Permit n CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00573
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2009
aTIGARL 9 Parcel: 2S111ACO5800
Jurisdiction: Tigard
Site address: 15010 SW 92ND AVE
Subdivision: LAUNALYNDA PARK Lot: 26
Project: Heston
Project Description: Install gas line to range.
Owner: FEES
HESTON, DIANNA NOEL Description Date Amount
15010 SW 92ND AVE
TIGARD, OR 97223 Fuel Piping 10/29/2009 $14.15
12% State Surcharge - Mechanical 10/29/2009 $10.80
PHONE: 503 - 639 -9576 Minimum Fee Adjustment - Mechanical 10/29/2009 $75.85
Contractor:
SUNSET HEATING & COOLING
0607 SW IDAHO ST
PORTLAND, OR 97239
PHONE: 503 - 234 -0611
FAX: 503 - 234 -0439
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952-001-07>4 may obtain a copy of the rules
or direc uestions to . - C by calling 503.246.6699 or 1.800.332.2344.
f
Issu By: Permittee Si • .. / fryi / om
CaII 503.639.4175 by 7:00 a.m. for an inspection that b -mess 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.
RECEIVED
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard 0 C T 2 9 2009 Date/13y: l0 4 D' Permit No.: He Argo , „ Q p 57 •
14 13125 SW Hall Blvd., Tigard, OR 972.23 Plan Review
= Phone: 5 03.639.4171 Fax: 503.598.9 ry\' O TIGARD Date/By: Other Permit:
TI GA R D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready /By: El See Page 2 for
Internet: www.tigard or.gov Notified/Method: , Supplemental Information
. ' TYPE - OF WORK • COMMERCIAL. FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction t Addition/alteration / replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value: 5
CATEGORY OF CONSTRUCTION . -
RE SID ENTUiL EOLIIPMENT / SYSTEMS FEES`'
It 1- and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. , Ea. I Total
• JOB SITE • INFORMATION AND LOCATION . Heating/cooling __
Air conditioning
Joh site address: 1 C2 L. ‘ (;• j L.0 Ci Zt (requires site plan showing placement) 46.75
City/State/ZIP: ` (L'I t k1'ri� �'
�.)- q Furnace 100,000 BTU (duets/vents) 46.75
JJ Futuace 100,0001 BTU (ducts /vents) 54.91
Suite /bldg. /apt. no.: r Project name: j ]t7 C5 y Heat pump 61.06
Cross street/directions to job site: r„ J Duct work L 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
r in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot nu.: Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION ;OF WORK. Water heater 23.32
33.39
Gas fireplace
`` , Flue vent for watcr heater or gas
��.L? ,1 ,� l r'.._ t �.� o ,) fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove _ 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
PROPERTY OWNER ❑• TENANT Other: 23.32
Name: ' \ CLi" y�-- aP�-1tiY-\ Environmental exhaust and ventilation
Range hood/other kitchen
Address: k SL.1 C:: SIX) 0( L. equipment 33.39
Clothes dryer exhaust 33.39
City/State /ZIP: r I� Z Single -duct exhaust (bathrooms,
Phone: ( 1 .
) . -, .4.j (IS 7 1G j Fax: ( ) toilet compartments, utility rooms) 23.32
'' �'
i=1 Attic/crawlspace fans 23.32 •APPLICANT . 0 CONTACT PERSON 23 32
Other:
Business name: _ Fuel piping
S14.15 for first four; $4.03 for each additional _
Contact name: _
Furnace, etc.
Address: Gas heat pump
— City /State /ZIP: WalUsuspended/unit heater
Water heater
Phone: ( ) Fes ( ) - Fireplace Il
E -mail: Range _
. CONTRACTOR Barbecue
Clothes dryer (gas) I
Business name: S l: tl St':r' t ' t ��� J j `L. (,,Z� i tri Other: 1
Address: O�:•G1 5 0; 1 tiej I O S'treek . MECHANICAL PERi1.11T FEES*
Subtotal ILI,1C
City/Blatt /ZIP: Pit v tra 6o2- "t Minimum permit fec (590.00) CIL ,
Phone: (6 23q--UL 1 I _ Fa (%3 ) Z. 311 —C +3' + Plan review (25% of permit tee)
' State surcharge (12% of permit fee) 6 t
CCB tic.: ( 0 j V - J r (." TOTAL PERMIT FEE \�� r-,�CJ
f � This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Authorized signature:
j �i � � y L � ` 1 • Fce methodolo1 y set by Tri Building industry Service Board
• 1 Print Warne: 5 �. ,;
Y11Oi•IL l Date: -; ( A l
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