Permit MECHANICAL PERMIT
. CITY OF TIGARD
71 •
? COMMUNITY DEVELOPMENT Permit #: MEC2010 00027
TIGARD; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued 01/20/2010
Parcel: 1S133DD11500
Jurisdiction: Tigard
Site address: 11815 SW 125TH CT
Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 152
Project: David
Project Description: Replace furnace.
Owner: FEES
DAVID, THEREASA Description Date Amount
11815 SW 125TH CT
PORTLAND, OR 97223 Furnaces < 100K BTU 01/20/2010 $46.75
Minimum Fee Adjustment - Mechanical 01/20/2010 $43.25
PHONE: 503- 267 -4193 12% State Surcharge - Mechanical 01/20/2010 $10.80
Contractor:
MECHANICAL INC
PO BOX 19569
PORTLAND, OR 97280
PHONE: 503- 244 -1730
FAX: 503- 245 -7613
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 quests • - • OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued =y: / 40 Permittee Signature: , , 7 4 / /
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.
IP ., . t M Tigard 11ICr`ll[l0 CEIVED = 2 2 , '
1 Tt and Recery
"' nr `rd City 0 Data/By; Permit No.: • � t " m 9
'' 13125S,, HallBIVd Tigard, OR 97223 1 r
°' _,��
- e il Phone.' 503.639,4171 Fax 503,598;' 1960 �AN. 19 'Rio Plan , Review
503.639.4175
a r> ` Inspeotion,Line; Dtrte/8y: Other Permit:
',} r ih "t Internet: www.tig Date Ready/By: ® See Page '2 for
CITY OF TIGARD Date Reedy/By:
:
dy/By:
u ' BUILDING DIVISIO Ell g °PPlemantal Informatio
1,vy . r. # p�. d m nl ui 41 4.,',1,,a, 6 L e," R Ynd ° {q a nti "d s n r 4Si r, L2s• <+
to rW�;k urJr z�i�F�C� Rat rta � rle�• r,.i� ,
r ew construction , Addition/alteration/replacement Mechanical permit ees* tire based on the value of the work
❑ Demolition ❑ Othor: performed. Indicate the value (rounded to the nearest dollar) of all
� , rti'a^� r
mechanical materials a ui:men labor overhead and •rofit.
a is,nI ram �''•'�' 6 7 ' k lYt
e�m1 c>�.�i a; «v: �,,;cxa h�us � a� r�necf� r a
(&1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ' ,,M" ��' (7Pf`'1 � °' - '-� °^ ';( r "� ' _
SNMt ,i:G4&. ? „7•. X./�F6,n9.9'.1J ,F4r M. ,y ^fi I
❑ Multi- family ❑ Master builder Q Other: For epack7l ir�ormarion use checklist M
r 3� Description
�' &, ty ',he rrat:;r�.p'a'” Fi` �asx gay y;.v Heating coolin.
•M Ea. Total
78 . s'i a °Z 1 „° r - V� wt,"`
Job site address: .—
I -, "� Air conditioning or heat pump
W (requires site plan ahowiagp {aoemont � 14A0 _.
City/State/212 �� Furnace 100 000 BTU ducts/vents 14:00
MIN
Suite/bldg. /apt. no.: Project name: `— 74) Purnacg 100;000+ BTU (ducuJvenra 11:40
Oas heat Bump 14.00 OM
Cross street/directions to job site: . Duct work
10.00
H dronic hot waters stem 14,00
Residential boiler (radiator or
hydronic) 14.00
Unitheaters (fuel -type, not electric),
in -wall in-due sus.endcd etc. 14,00
Subdivision: Lot no.: Flue/vent for any of above r 6,80
Tax map /parcel no.: Other: 10.00
`;y'iJ"i a. +t "� '^ tlfi r +".f F kvc:tit r- -,Pr � y ..... { „�;�tyy
Other tuei'a. ° llama '�. 2 i ' � sl k �i r m ;,
Y1 t` r� {ire :; 2t '1 1712111 I0.00
Qas fireplace 10,00
- gig • ' r a .. - Flue vent for water heater or gas
fireplace 10.00
L.og,lighter (gas) , 11 10.00
Wood/pellet stove 10.00
i ,i " vm - : p t; *i . l t l i y 3P, _ m t t r r.o V✓oode /1Ifl ce/ u s e/vent 10.00 MIMI
W: " �sa��k pit(' iF r�i�, I Ch'lmne /liner %fl 10.00
�, a rteiktt � Other: 10.00
�• a �_ Environmental exhaust and ventilation
Address: ! �. 1 Z r� Range hood/other kitchen
equipment 10.00
City/State/ZIP: ' • � „..— . .—. 97 . Clothes d er exhaust 10.00 •
Phone; ( Fax ( Single duct exhaust (bathrooms,
hon
e = 45' r a ” r ,,, toilet compartments, utili rooms 6.80
,�'. �1 *fir ',*�",�' � f� a rr +' � ' a13;'�`/ r7 v "" �""'�' r 4r S?4.
..1>ti � lfgr pis , �hxte:aikag l r� x1»1 :,m erk43 �• ,t5 i r .1 A Wcferawlspace fans 10.00
Business name: Other: 10.00'
A.. <' Fuel ppla¢
Contact name: t `� 55.40 for first four; S1,00 for each additional
Ad "dress: _ - d. . / 9 AP IEMMINNEE Furnace, etc.
City /State/ZIP: A4, i / Tale) Wa /sus pump _ Mill
� ��rUV Wall /sus .ended/unit heater
Phone: . 4 — 1 C) Fax: : 46)::4 lIZZINE
MI
E-mail: AL 1 ' � — -
" J f +nl, 1'"D ".,ry • n 4�1R�S1. alb rid ' , MI
i : n dPud ., t4 !dy "0 i of o tl e' l *A offs Bbibeme IMMO
• /Business name: Clothes d er as
V Address: ee Other
.� d1 G ' ,A ..4 4 1 'Ygi i r 8: � ?x 1 5 r � ' �kkT ri'�� "� �'S� K4, r��" A G
9;a s 41 .a w C- 11;'n1rke:.ii IP + I'g k6, { s rt�'h T "' ` • •
City /State /ZIP: x r'nh43rc"z Subtotal
Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee ($ a CtQ - i
1 � Plan review (25% of pemut fec)
CCB lic.: State surcharge (12% of permit fie) d
... TOTAL PERMIT FEE i 00.1
Authorized signature' This permit application expires If a permit is not obtained within 180
days after it has been accepted as complete.
141, Print name: r - Date: (0,... * Fce methodology set by Tri- County Building Industry Service Board
I.∎ euliainp \Permiu\AEC- PcrmhApp.d.- •1/) 9 /D7 4404617T (i1/02/C0MJwE2)