Permit z
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CITY OF TIGARD MECHANICAL PERMIT
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COMMUNITY DEVELOPMENT Permit#: MEC2010-00037
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/22/2010
Parcel: 1 S134CB06000
Jurisdiction: Tigard
Site address: 12440 SW NORTH DAKOTA ST
Subdivision: Lot: 0
Project: Smith
Project Description: Replace existing furnace.
Owner: FEES
SMITH, ROBERT B Description Date Amount
12440 SW NORTH DAKOTA ST Minimum Fee Adjustment - Mechanical 01/22/2010 $43.25
TIGARD, OR 97223
Furnaces < 100K BTU 01/22/2010 $46.75
PHONE: 12% State Surcharge - Mechanical 01/22/2010 $10.80
Contractor:
ANDERSON HEATING, INC.
6463 DAWN AVE.
LAKE OSWEGO, OR 97035
PHONE: 503-841-0742
FAX: 503-536-6615
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 c y of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
1
Permittee Signature:
Issued By:
L4 ~ & L g ~ i ~4~
Call 503.639.4175 by 7:00 a.m. for an inspection that busin 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 EC EIVED ® R
Received 2010 -
City of Tigard Date/By: Permit No..
13125 SW Hall Blvd., Tigard, OR 97223 JAN 2 2 2010
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: :61:0S pplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE --USE'CHECKLIST
❑ New construction ® 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
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead; and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT'/ SYSTEMS FEES*
® 1- and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building
Multi-family Master builder For special information use checklist.
❑ ❑ ❑ Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 12440 SW North Dakota St. Air conditioning
(requires site plan showing placement) 46.75
City/State/ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts/vents) 1 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite bldg./apt. no.: 7 Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 46.75
Subdivision: Lot no. Flue/vent for an of above 1 23.32
Other: 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Change out old 80% furnace with new 95.5% Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
® PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: Robert Smith Environmental exhaust and ventilation
Address: 12440 SW North Dakota St. Range hood/other kitchen
equipment 33.39
City/State/ZIP: Tigard, OR 97223 Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: (503)521-0718 Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawls ace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E-mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: Andersen Pleating
Other:
Address: 6463 SW Dawn Ave MECHANICAL.PERM.IT FEES*
City/State/ZIP: Lake Oswego, OR 97035 Subtotal
Phone: (971) 239-1466 Fax: (503) 536-6615 Minimum permit fee ($90.00) $90.0
CCB tic.: 168214 Plan review (25% of permit fee)
State surcharge (12% of permit fee)
TOTAL PERMIT FEE $90.00
Authorized signature:
Print name: Shawn Helm Date: 1-15-10 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. / UGC QO
1:\Building\Permits\MEC-PermitApp.doc 10/01/09 440-4617T(11/02/COM/WEB) ( (J