Permit CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2010 -00191
TI GAFLD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/29/2010
..r3.
Parcel: 1 S 134DA05400
Jurisdiction: Tigard
Site address: 11310 SW 105TH PL
Subdivision: NODAK Lot: 2
Project: Mills
Project Description: Replace furnace.
Owner: FEES
MILLS, DONALD Description Date Amount
11310 SW 105TH PL
TIGARD, OR 97223 Furnaces < 100K BTU 04/29/2010 $46.75
12% State Surcharge - Mechanical 04/29/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 04/29/2010 $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:
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �� / � Permittee Signature: t) /1-pPG/ C4 7OA/
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
04/28/2010 WED 12:48 FAX 5032619184 2001/001
Blvd l 7 � a3 /5
Mechanical Permit Application . � . I • 1 5 " ,1 r - ,
`a., r'q cl 2S SW Hall Ti and A P R 9722 2 8 _ Date/By: A9 y � 4/ 6 0/a -60/7/
. ii 13 `' g 2 0 G Date/By: Permit No.//:
r 125 ll ., ,
'€i Tigard OR Plan Review
I "� Phone: 503.639.4171 Fax: ' r I f . r ei , i�l� Date/By: Other Permit:
4P1GA
Inspection 503.639.4 Ir f � ' I I , ON DateReady/By: 1u / ® Page2for
! rw. °. rat Internet: www.tigard -or.gov ) ' • Notified/Method: /J e ( v im Sa Page Information
Tel `. £ � i x lu.z 5135 P i r l'+: ` � t T , ? ' a,�'h�'� i x RIT... L, r,� �;, �., ' fPiµ ,, : , t .� ;•_ :p t '$ r Wi'f , :.r-:
;v: .4, ,, .- ki r r,�' s iii:1 a - � ^›.2 ..iJ n . . r N. ` f s -. J t r j? i Gir t r oT j ?, i e r t -,
° C - - A. c.?�.� �.c�.^,�xiZ- ,..-.wY,.ca.-z},a1» ��. ss' v..,,,.... v.. 4t�r.. ec3: l+ u c_. :- a..�.4..- xrS..�v�:+Ge�.'.�.g -�i' -.5 p :�,.. {�� t s.. •
Z .- e.. -A4. �L� i.e_ • v.. .��f� S.. �•1 /l 5�� .i i
Mechanical permit fees* based on the value of the work
❑ New construction ' .1 Addition/alteration/replacement
/ performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition • Other: mechanical materials,
equipment labor, overhead, and profit.
d ' ' ' < K�£.dt tt /' Jatt e r 9P c K c) r '� t ww ' -
i Value $
:r w - tf.::.feht ttliS _.- a.:YitvC . Z44.vz�d ..mic t 5.'_.3.kwi. f r R:.{ ' n - r t o f ti ' E i .,a v 'W ,: j t c i
1 :1 1- and 2- f amily dwelling ❑ Cornmercia l/industrial e i - 0 .,,hx Z s fi x"� 'la ir , y r 3 ` a.
� 0 building `
For special information use checklist.
IN Multi family ❑ Master builder ❑ Other Description I Qty. Fa. I Total
,,.:`: 2; r �r.iit- I,: .ear_ i �� -- ):. a e r k a :1 4 ria Heatingleooling
Job site address: / /3l() Su) /L5'71. PL Air conditioning
(requires site plan showing placement) 46.75
City/State/ZIP: Furnace 100,000 BTU(duets/vents) / 46.75 E/• r
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: I Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: 1 Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
1. 7 t Ega n £ ice" ' _ r. ', 3 , q ° � �
,- 1 'th „' , -,:,4 fi . ° t ,a< a e £ , ' i v `s ! it � d'x Water heater 2332
- s�:i";a:: ._,�.�... x.,h. xs� . -��s`� "mss:, .� _ " ° � °. � Gas fireplace 33.39
Flue vent for water heater or gas
nn j2k /pu L( Y" ` ` �/ Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
5 ' : 'v ;
,r� -~ �° {,,�v u • x'I,T, N s,, :'=°u r P: Chimne /liner/flue/vent 2332
ti _ a'„j1,V)oittit-sYp'.:i -.ilia "{- t` - -r-.'� -0 r 1i 414.• i, ?. ah.Y ;; -u4:'. i t�� , 7 £ 'V
t �? ,_ , Other 23.32
Name: 'I r ( Is Environmental exhaust and ventilation
/ Range hood/other kitchen
Address:
CZ-ba 2 equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Phone: ( ) Fax: Single-duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 23.32
y � :«�< c (! , �' � r V 4, $:y Attic %rawlspace fans 23.32
Business name: Other 23.32
Fuel piping;
Contact name: 514.15 for fast four; $4.03 for each additional
•
Address: Furnace, etc.
Gas heat pump •
City/State/ZIP: Wail/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E-mail: Fireplace
Range
t3 s'dl : 'h4 F' ' AVER- t`fy� ii x r z „. v r r ¢ o f � � .,' __
fj .SS £ ..y; 'k-.au �_ �z � t 10A"r ., r. r t- -4,' 4 'r' . - F . 8 f. Barbecue
�.. 1.:. v.. i� . i.. ti.. -. r.2 x,� a �,6 �u 1 ] rte t � �.tiSa u. t t..y _ w.�^? ..._..w
Business name :� Clothes d er : • =
�- �.�1' -� - Other
�
Address �� / . ct s, z- e r s 514 n
.tea � � _` � ' i J t �llt� `��- - A'a1r ,5 - y, '1 ti �. C ,r - `Y'� l�' 7 , si � yr ^5 ,, ..
1 1 �� ! ..5s z - X.. « '-- -- f .,. ,.. ...... w;4.. mac '.:j2� 0
City/State/Z t' : M + / J ., / t3 Z iiii Subtotal
• .i�`CI1t . a - _
' hone: ( •„. < _._CO G Fax: (f�', ¢ , , Minimum permit fee ($90.00) Il
/ t t%� Q I - a ! t4 Plan review (25% of permit fee)
I r / n State stuch arge (12% of permit fee) /0 r �i
• CCB lie.: , , j t /
/ f / J /1, TOTAL PERMIT FEE r / . ' 0
Authoriz _ - . _ , / Ia/ , , ,, • his permit , pplication erpires if a permit is not obtained within 1
/ days after It has been accepted as complete.
Print name: `� � � Da�ta A t Fee 1. odology set by Tri-County Building Industry Service Board
MIluildiwaenaiutMF-C•PemutA Idoc IO/01/09 - 441 •617T (II /0 •'MIWEB)
� eA/E