Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00462
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/22/2010
Parcel: 1S135DB02600
Jurisdiction: Tigard
Site address: 11405 SW 90TH AVE
Subdivision: TIGARDVILLE PARK Lot: 0
Project: Powloski
Project Description: Range hood vent. 9/23/10 added gas line to range B.T.
Owner: FEES
POWLOSKI, C KENT & LISA Description Date Amount
11405 SW 90TH
TIGARD, OR 97223 Range Hood /Other Kitchen 09/22/2010 $33.39
12% State Surcharge - Mechanical 09/22/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 09/22/2010 $56.61
Contractor:
WATTS HEATING & COOLING INC
580 PORTLAND AVE.
GLADSTONE, OR 97027
PHONE: 503 - 786 -2858
FAX: 503 - 786 -2807
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 questions to OUNC by calling 503.246.6699 or 1 . 8. . . . . . . . . .4 .
■
''
Issued By: �� t —, -,1!1- Permittee ec?...e.42
Call 50 4 75 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.
Sep. 22. 2010 12:56PM WATTS HEATING No. 1061 P. 2
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED Re y : Pem+iINo.•
t3` g DatNBr 9 - /p . - ;� �`lECO -i i
q 13125 SW Hall Blvd., Tigard, OR 97223 '
i C Place Raiew
Phone: 503.639A171 Fax: 503.598.1960 D "vy6CoV /o -- /Z9 yy6
I 1 c, .11 < U Inspection Line: 501639.4175 S t 2 2010 Date Ready/By: FM PI See Page 2 for
Internet; www,ligard - or,gov Notified/Method: Supplementallnformalinn
CITY OF TIGARD
TYPE OP liiiiikDINuDI CoM61ERCrAL pos. SCHEDULE - USE CHECKLIST'
Mechanical permit fees* are based on the value of the work
❑ New construction ," Addilion/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead, and profit.
CATEGORY OP CONSTRUCTION' Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
„ and 2 - family dwelling ❑ CommerciaUndustrial ❑ Accessory building
El Multi-family ❑ Master builder
For special hiforntallon use checklist.
❑ Other: Description 1 Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
lob site address: //YO .1 ..r. or,p 4i... (requires site plan showing placement) 46.75
Cit /Stale/Z1P:_-77 4 , G 9 7 z . 3 Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts vents) 54.91
Suite/bldg./apt. no.: Project namer //
Gd[�� �QGa,lo-YA Heal 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 -duce, suspended, etc. 46.75
Subdivision: Lot no.: Fluclvcnt for any of above 23.32
• Other. 23.32
Tax map/parcel no.: Other fuel appliances
p)ESCRIPTION OF WORK Water heater 2332
Gas flroptace 33.39
11 44 r . 44 s et q( Flue vent for wafer heater or gas
s� fireplace 23.32
Log lighter (gas) 23.32
Wood/pcllet stove 33.39
Wood fucplaeetinsert 23.32
Chimney/liner /flue/vent 23.32
1=1 PROPERTY OWNER 1 ❑ TENANT Other. _ 23.32
Name: ll -- Environmental exhaust tll tion
n vronmenal exaus and veua
.G.J.�.0 //L.�.9� �u�� r
! !�� Range hood/other kitchen r� A
Address: .1441,. 9� Atz_ equipment / 33.39 ..
City /Slale/ZIp: 2 ... ee e, 9 v zz- Clothes dryer exhaust 33.39
) Fax: Single -duct exhaust (bathrooms,
Phone:
( ( ) toilet compartments, utility rooms) 23.32
,. 3 PPLICANT ❑ CONTACT PERSON Atliderawlspace fans 23.32
name: ' - Other: 23.32
Business Wa
`iU '�" 05 4... .i 6 - Fuel piping
Contact name: 726 .', , f . J 3 $14.15 for first four; S4.03 for each addition
Address: . 1-63 O pjr-' d Ado., Furnace, etc .
