Permit a CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: MEC2009-00628
T1 GAR Q' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/24/2009
Parcel: 2S114AB02600
Jurisdiction: Tigard
Site address: 9220 SW MILLEN DR
Subdivision: KNEELAND ESTATES Lot: 13
Project: Butler
Project Description: Install furnace.
Owner: FEES
BUTLER, KAREN Description Date Amount
9220 SW MILLEN DR
TIGARD, OR 97224 Furnaces < 100K BTU 11/24/2009 $46.75
12% State Surcharge - Mechanical 11/24/2009 $10.80
PHONE: 971 - 506 -6118 Minimum Fee Adjustment - Mechanical 11/24/2009 $43.25
Contractor:
TOTAL SYSTEM SERVICES
1220 SW THIRD AVE B78
PORTLAND, OR 97204
PHONE: 503 - 227 -5955
FAX: 208- 376 -1395
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
Issued By: Y r J 1 ► Y J W Permittee Signature: % q App
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.
A/23/2009 09:03 2083761395 TOTAL SYSTEM SERVICE PAGE 01/02
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Mechanical Permit A Iic � . n T '
Received �� Permit No., / �� � ��
City of Tigard Mc/By. N _
v 13125 SW HaII Blvd., Tigard. OR 9711 y 2 4 2009 Plan Review
1 111 : Phone: 503,639.4171 Fax: 503.598.1.96 DnteA ;Y: Other Permit
n , _ . ■+ inspection Lim 503.639,4175 rur+ C ITY OF TIGAR Datc Rcody/By : to See for
[%mCARD Supplemental lnforrttndnn
Internet: www.tigard or,gav Notified /Method: T C�
BUILDING DIVISION
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r. °MER ,,pp. , gN� 1537,. .^).' ' ' . + �1�� Y : j t+ i,�k.• i . Al �b 1 ..i LA .� tax:: 7 '' N « rt
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Mechanical permit fees" Are based on the value of the work
E] Ncw construction El Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials. equipment, labor, overhead, and profit.
rn ' — % i i ' �4�e t9q.,.'� p 'l 171-7 n .V [ ma y ® rlt.'... L t( p ��i•{ '7"0.1W,47771, I ValuC $
Elt:c`t'�.L'i , �7 � t2 �S: ^ `�. :.. :4 jtit wCiS 7t % ¢E'."''�c -� i ' - c e . P+H! iet .i'Jt , ' �C i; 't` •w. Tr' y ,err P to y c ? . +. r V N
as M:al r s '� ` : i :`. i a ifri 00 ti 1 1 rs ' t i it
❑ Commercial /industrial ❑ Accessory building •X� ..4V ^ . .,..m Emt 27 . 7P.a.. i uzi.1 .V4:1/41'4:0',1
0 - and 2- family dwelling ry € For s ecial information use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
yy .V '.s
1wN���d1� ���. n•.dL�.O �,'4. + 1 1 A i�.:1i� z' �... ,^}'�> m 1�CAtin COOIin+
;� "'"�° " r � Air conditioning
Job site address: �' 2 0 - >kr m uirds site .inn showin: rloccment 46.75
City /Statc/ZJP: s s • , J Furnace 100,000 BTU (sleets/vents) 46
` 4 �! Fumaee 100.000 BTU (ducts /vents) 54.91
Suite/bldg. /apt, no.: Project namc: Heat .um' 61.06
Cross street /directions to job site: Duct work 23.32
Hydronic hot water system 23.32
MINFIrii
�' k t , `� _ Residential boiler (radiator or
1 n �, ' 1 hydronic) 23.32
�',� ' t t� /:: _ of _ A 1 Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Subdivision: Lot no.. Other: 23.32
Tax map /parcel no.: Other fuel appliances
nr s xt „ r" t . z,; r Water heater 23.32
. 1'G NSME 4 m° ' i? k 2 • ,. : 3 4 -' B r ra , n 1
A * Ga.Q flreplacc
a- , 1r 4 — Flue vent for 33.39
water heater or gas
!! ■■ 1 fireplace , 23.32
Log lighter (gas) 23.32
Wood/ ellet stove 33.39
Wood fireplace /insert 23.32
;;gg// g {q�7 wML' q �L R � 1t ,, #r �7 1 kti wt5; Si , Chime /liner /flue /vent
I ad> i4):1 s ' t0 .'W,l\71' , :qfE E;g „ ^s-�•i1,� 1V'tt3ut'�i3'FE..i 4I Other. 23.32
Name: L . Environmental exhaust anti ventilation
Range hood /other kitchen
Address: 41' / 4.,i '. . k ■ \ equipment 33.39
City /State /ZIP: " alit • • - Clothes dryer exhaust. _ 33.39
Single -duct exhaust (bathrooms,
Phone; (j ) 1 ♦ Fax: ( ) toilet compartments, utility rooms) __ 23.32 ■ A
3 p�� - r . ■ , , Er g�', ' s° : e ; , Attic /crativtspacc fans 23.32
i i+ ` , ..a is t?,1 4 ∎ l t "` , s • ` .. e xtla(4.Jt. , tr:e: . AZ, 23.32
_ Other:
Business namc: (+� 0 Al • ,iP ^,i End piping
Contact name: "A - 1., i -' ' $1.4.15 for first four; S4.03 for each additional
Fumacc, eta -
Address: �/ - ) Gas heat pump
City /State /ZIP: 4 5 ( jit e Wa11 /supended /unit heater
Phone:,() %) r ' -4 — 1 , i Fax:: t. ") ..1, , r Water heater
Fireplace
Ji mail - _jai- ' 1 W. ' J >rw .11. f A Ran • e
F i 7id' { l ,r1O ''! i d - y . ,.Lo-4 ', 'l.E ", Barbecue
__.--- ,^, Clothes dryer (gas)
Business name: al_ 1 , _. ,_ t' fait, other _
t f ,,,- ems-� �9N ^.4d ,,,.., zx yi
Address: a S )..ak 4 ► X ',,:ter :.. "11 t .,t;set.rrta.�•, :,.
Cit /ZiP: Ili )y Snbtntal
Minimum permit fee ($90.00) _O r U U
Phone: f ) Fax: (' % , ) Plan review (25% of permit fee)
CCB lie.: , + 1 State surcharge (12% of permit fee) 1
TOTAL RMiT FEE P E
__ r �, This permit application expires if a permit n not obtained within 180
Authorized signature... ,_ 44 ,, �,� days niter It has been accepted ns complete.
Print nam ' . a iariar " Pee mcthodoloay so by Tri- County Building industry Service Board
1;113uiWina \Pcrmitc\.' C- PcrmitApp,dot 10!07/09 44n- 46I (II /02 /COM/w6n)
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