Permit v CITY OF TIGARD MECHANICAL PERMIT
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` 2 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00491
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/18/2009
T1GARIJ; 9 Parcel: 1 S125DA00400
Jurisdiction: Tigard
Site address: 9130 SW 66TH AVE
Subdivision: Lot: 0
Project: Lane
Project Description: Install gas furnace and gas lines for furnace and range.
Owner: FEES
LANE, CHRISTOPHER J Description Date Amount
P.O. BOX 12092 Furnaces < 100K BTU 09/18/2009 $14.00
PORTLAND, OR 97212 Fuel Piping 09/18/2009 $5.40
PHONE: 503 - 706 -8342 12% State Surcharge - Mechanical 09/18/2009 $8.70
Minimum Fee Adjustment - Mechanical 09/18/2009 $53.10
Contractor:
EASTSIDE HEATING & AIR CONDITIONING
7200 SW JOHNSON CREEK BLVD
PORTLAND, OR 97206
PHONE: 503 - 774 -3281
FAX: 503 - 774 -3057
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $81.20
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: /CSC �,; i� Permittee Signature: al/V. �, L ! e1�% /V
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.
•
From: 09/1712009 11:33 #735 P.002/002
Mechanical Permit Applicatio CErvED 9 » ul rlc 1 I S!. O .,.4• ' :
'M City of Tigard Receive M d f�I�- /� /� ♦��j�
• Permit No/I C ,... (. O i
13125 SW Hall Blvd., Tigard, OR 97223 S E P 17 2009 Revt I
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
n I tJ A R D` Inspection Line: 503.639.4175 Date Ready /By: Ju/ ® See Page 2 for
.z ,' Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction �Addition/alteration /replacement
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 ❑ CommerciaUindustrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other:
Description 1 Qty. Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: CI , 3 U S W ' i\ Air conditioning or heat pump
4}" Lo v Q ' (requires site plan showing placement) 14.00
City/State/ZIP: (30 ..., C .A ` OV c --` 233 Furnace 100,000 BTU ( ducts/vents) t 14.00 jLk. Or)
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work
I 10.00 16 t)I)
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 any of above
Subdivision: Lot no.: 6.80 iy,�Q
Other: 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
\ (' s 'C Gas fireplace 10.00
1 h'g - b.\ 1 u0. ' !It 1(\0..0 e - Lc.-) ac..S 1 1 Y\�. - Flue fireplace vent for water heater or gas
!) J J 1 10.00
1S�`r C: 1 \ Nr1 �b <-- a2r, Q Log lighter (gas) 10.00
J Wood/pellet stove 10.00
Wood fireplace/insen 10.00
• /PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: (y ��� e,_ Environmental exhaust and ventilation
Address: () " 12_09 2 Range hood other kitchen
equipment 10.00
City/ State/ZIP: d � �o: � o_v�c� 0 I .- 12t Z Clothes dryer exhaust 10.00
,
Single -duct exhaust (bathrooms.
Phone: ( c F
J 03 -/ 0 (•o - 7 L\ Z Fax: ( ) toilet compartments, utility rooms) 6.80
0 APPLICANT 0 CONTACT PERSON Attic/crawlspace fans 10.00
Other: 10.00
Business name: Ee�St'S t, «�i s
N.:.e C,b�AVpv t'S Fuel piping
Contact name: at✓vs, r.\ E. \wood $5.40 for first four: 51.00 for each additional
Address: 12.00 `,I SChr‘SCr % Lc . V., ..Z \\A. •
Furnace, etc. ' . S �d
Gas heat pump
City /State /ZIP: par�ko..v\I: v o'' c\1ZOO:, Wail/suspended/unitheater
Phone: ( 543) `1 tA- 3 2_,8‘ Fax: : (5c3 ) ? 1 y - 306'1 Water heater
�.;
i Fireplace
E-mail: ■ v-%c e e ..S.i .,) � e,\-N'��;.r ct cc,-,"1 Range I ,--
CONTRACTOR Barbecue _
Clothes dryer (gas)
Business name:
0.S■,..S vc1 e..__ \.\ \ yv 4 r . \ Cc �' Other:
Address: - 1100 SE �t,�t•.v-.•;Ci- C'r'2 -z.� ?, . MECHANICAL PERMIT FEES*
City/State /ZIP:.P c'.1,-�,,,..., , C1"� q -12,0 CD Subtotal
Minimum permit fee ($72.50) 1 2. SD `
� Phone: ( ) "1 V - 3'Lg 1 Fax: ( S03) ' ,C S Plan review (25% of permit fee)
L 1FI CCB tic.: 'SS S S f State surcharge (12% of permit fee) 8 , ' ' Q
TOTAL PERMIT FEE ,2p j
` s T bis permit application expires if a permit is not obtained within 180
Authorized signature: l o:. . Q,
� days after it has been accepted as complete.
n ^ ^' " °'^A•
a .�- ,�`� �.l�rs 1 n °rA 9 9 1 ' Fee methodology set by Tri- Countv Building Industry Service Board
- 1 1 0