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Permit Y CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit#: MEC2009-00556 p e 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/20/2009 Parcel: 1 S133DC03400 Jurisdiction: Tigard Site address: 13250 SW FALCON RISE DR Subdivision: Lot: 0 Project: Bianconi Project Description: Run 2 gas lines Owner: FEES BIANCONI, JACQUELINE M Description Date Amount 13250 SW FALCON RISE DR TIGARD, OR 97223 Fuel Piping 10/20/2009 $14.15 12% State Surcharge - Mechanical 10/20/2009 $10.80 PHONE: 503-524-8744 Minimum Fee Adjustment - Mechanical 10/20/2009 $75.85 Contractor: WESTERN HEATING & COOLING INC 50618 COLUMBIA RIVER HWY SCAPPOOSE, OR 97056 PHONE: 503-647-5808 FAX: 503-543-3693 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: Permittee Signature: 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. 0-4 20 09 01,:37p Western Heating 503 - 543 -3693 p.1 s . pp . CEI`' D r 1,7.0 , lr, 3,y; %.:::' �I `; .1 a �j e i i . - t n, �e �t a "1 terfr ,*'.4%, iy �4,,,,t ,, W }7 v IMechanical I'e>rmet;.A. �><c �o . I �r , , a E t > �c i �I SEwc��L�� ,r � . ��� t p itV Received u� v City of'Tfgaril 2 Date,B Permit g/ . �, a 13125 SW gall slid:, Tigard, OR 72 3 OCT 2009 5 lu 3 -ODS Plan Review S t' . Phone: 503.639.4171' Fax: 503:5S13.1960. - ' OtherPermit 4 ~ r {�', Ins ction Line: 503.639.4175 D ace/Re y ( T R D I6 A CITY OF TIGARD Date Ready /By: ® El ' See Page 2 for N.40•:.4!_att , .Internet:.www,tigard- or:gov BUILDING NG DIVISIO Notified /M Supplemental information TYPE 06 WORK iJl ' COMMERCIAL FEE* SCHEDULE -- USE CHECKLIIS T Mechanical permit fees' are based on the value of the work 0 N'ew construction Additienk teratiotireplacement performed. Indicate the value to the nearest dollar) of all ❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit. $ CATEGORY OF CONSTRUCTION Value: RESIDENTIAL EQUIPNIENT / SYSTEMS FEES* X 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building Multi-family For special information use checklist. ❑ y ❑ Master bu _der ❑ Other: Description. I Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating /cooling Job site address: �/5 / j , l Air conditioning 3�b l/� � / W `� i �e (requires site plan showing placement) 46.75 Cityi State /ZIP: ``' i` 3 ii ' 0C--- Furnace ;100 BTU (ductsrvents) 46.75 Suitelbldglapt. no.: Project name; • Furnace 100;000 + BTU (ducts/vents) 54.91 t G rti C ^r heat pump 61.06 Cross street/directions to job site: Duct work 23.32 23.32 23.32 1"lydronic hot water system Residential boiler (radiator or hydronic) 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 heater 23.32 Gas fireplace 33.39 2 ..1 11 a TS �i (�� S Flue vent for water heater or gas fireplace 23.32 _ Log lighter (gas) 23.32 • Wood/pelletstove 33.39 Wood fireplace /insert 23.32 ' i PROPERTY OWNER 0 TENANT Chimney,7iner /fluelvent 23.32 Other: 23.32 Name: 3QGh i I r a n Co t Environmental exhaust and ventilation Address: J � J0 S(� cGA aj I Se. Range hood /other kitchen 1 equipment 33.39 1 City /State /ZIP: - 1 - "( C6),r• DR G.7aa - 1 iC53 Clothes dryer exhaust 33.39 Single -duct exhaust (bathrooms, Phone: ( ) f Fax: ( ) toilet compartments, utility rooms) 23.32 ❑ APPLICANT I ❑ CONTACT PERSON Attickrawlspace fans 23.32 Business name: Other. 23.32 Fuel piping Contact name: p' 5 /� _-(4 $14.15 for first four; $4.03 for each additional Address. (, V' p (% ` Furnace, etc. 6611(° Gas heat pump ' City /State/ZIP: 0 Wall/suspended/unit heater Water heater Phone: ( ) Fax:: ( ) �y Fireplace E -mail: Range CONTRA TOR Barbecue Business Warne: } Clothes dryer (gas) e er ( -) Re l � ,F f 1 � C Oth er: Address: t L C ©)UnMb (, L g 1/ 'iv MECHANICAL PERMIT FEES* Woos Q a, Subtotal ' � CityiState/ZlP: Phone: ( ) Z 7- J c -Dg Fax:( ) G43 - 3 bY3 Minimum permit fee permit e ) ` -( 'j 1 Plan review (25 °1* of permit feej . �- CCB tic.: 7th 7q State surcharge (32% of permit fee) //) , Kb aba' TOTAL itiIIn FEE 1 ' Authorized signature: T his p ermit application expires ifa permit is not obtained within 189 days after it bas been accepted as complete. Print name: (Cy ` 4J) { - 1 Date: /0 - -- 0 2 ' Fee methodology set by Tri Building industry Service Board tlnuilding TerntitstmEC PermitAppp. Ie /01/09 410- 4617T (1I /MCOM,WEB)