Gas heat pump
City /State/ZIP: ‘ 442 4 :40 , 1 ( 4 4. 4 „ ei 0 77 Wall/suspended/unit heater
Phone: (re, A 906 .z6 I Far :: Va j 7 B 4 ,..0,0-7 Water heater
Fireplace
E -mail: `'(> t o 44 . :,./ie:aof/ r Go es-+ Range
CONTRACTOK Barbecue
Business name: Clothes dryer (gas)
Other:
Address: .5i0'/ e9 /4-r Appl A"Cr MECHANICAL PERMIT FEES'
City /State/ZIP: Subtotal 33,0
Minimum permit fee ($90.00) i9 r
Phone: ( ) I Fax: ( )
Plan review (25% of permit fee)
CCf3 tic.: /3516 Q Z State surcharge (12% of permit fcc) /p , -
TOTAL PERMIT FEE, 4 9 ` 0
=--'----) This permit application expires if a permit is not ob ggRR 1 . -,
Authorized signature; ' days after 11 has been accepted as complete.
Print names A y e G j l Dale: 9 zI / 0 • Fee methodology set by Th.Counly Building Industry Service Board
r: 19o1IdingpermtfarEC•Perm4Appdoc 10(01/09 440- 1617T(11107/COWWED)
Sep. 23. 2010 1:41PM WATTS HEATING No. 1075 P. 1
Mechanical Permit Application FOR OFFICE iUSE'. ()NIA
City of Tigard R ECEIVED ° me )--
I _ u 13125 SW Hall Blvd., Tigard, OR 972 Y 10
Phone: 503.639.4171 Fax: 503.598.1960 p at es v v Other Permit:
T t G A ti
Inspection Line: 503.639.4175 S E P 2 3 2010 Date Ready/13y: soik BJ See Page 2 for
Internet www.tigard -or.gov Notified/Method: 1 G Supplemental Information
CITY OF TIGARD .
TYPE c9iffitinrciNG RIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction . Q 'ddilion/alteralion/reptaccmenl Mechanical permit fees• are based on the value of the pork
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 1] Other: mechanical materiels, equipment, labor, overhead, and profit.
CATEGOIW OF CONSTRUCTION
Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
13-r and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building
Far special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. J Total
JOB SITE INFORMATION AND LOCATION Healing/cooling
Job site address: r Air conditioning
//yes 5 .5 + 90 Ai/v. (requires site plan allowing placement) 46.75
City /Slale/ZIP :.1-,► 9"' `"' 02 9 720_ 3 Furnace 100,000 BTU (ductsfvenls) 46.75
Suite/bldg./apt. no.: Projeet rnaznre Pomace 100,0004- BTU (duets/vents) 54.91
6eJ /aSik/ Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
- ltcsidential boiler (radiator or
hydronic) , 23.32
Unit heaters (fuel•type, not electric).
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above 2332
— Other: 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF 'WORK Water heater 23.32
Gas fireplace 33.39
A jed .41 .de 4 �,• "+;V Flue vent for water heater or gas
IL fireplace 23.32
46 reed laic' -.Ua e ,?c r Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney liner /Flue /vent 23.32
❑ PROPERTY OWNER I ❑ TENANT Other: 23.32
Name: Environmental exhaust and ventilation
Address: equipment hood/other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) rax: ( ) toilet compartments, utility rooms) 23.32
$APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
' Other: 2332
Business name: € fr79 6 Aker/t
/ . 1/ y Fuel piping
Contact name: •�6 siezzzA h 514.15 for first four; 54.03 for each addltlonal
Address: Furnace, eta
S" 45, r �d n d e- • Gas heat pump
City /StatefZIP: A/a/ .,74ri,e, e� Far. .77O 7 7 WaWsuspendcd unit heater
. 7eb -?6 1 � Ieb- 0647 Water heater
Phone:
J
Fireplace
E -mail: re) b [ Lt S r4 rc 4pg . cc, .. r Range
CONTRACTOR Barbecue
Business name;
Clothes dryer (Ras)
Other.
Address: S i A. ,� M � / � MECHANICAL PERMIT FEES*
City /State/ZIP: � f J Subtotal
Minimum pemnit fcc ($90.00) j1-1, 1
Phone: ( ) I Pax: ( ) Plan review (25% of permit fcc)
CCB tic.: /3 w State surcharge (12% of permit fee) i t. 7ej
TOTAL PERMIT FEE _ /J; 1-5
Authorized signatr This permit application opine ire permit is not obtained within NO
_ days alter it has been accepted as completes
r rrnl nar‘ feeP 6 3;4.4.4 4G I Date: 9/ _ 0 . Fee methodology set by Tri- County Building Industry Service Bond
rutuaasrreeermliNMEC- PermitApp.aoc 10r01/09 4- 10-4617T (1)OVCOMMO;n)