Permit '; MECHANICAL PERMIT
' CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00120
xD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/25/2010
T t GAR
F,.h.,, ^ ,:w,.,., Parcel: 1S134DA06200
Jurisdiction: Tigard
Site address: 10741 SW NORTH DAKOTA ST
Subdivision: Lot: 0
Project: Sexton
Project Description: Replace furnace.
Owner: FEES
SEXTON, HELEN Description Date Amount
10741 SW NORTH DAKOTA ST
TIGARD, OR 97223 Furnaces < 100K BTU 03/25/2010 $46.75
12% State Surcharge - Mechanical 03/25/2010 $10.80
PHONE: 503 - 624 -5603 Minimum Fee Adjustment - Mechanical 03/25/2010 $43.25
Contractor:
CHASE HEATING CO
2236 NE 82ND AVENUE
PORTLAND, OR 97220
PHONE: 503 - 254 -1274
FAX: 503 - 254 -1816
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: (- n )1>-\ 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.
•
Mechanical Permit Application " ., 1 : , ( ±) l I I (+�I I} y i t ) \ ' i Q t' ' ' 1 Fi;°
Cl O g'l -(Y Date/By. � () kermit No.: (� �7 of
13125 SW H� Bl Tigard, qt ".11224''-' q p Review ` `v` Q ` 1 ��
"1 0 ' Phone: 503.639,4171 Fax: 503:0,81960 `*^., \JE . ot> Wit 503639.4175 1 � ... ,
Date Ready/By: tad : la See Page Z for
, Internet: www.tigard- or_gov Notified/Method Supplvmentol Information
MAR. 2013 ' - -'
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Ne
New construction C:4 Additi��alterati p c t v, v on/r 1atteht"' Mcchaniea1 permit fees* are based on the value oleic work
Dun �_,. t •:■,,r e t d performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
+'fit + ma c y �- .1 - s - - z r � !�a.3,�" .. . - - Kra. - •�; r y am , �- value $
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p` 1' � ' ! - :; �D.§I'R 1!i. ty._ ,.... �'. �:_. , T°^�! fi `.e 411.---•:: x ir % ? Ira wxry n. , .i ^ lS� , "i .I 3
(% 1- and 2- family dwelling ❑ Commercial /industrial ID Accessory building = __. ... :,.�....: /, _._ �•r -=
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea, I Tatar
Y A�.'k . l �* i nr,C: e _ . n ... - QC .r M 1, ?.�^s �. t^J r u ,xm 'al@" n r., 1P .7
k +.: � :ire'" k- ;,.. :.11 :. te:-t A i : ,. . ., --7,7, 2.:, „- ..:-- - 1 . t R''';''''
.. z Y! °i+» , t- ..; v;e .. ; Heating/cooling
rte,,_ Mr conditioning or heat pump b.
Job site address:
); ... r lo . s .. tom, ' -o_L - ' -s site plan showing placement) 14.00
+ r Furnace 100,000 BTU (dacts/vents1 1 14.00 e
Furnace 100 ,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
lsvdronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, induct, suspended, etc. 14.00
Subdivision: Lot no -: Flue/vent for any of above 6.80
,,.. Other: 10.00
Tax map /parcel no.: Other fuel appliances
E „w. r..4, -,.a.. < ... a - ors 'T 7- T7.7_4 t � 'r?l.,___ I __., ''z`'i , 1.. Water heater 10.00
"Tt.c i. lint ( N "411i.,At M "' , P,P .`4;,.ie1 �.Y a :oa: ,e:r,; ,4S.V4 . 'MeY S `Ve- , - ...'� k 1. ': tl r �ie_.r
Gas fire 'lace 10.00
p i t .. r w i Flue vent for water beater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
;.:177711:2t,,,.„'�r ' v • T • - a yty lti 7 why, o 1 .1�. ii t 'jhy p x� 05 r .�lr. R Chimney/liner /flue/vent 10.00
a.�9u�: Fr.m1.,._.y l.7. , -tit .,r .:,- t•.- :. r cu1,; ^. ..1t 1., rm.n r.:iw�.: •_:..a , i ;,....."'. Other. 10.00
Tnvironmental exhaust and ventilation
Range hood/other kitchen
Address: 10. A • .a 4 . • • S equipment 10.00 ,
City/State/ZIP: (, a Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (5(,) , al Fax: ( ) toilet compartments, utility rooms) 6.80
t w '7 - Vi ' - - -X14- :�, "'"4 N ^ ' l , its '� 41i '-� - •r -- .f�ttlC/CraW is , 8eP. fans 10.01)
r ;1. ..,.: z�'!°:�f.1 -�'; ��_C. Y . : _•_�o. ✓.t ��. ..
ll I a
.
'
Other. _ _ 10.00
* N _� ti. �•...r�� '� I A I• 't Fuel piping
Contact name: $$.40 for first four $1.00 for each additional ..
Address: i)-'a Furnace etc. NM
•- �! ai II ` Gas heat pump .�
. M / '� •
Wall/sus ended/unit heater
1 L Water heater
l
• Fax:: ( 3) - - Fi ,lace
Ran Le
1 a Z n 1 to n. 15 arw.7i .4614: -, a. r
gi - t art ! " x w•? � y t It t , + >.< r1 4- .. . .---1-- ,, Barbecue
Clothes iJi a 1: • 1111111=111
Business name:
• Other; -__
Address: E Q- I I r 6 _ 1 i - .11c.._ ,. ,, ,,-t>x,,: - - -,, ..?FeG._S _
City /State/ZIP: Subtotal
Minimum permit fee _ , 0) 7,1 O•(.
Phone ( ) Tax: ( ) Plan review (25% of permit fee)
State surcharge (12% of permit fee) _lair r 0 .60
TOTAL PERMIT FEE ' 00
This permit applicnfinn expires if a permit is not obtain . within 180
Authorized signature: �,+ days after it has been accepted as complete.
Print :, .�elr, .J + . / jt _ Date: 3 -2 / -/) . Fee methodology set by Tri- County Building Industry Service Board �
. ._ - - .. . _.....:.... •nn Ac.'rr /. , IM N`/IIA f1PED%