Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00464
T [ G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2010
Parcel: 2S103CB08300
Jurisdiction: Tigard
Site address: 12373 SW QUAIL CREEK LN
Subdivision: Lot: 0
Project: Yuzon
Project Description: Tankless water heater installation.
Owner: FEES
YUZON, JASON B & KELSEY M Description Date Amount
12373 SW QUAIL CREEK LN
TIGARD, OR 97223 Hydronic Hot Water System 09/23/2010 $23.32
Water Heater 09/23/2010 $23.32
PHONE: Fuel Piping 09/23/2010 $14.15
12% State Surcharge - Mechanical 09/23/2010 $10.80
Contractor: Minimum Fee Adjustment - Mechanical 09/23/2010 $29.21
IMAGINE ENERGY LLC
439 N BROADWAY
PORTLAND, OR 97227
PHONE: 503 -477 -9585
FAX: 503 - 477 -8340
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: a /// Permittee Signature:
•
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
c 9‘k\fiC ., V
Mechanical Permit Application �` FoR orFlc USE ONLY
City of Tigard . ` e3 `l � , gyp Received
a 13125 SW Hall Blvd., Tigard, OR 97223 .1,, 'y: ' ;3 ISMI MENNI
C� Q , �
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IIN ' la . Phone: 503.639.4171 Fax: 503.598.196 S�.Q GG , -
. Other Permit:
T I G n R D Inspection Line: 503 .$ Date Rea /B orr is:
r Q Ready /By: ,� ® See Page 2 for
Internet: www.tigard 6\ c) *CT Notified/Method: (0 Supplemental Information
TYPE OF WORK V V\� COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Mechanical permit fees* are based on the value of the work
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: $
1 - and 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
Master builder For special information use checklist. •
Multi -famil
❑ Multi-family ❑ ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / A373 SLR LauM � t
• Ci &IC. '.4 Ai s ite te plan (reqq uifires res site plan showing placement) 46.75
City /State /ZIP: T 44 Aoi 0 Q • • 17 a3 Furnace 100,000 BTU ( ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) _ 54.91
Suite/bldg. /apt. no.: Project name: O'Zdn/ Heat pump 61.06
Cross street/directions to job site: / Lor tE14 er Gol.ri EA, OF Duct work 23.32
Hydronic hot water system 1 23.32 1 3 , 3 ) .
Q441 L CjE11" L- 4.14E. AND /4 41 '441/E - /4ORTN Residential boiler (radiator or
J 1 bit.. OP 7 .&i.T Unit h ic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue /vent for any of above 23.32
Subdivision: Lot no.: Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater I 23.32 ,3',)
Gas fireplace 33.39
i IV TR-4 L. TA /4141.4 $$ tense.. ? er#70 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: J A I A/4 D �.L6Ly Yu z.c 4 Environmental exhaust and ventilation
Address: / 01373 .S� Qlda! Range hood/other kitchen
C�.i ¢IIG. LANE. equipment 33.39
City /State /ZIP: T 4 4 04, ID . 4 7 R a 3 Clothes dryer exhaust 33.39
J Single -duct exhaust (bathrooms,
Phone: (471) 9 49 ._ 66 . S ' Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT FeCONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: mi44 jpj"1E ow ireL4y Li. t.
Fuel piping
•
Contact name: Tu STA'N e_'e i ' j $14.15 for first four; $4.03 for each additional
Address: q3d N. O * b �•( r. Gas heat e
/ &2„ pump
City /State /ZIP: pej(L 04. . 4749.27 Wall /suspended/unitheater
Water heater 1 tl y_
Phone: (663) SG3 - 7y 91 Fax :: ( ) Fireplace
E- mail: Goo (el 3 Q, /M r tR� V eN.44 ", . &et Range
C CONTRACTOR Barbecue
Business name: 1 144 iM� ONEgI(V
Clothes dryer (gas)
Lt.c.
Address: L13C1 /. 84.04. '&4Y 6.r. MECHANICAL PERMIT FEES*
City /State /ZIP: Pao. - r L,q‘ 4 t 15 A . q 7.2 a.-7 Subtotal
Minimum permit fee ($90.00) q1 a. (k)
Phone: (6,3) 47 - q6 Fax: (93) 1 977 831k) Plan review (25% of permit fee)
CCB lic.: 14 7l 14 71 63 State surcharge (12 %ofpermit fee) to p0 .
TOTAL PERMIT FEE 1 c l u . 5-
This permit application expires if a permit is not obtained within 180
Authorized signaturc--
days after it has been accepted as complete.
Print name: -net ST 461 Coot, EY Date: Va3 ii G • Fee methodology set by Tri- County Building Industry Service Board
I:\Building\Permits\MEC- PermitApp.doc 10 /01/09 440- 4617T(1I /02/COM/WEB)