Permit � CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2010 00050
:TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/02/2010
Parcel: 2S112CD00200
Jurisdiction: Tigard
Site address: 15685 SW 76TH AVE
Subdivision: DURHAM ACRES Lot: 15
Project: Christensen
Project Description: Replace wood stove.
Owner: FEES
CHRISTENSEN, PHILLIP E AND Description Date Amount
SALLY C, 15685 SW 76TH AVE
TIGARD, OR 97224 Wood /Pellet Stove 02/02/2010 $33.39
12% State Surcharge - Mechanical 02/02/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 02/02/2010 $56.61
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Solid Fuel
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 question to O NC by calling 503.246.6699 or 1.800.332.2344.
Issued By: CI I Permittee Signature: 1 • E 1
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.
RECEiv . t- "'' x ..) "., R 0)I;I I( I: t �I l�)\`I
Mechanical Permit Application LL ., , -
. City of Tigard Date/By: Permit No.:
111
13 125 SW Hall Blvd., Tigard, OR 97223 R 7,6(0 a n O Plan Review
a : Phone: 0 Other Permit:
fr r Date/By
cl sax R,t�j Inspection Fax: 503.598.1960 FEB 0 2 Line: 503.639.4175 Date Ready/By: '
eady/By: ® See Page 2 for
:i_ ‘A ^r Internet www.tigard- or.gov CITY OF TIGARD Notified/M s ethod: q Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
❑ 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 a and profit.
CATEGORY OF CONSTRUCTION Value: $ (p 9,
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1 I- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. J Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: )5-4 D S S , W . 7 [a t hA V { Air conditioning
0 (requires site plan showing placement) 46.75
City/State/ZIP: 9 a rd D ie cl7 A 2 tJ
Furnace 100,000 BTU (ducts/vents) 46.75
Suite/bldg. /apt no.: ( Project name:
Furnace 100,000+ BTU (ducts/vents) 54.91
Cross street/directions to job site: r ^ L
TW O f C
bid nQr.I-A OT nu On7hth Heat
, 61 . 06
L a ST O us C Q A FA r Le -'f ' Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
Subdivision: Lot no.: hydronic) 23.32
Tax map /parcel no.: 2. 5 1 1,2 C D -0o 2 0 0 Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
DESCRIPTION OF WORK
p Flue /vent for any of above 23.32
/L 17 )Q c s' h f O 1 rd (J 0 r1 .540 U G L1f i �A n Lt) !1 n Other: 23.32
/ / Other fuel appliances
Water heater 23.32
PROPERTY OWNER ❑ TENANT Gas fireplace 33.39
Flue vent for water heater or gas
Name: Ph i M� C i r tS4d».s < PI fireplace 23.32
Address: J S ^ � g , Li. 761.4 )I v T Log lighter (gas) 23.32
City/State /ZIP: T' o f J Q 12 9 7 2 2 9 Wood/pellet stove 1 33.39
Phone: ( 5-03 ) 6, Fax: ( ) S U T
Wood fireplace /insert 23.32
❑ APPLICANT ❑ CONTACT PERSON
Business name: Chimney/liner/flue/vent 23.32
Contact name: Other: • 23.32
Environmental exhaust and ventilation
Address: Range hood/other kitchen
City/State /ZIP: equipment 33.39
Phone: ( ) Fax: : ( ) Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
E -mail: toilet compartments, utility rooms) 23.32
- CONTRACTOR Attic /crawlspace fans 23.32
Business name: Other: 23.32
Address: Fuel piping
City/State /ZIP: $14.15 for first four; S4.03 for each additional
Phone: ( ) Fax: ( ) Furnace, etc.
CCB tic.: Gas heat pump
Authorized signature: P 1' _ Wall/suspended/unit heater
1 Print name: Date: Z 2 / 0 ` Water heater
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