Permit CITY OF TIGARD MECHANICAL PERMIT
Is COMMUNITY DEVELOPMENT Permit#: MEC2010 -00497
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 10/12/2010
Parcel: 2S104AB13700
Jurisdiction: Tigard
Site address: 12407 SW 133RD AVE
Subdivision: MORNING HILL NO. 7 Lot: 165
Project:
Project Description: Install gas furnace.
Owner: FEES
YOZAMP, GRANT R & KIMBERLYN A Description Date Amount
12407 SW 133RD AVE Furnaces < 100K BTU 10/12/2010 $46.75
TIGARD, OR 97223 FlueNent For Any of Above 10/12/2010 $23.32
PHONE: Fuel Piping 10/12/2010 $14.15
12% State Surcharge - Mechanical 10/12/2010 $10.80
Contractor: Minimum Fee Adjustment - Mechanical 10/12/2010 $5.78
MIDWAY HEATING CO
12625 SE SHERMAN
PORTLAND, OR 97233
PHONE: 503 - 252 -4003
FAX: 503 - 252 -5881
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: Permittee Signature: DN /97 /eel
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.
Mechanical Permit Ap licati t `` � rent ()FYI( lc:l; t'i: c�Nl.ti
Iii P �Q Received
City of Tigard Date/By /o /Z 10 � = Penttit No. /O 40 y97
• 13125 S W Hall Blvd., Tigard, OR ', a'. , 1
C Phone: 503.639.4171 Fax: 503.59 , .1960 c.,\ P�`� Pfau Review Other Permit:
I 1 G n F: C Inspection
www tigard- or.gov O k „) N ( 1 \( O `��e� N` t Suppleme tst for nformation
G� ® �G V
TYPE OF WOR; COMMERCIAL FEE* SCHEDULE USE. CHECKLIST
❑ New construction Addition /alterationlreplacement
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: S
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
A 1- and 2- family dwelling ❑ CommerciaU"industrial ❑ Accessory building For special irtforrxariart use checklist.
❑ Multi- family 0 Master builder ❑ Other: . Description I Qty. I Ea. ) Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: io)y 0 i S L1/41 k , _ 'F ft of, Air conditioning f 46.75 --
rites site an shoKin acemem '
City/State/ZIP: �'" 1 G If- e) € q--A-3.2 3 Furnace 100,000 BTU (duets/vents) / 46.75 L[
i Suite/bldg./apt. no.: g Project names Furnace 100,000+ BTU (ducts/vents) 54.91
i 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, dc. 46.75
Subdivision' 1 Lot no.: Flue/vent for any of above 2332 6,71, 3,E
Other. 23.32
Tax map /parcel no.: Other fuel appliances
• DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
7 /1.S Z 0 9 4S f i ll (, for water heater or gas :
fireplace 23.32
9 Log lighter (gas) 1 23.32
Wood/pellet stove 33.39
Wood fireplacelarsen 23.32
V-PROPERTY OWNER 1 ❑ TENANT Chimney/liner/flue/vent 23.32
Other. , 23.32
Name: y Q 2,�-n� Environmental exhaust and ventilation
Address: / A2 4 /0 ? f'& X 33 11 19`/r Range hood/other kitchen
equipment 33.39
City /State/ZIP: ��"7-2a , e 4 9 72 2 3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON AttiGcrawlspacc fans 23.32
Other: 23.32
Business name: -
Fuel piping
Contact name: 514.15 for first four; S4.03 for each additional
Address: Furnace, etc. j . /'. /}
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) ( Fax:: ( ) Water heater
Fireplace
E -mail: . r / � Range -
M I A� V rT CONTRACTOR Barbecare
Business name: ,(y1 i t, t, RI { � u� A Clothes dryer (gas)
. Address: 111��/��• ,?.S-- �• S� " S I1_q r /IA 6.1 S • t Other: MECHANICAL FERMI* FEES'
City/State/ZIP: . E ��; ,� U FL 91 - ).'1 subtotal ,i. 2,
_ � Minimum permit fee ($90.00) g 0 , `mi
: ( &iD) J o2 v 6()1 Fax: ( 9)3 ) e . Serf / Plan review (25%of permit fee)
. CCB tic. -? l y '1 irrie4.r0 1 .1 1 . State surcharge (12% of permit fee) it ✓
TOTAL PERMIT FEE MO
Authorized This permit application expires if a permit is not obtained within 180
days after it bas been accepted as complete
Print name' Date: / 6, - - 3 1 • Fee methodology set by Tri-County Bolding Industry Service Board
Lu ruilditg lPermitrMEC•PecmitApp.doc 1/09 440.4e77r(II/02/COStFWEa)
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