Permit CITY OF TIGAR® MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00248
T1CARD ?; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/28/2010
Parcel: 1 S135CD02402
Jurisdiction: Tigard
Site address: 11895 SW 95TH AVE
Subdivision: BOETCHERS ADDITION Lot: 8
Project: Carter
Project Description: Install gas furnace.
Owner: FEES
CARTER Description Date Amount
11895 SW 95TH AVE
TIGARD, OR 97223 Furnaces < 100K BTU 05/28/2010 $46.75
12% State Surcharge - Mechanical 05/28/2010 $10.80
PHONE. Minimum Fee Adjustment - Mechanical 05/28/2010 $43.25
Contractor:
PIONEER GAS FURNACE
2636 NE SANDY BLVD
PORTLAND, OR 97232
PHONE: 503 - 249 -5000
FAX: 503 - 249 -8260
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 -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: 0/7
,L i C /9-/mod
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.
May 28 2010 7:51RM HP LFr P Fl X P • 3
Mechanical Permit Application ., ,- ' !, " ' ' FOR OFFICE IISE ONLY
City of Tigard Received .C" .., e ,
MAY 2 8 2 010 Date/B .1 4- i ° A4 Permit N° W 6- 6 7 c720 / --'400? CP
13125 SW Hall Blvd., Tigard, OR 97223
.
Ph Plan Review
Phone: 503.639.417 I Fax: 503598.1960
°thee Permit
UTY r .Yi ‘ K.: , Date/Sy:
i ,
Inspection Line: 503.639.4175
Ttc:A1-:1) ,,.. , , ...,.-if t:" Date Ready/BY: lin III See Page 2 for
Internet: www.tigard-orgov RV i r...0%;Ki 0;Y:7 ' NctinecilMetimd: Supplemental lafermatMa
. r . ; r04. 1' ...**04 1 4*,t'' ' ::****; 14 ,....rti . 0.. OCE.
New construction Aa 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
El Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
0.4t.tic*.06.'0;:001N§Tget ,...,.,,, —,... ...
- — i
1
' im..0r014 0..1144-TslisTEks - iits,-Ari:; , :2;
k
1_ and 2-family dwelling 0 Commercial/industrial El Accessory building
For special Informaiion use checklist
0 Multi-family 0 Master builder 0 Other: Description 1 Qty. Ea. Total
Mili.WW".44.5.*4tt,0•0164*OSI*!0...'04.TiO$3.41,0011KTOI tkeinpicoolfika
Job site address: // ?5 se, q6544-% Av.6.- Air conditioning or heal pump
,.. (requires site plan showing placement) 14.00
.., ae
City/State/ZIP: 0 aro ', f 9e.. q 7?-3-5 Furnace 100,000 BTU (ductsivents) j 14.00 /y
/ Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: CetreSte p r"
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
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 14.00
Flue/vent for an_y of above 6.80 !
Subdivision: Lot no.:
Other: _ 10 00 .
Tax map/parcel no.: Other fuel appliances
■
:4TV-4 Otiiainniiii:cii-IWOitt&O;4:-.ggii.viovvpift04., Water heater 10.00
...,,,...., _.,„ ..,,.:. .,.0, -., :,' "'"-.-
Gas fireplace l 0.00
. .5 2 cla i I el.sei 4.1--fr r /I+ r 5 bt.../` ly Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Vkiet1711 i:iaOPatttiK:o*iektt El iiii,ii+tiSkP*Atai cnimney/lineralue/vent 10.00
10.00
Name: Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
triii *A •IiiiikihiPIW;,'.1 A
ttic/crawlspace fans 10.00
Other: 10.00
Business name: ___...,
Fuel piping
Contact name: 55.40 for first four; SLOG for each additional
CAI" C AS 6F Furnace, etc.
Address: .
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E-mail: Range
4* . ,6c9TTIflitAc.TOPW-.44,41:15.4f.!h".0,1115-lil;:ztilc:4:: Barbecue
_.,
Business name: r a3 E , ,,,
Clothes dryer (gas)
Other: _
Address: 4 2 (,3 , Alt if n '4 , 0 .
i g.
,,MECHANICALPERMIT
City/State/ZIP: / & i 4 , , i 0 A[ .,,, Subtotal 7 , 07)
t''
--- l Minimum permit % fe (S72.50) 4 „,„7.- 4 9•TS - E
Phone: . 1• 1 11110 1 . Fax: A g a ) _ A i l t r ao , l■
Air - Pan review (25 of 'permit
6 ,4 , 4,/ - CCB lic.: /731 a / State surcharge (12% of permit fee)
TOTAL PERMIT FEE mo ,
Authorized signature:/10/11 8 4,4 This permit application expires if a permit is not obtained within 180 ...------
days after it bas been accepted as compiete.
Print name: flieS S 1 D • Fee methodology set by In-County Building Industry Service Board
IABuildineerrniteMIC-Perni App ■• 44 171r 01/02 OMIWEB)