Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2010 00489
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/06/2010
Parcel: 1 S 136AB04300
Jurisdiction: Tigard
Site address: 7106 SW MAPLELEAF CT
Subdivision: MAPLELEAF Lot: 1
Project: Carey
Project Description: Gas furnace replacement.
Owner: FEES
CAREY, HENRY L & MARY FRANCES Description Date Amount
7106 SW MAPLELEAF CT Furnaces < 100K BTU 10/06/2010 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 10/06/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/06/2010 $43.25
Contractor:
WESTERN HEATING & COOLING INC
50618 COLUMBIA RIVER HWY
SCAPPOOSE, OR 97056
PHONE: 503 - 647 -5808
FAX: 503- 543 -3693
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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: P ermittee 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.
Oct 04 10 01:51p Darcy 503 -543 -3693 p.1
Mechanical Permit Application FOR OFFICE USE ONL1
City of Tigard �l E D Received
L3125 SW Hall Blvd, Tigard, OR � /� V Date/By: !� Permit No.: l- �� /0__ -
A l . .
+'�' Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639
Internet: www.tigard -or.gov O L I �0
-1 G D Date
hod: P :for
D> �'[GM D 1 f , Supplemental information
l lk TYPE OF 1 �l1 `NG DIVISIO COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical pemlit fees* are based on the value of the work
❑ New construction ® Addition /alf&aabon/replacement
❑ Demolition ❑Other performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead. and profit.
CATEGORY OF CONSTRUCTION Value: $
® 1- and 2- family dwelling ❑ Commercial' industrial ❑ Accessory building RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
0 For special information use checklist.
❑ Multi- family ❑ Master builder
Description 1 Qty. I Ea I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 7106 SW MAPLELEAF CT Air conditioning
(requires site plan slowing placement) 46.75
City/State/Z1P: TIGARD, OR 97223 -1175 , Furnace 100,000 BTU (ducts'vents) 1 46.75 46.75 '
Suite/bldg./apt. no.: Project name: Furnace 100.000+ BTU (ducts/vents) 54.91
W 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, induct suspended, eta 46.75
Subdivision: Lot no : Flue /vent for any of above 23
Other: 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
REMOVE & REPLACE GAS FURNACE Gas fireplace 33.39
Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood firtlacc/insett 23.32
® PROPERTY OWNER ❑ TENANT Chimneytliner /tlue/vent 23.32
Other: 23.32
Name: FRAN & HENRY CAREY Environmental exhaust and ventilation
Address: 7106 SW MAPLELEAF CT Range hood/other kitchen
equipment 33.39
City/State/ZIP: TIGARD, OR 97223 -1175 Clothes diver exhaust 33.39
Phone: (503)244 -0330 Fax ( ) - Single -duct exhaust (bathrooms.
toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawly= fans 23.32
Business name: WESTERN HEATING & COOLING INC Other 23.32
Fuel piping
Contact name: DARCY NELSON 514.15 for first four, 54.03 for each additional
Address: 50618 COLUMBIA RIVER HWY Furnace, etc. t
Gas heat pump
City/State/ZIP: SCAPPOOSE, OR 97056 Wall/suspended/unit heater
Phone: (503) 543 -5599 Fax:: (503) 5433693 Water heater
E -mail: DJNELSON@WESTERNHEATJNG.COM Fireplace
Range
CONTRACTOR Barbecue
Business name: WESTERN HEATING & COOLING INC Clothes dryer (gas)
Other: •
Address: 50618 COLUMBIA RIVER HWY
MECHANICAL PERMIT FEES*
City /State/ZIP: SCAPPOOSE, OR 97056 Subtotal 46.75
Phone: (503) 543-5599 1 Fax: (503) 543-3693 Minimum permit fee (S90.00) 90.00
Plan review (25% of permit fee) 0.00
CCB lie.: 76978 State surcharge (12% of permit fee) 10.80
2 j4' - / TOTAL PERMIT FEE 100.80 Authorized signature: T his prmit applicaion expires if a permit is not obtained within 180
days after it has been accepted as complete.
I Print name: DARCY R NELSON Date: 10 - 2010 I • Fee methodology set by Tri- County Building Industry Service Board
1 :IUuildog1PcmihUNEC 10.111I09 440 -44177 (111021COWWEB)
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