jdd ONIld3H N09360 9558-TG9-E05 Z9:5T 0T0Z/tie/T3