Permit 2 = a CITY OF TIGAR® MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2009 -00683
T G j Ej 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/24/2009
• g
;,. Parcel: 2S104CD05000
Jurisdiction: Tigard
Site address: 13822 SW HILLSHIRE DR
Subdivision: HILLSHIRE ESTATES Lot: 50
Project: Ou
Project Description: Replace gas furnace.
Owner: FEES
OU, JEANIE YOUNG Description Date Amount
13822 SW HILLSHIRE DR Furnaces < 100K BTU 12/24/2009 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 12/24/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 12/24/2009 $43.25
Contractor:
HEAT RELIEF CO
13122 NE DAVID CIR # 800
PORTLAND, OR 97230
PHONE: 503 - 261 -9915
FAX: 503- 261 -9814
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 No • ation Cen Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dire questions to OUN ing 503.246.6699 or 1.800.332.2344.
Issu d By: Permittee Signatrtie - , 4, �'Vigflir/
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.
IIIL 2/4/2009 THIJ 8:38 FAX 5032619184 f j002 /002
1, CEWED
Mechanical Permit Appli ? 111 , t '= FOR.OFFICE USE ONL `.•. , ter . ,
" `4 City of Tigard 2 4 2409 Received
°4..'. '- .
v D ate /B y: / g y elf Permit No.: nteAte f• 6(�
1 13125 SW Hall Blvd., Tigard, OR 9722 ` �•�
;� Phone: 503.639.4171 Fax: 503.598,49V 0V Date/By: 1CW Other Permit
e'�►"ry Inspection Line: 503.639.4175 Cl1 a V1S1 N
10 424 RD ' G D1 C Date Ready/By: finis: El See Page 2 for
t rat Internet: www.tigard-or.gov gt)1LD Notified/Method: Supplemental Information
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❑ New construction ® Addition /alteration/replacement Mechanical permit fees* are based on the value of the work
performed. indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
Y �C^ . JL 1. • '1f .�
i- and 2-family dwelling Commercial/industrial . I.f.R iP t k. `
ID 1- g ❑ ❑ Accessory building
For special information use checklist.
® Multi - family ❑ Master builder ❑ Other:
,�,,_�r�n Description I Qty. Ea. Total
irk • ' .:Z.. O �i:'11,�s -*.' t 4 S1.S�.-'.r' Heating,/cooling
•
Job site address: g"_ � ,� Air conditioning or heat pump
�
/r( —Q,- 4 ye � Furnace (requires site plan showing placement) 14.00
City/Statel2lP: av Fuace 100,000 BTU ( ducu /vents) / / y
_ Furnace 100,000+ BTU (duets/vents) 17.90
Suite/bldg. /apt. no.: Project name:,C� / Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue/vent for any of above , 10.00
Other. _ 10.00
Tax map /parcel no.:
Other fuel appliances
se „ a� - c , ri C ., r�.,,x.. , a ` ` ;{ : � 1^tir, % , Water heater 10.00
Gas fireplace 10.00
Flue vent for water heater or gas
1 A 7 `/ L/ r fireplace 10.00
Log lighter,(gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
' :° }r " j `°" '. is ,,.. t .7.1.1. Chimney /liner /flue/vent 10.00
. , other: 10.00 •
Nance: c . L_ n ,- a' Environmental exhaust and ventilation
Address: l � " V —' ) Range hood/other kitchen •
equipment , 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Phone: ( ) Fax: Single -duct exhaust (bathrooms,
( )
= toilet compartments, utility rooms) 6.80
� `;`r'"F` t der a _ 0 Attic /crawlspace fans 10.00
�:h� z vnr �` a e: o er e
Business name: HEAT RELIEF Other: 10.00
Fuel piping
Contact name: MARK DEFRANCISCO $5.40 for first four; $1.00 for each additional
Address: 13122 NE DAVID CIR DR # 800 Furnace, etc.
Gas heat pump
City/State/ZIP: PORTLAND, OR 97230 Wall/suspended/unit heater
Water heater
Phone: (503) 261 -9915 I Fax: : (503) 261 -9814 Fireplace
E -mail: Range
e`,,,�r�rgEt4 �," Kofttllt 5 � a Barbecue
Clothes dryer (gas)
Business name: HEAT RELIEF
Other: _
Address: 13122 NE DAVID CIR DR # 800 , ; e � a e ' ''s �R '
city,...), PORTLAND, OR. 97230 Subtotal n „,,_
Minimum permit fee ($72.50)
p.._ YI, 0'
Phone: (503) 261 -9915 Fax: (503) 261 -9814 Plan review (25 %ofpermit fee) gO
CCB lie.: 122424
I State surcharge (12% of permit fee) ”. y tv •
TOTAL PERMIT FEE QO
T his permit application expires if a permit is not obtained h m 1
Authorized signature: __ � days after it has been accepted as complete. 10'19 44_, • Fee methodology set by Tri -County Building Industry Service Board
I Print Warne: MARK DEFRANCISCO Date:
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