Permit era Y e CI OF TIGARD MECHANICAL PERMIT
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' COMMUNITY DEVELOPMENT Permit #: MEC2010 -00260
Date Issued: 06/09/2010
Tif.,ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S112BC09100
Jurisdiction: Tigard
Site address: 14777 SW 80TH AVE
Subdivision: RAZE MEADOWS Lot: 14
Project: Teyler
Project Description: Replacing gas furnace.
Owner: FEES
TEYLER, ELIN R Description Date Amount
14777 SW 80TH AVE
TIGARD, OR 97224 Furnaces < 100K BTU 06/09/2010 $46.75
12% State Surcharge - Mechanical 06/09/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 06/09/2010 $43.25
Contractor:
BEN'S HEATING & AIR CONDITIONING LLC
PO BOX 80607
PORTLAND, OR 97280
PHONE: 503 - 233 -1779
FAX: 503- 651 -3345
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: //■ ILA 1 i ` � �_ Permittee Signature:
Call 03.63 9.4175 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.
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Mechanical Permit Application �//}��1 �, a , - w �,"a,ro,� a 2:r : (►I I it I)ti1 UNI l + >�, r � ,�o t ae;; ,1,
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Re caved ` �p
$"r4041 Ci ty o f T i gar d' datdpy. ( 10 ST 7— permit No.: r 0,e�io - �Q�0
'° 13125 SW Hell Blvd., Tigard, OR 97223
s t II, t Phone: 503.639.4171 Fax: 503.598.19¢Q i r 21 IV ter Plan Ry icw Other
AZ Permit;
1 Inspection Line: 503.639.4175 JUI'4 U R
Attf)' Date Reedy/By: lure. 6'J see Page 2 for
$ :c:;a,,,,•,rrs Internet; www,tigardmr.gov Notifed/Method; Supplemental information
CITY TIGARD
TYPE �tb131INt1 DIVISION t: COMMERCIAL FEE* SCHEDULE. - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction 71 Addition/alteration/replacement performed. Indicate the vale •undcd to the nears dollar) of ail
❑ Demolition 0 Other' mechanical materials, equipment, : -sr overhea _La. •rolit
-.
.. Value: $ `�_A�
CATEGORY OF CONSTRUCTION ; ;
and 2 -famil dwelling y :.: >. ,: , , ' ' RESIDENTIAL EQUIPM • / SYST • : EES*
1-
y g ❑ Commercial/industrial ❑ Accessory building
For special infarrnnhon use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty Ea. Tula)
JOB 3171E INFORMATION AND L O C A T I O N. . . . . . . . . . . . .' Heating/cooling
Job site address. /477Z ,� Q0 *h Air conditioning '
C , , (requires site plan showing placement) 46 75
City/Statc/ZIP: T! 9 4 Furnace 100,000 BTU (duets/vents) / 46.75 f44,75
Project name: _ Furnace 100,0001 BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: 1
,` k„,..- Heat pump _ J 61.06
Cross strccddircctions to job site: / Duct work 23.32
Hydronic hot water system 23 32
_ _ _ _���_ __ Residential boiler (radiator or
hydronic) 23. -
Unit heaters (fuel - type, not electric),
in•wnll, in -duct, suspended, etc. 46.75
Subdivision; Lot no.: Flue/vent for any of above 23.32
Other: 23.32
—
Tax nap /parcel no.: Other fuel appliances —
DESCRIPTION OF WORK Water h eater 2 3 32 1
A ^^. (4,641-J; Gas fireplace 33.39
- c,e, t1/')P C e..- Flue vent for water heater or gas _
fireplace 23.32
— -
Log lighter (gas) 23.32
Wood/pcIlcl stove 33.39
�_
Wood fireplace /insert 23 32
Chimney /liner /flue/vent 23.32
tig PROPERTY OWNER — • ❑ TENANT , - . Other: 23.32 _ " -.-
Name: a 1 )U le Environmental exhaust and ventilation
Address: )/• J 1 c -1'77,3 gO Range hood/other kitchen --
J rj 1 ee uiprment 33.39
City /State /Z1P': I '' en V Clothes dryer exhaust 33.39
( 3 ,1l (1 � _� ", J toilet compartments, rt exhaust (bathrooms,
Phone. ) G Q F�1 r Fax: ( ) lolfet Com artmtnts utility rooms) 23,32
APPLICANT 0 CONTACT PERSON l'• Atuc/crawl space fans_ 2332 ,
Business name: Other: 23.32
Fuel piping
C
• u1llata nielil • �� ' kkv S!4.15 for tint four; $4.03 or each addltlonal
Address Furnace, etc.
Gas heat pump _, ...
C icy /State /'LIP: Walllsuspended/unit heater
Phnne: (�L ` ''.3 t/ go Fax.: ( ) . Water heater
Fireplace
G•ntttil: - - ---
Range
CONTRA OR Barbecue
T llusiness name: " ... Clothes dryer (gas)
6 N &i 1 i A. Other,
Address: P D o4 tad 60 7 MECHANICAL PERMIT FEES*
City /State /ZIP: _P l i, 02, q 7 D , C3 Subtotal '47
[
(( ��tt ` ` 3 Minimum permit fee ($90 Op) 6 10 , 00
phorlC. ( :rJ. ) 7 7 q 3 ^ / Fax G i' ) IY l . J
?
l Plan review (25% of permit fee)
. _C13 1ic.: b 1- 1 s q 7 O ,. J 1/ i State surcharge (12% of permit fee)
/0 ti t
// ( TOTAL PERMIT FEE ((,�,�
This permit application eapires if a permit is not obtained within 180
Authorized Slgnalllr ' p days after it has been accepted as complete.
�` � /
Print name: . Date' 511111 • Fee methodology sot by T6-County Building Industry Service Huard
I ut.JJ,,,ot.n,,.t.0 ;- PmnrcAp• doc ioi01I09 440 e617T ( 1 /02/COM/W0D)
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