Permit CITY OF TIGARD MECHANICAL PERMIT
14 "
a - COMMUNITY DEVELOPMENT Permit #: MEC2010 -00505
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/19/2010
Parcel: 2S109AB03100
Jurisdiction: Tigard
Site address: 13441 SW MOUNTAIN RIDGE CT
Subdivision: THREE MOUNTAINS ESTATES Lot: 24
Project: Withycombe
Project Description: Replace existing gas furnace
Owner: FEES
WITHYCOMBE, KATHRYN N & THOMAS E Description Date Amount
13441 SW MOUNTAIN RIDGE CT Furnaces < 100K BTU 10/19/2010 $46.75
TIGARD, OR 97224 12% State Surcharge - Mechanical 10/19/2010 $10.80
PHONE: 503 - 590 -5901 Minimum Fee Adjustment - Mechanical 10/19/2010 $43.25
Contractor:
ABLE HEATING & COOLING
8900 SW BURNHAM F -5
TIGARD, OR 97223
PHONE: 503 - 579 -2250
FAX: 503 - 620 -3980
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: Q/i/ LPG / eff -%�oA.1
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 Applicatio'RECEIVED • halz OFFICE USE ON1..1
City of Tigard Received
• 13125 SW Hall Blvd., Tigard, OR 97223 OCT 15 2010 Date/By: /p , (. Permit HoJ �/0 _�0S5
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
, 1 t; ,� ,, 1 , Inspection Line: 503,639.4175 Date/By: Other Permit:
Internet: www.tigard-nr.gov CITY OF TIGARD Date Rti1dy /By: RI See Page 2 for
BUILDING DIVISIO
Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL. FEE* SCHEDULE —.• USE CFIEGKLLST IBM
❑ New construction ,� Addition /alteration/replacement Mechanical permit fees are based on the value of the work
❑ Demolition Oth performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: 5
L121<and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT /SYSTEM3FEES*
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist.
Description 1 Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: t " " ! , l l +, , to wy n (\ . E Air conditioning
F \ 1\ ' (requites site plan showing placement) 46.75
CityiState /ZIP: T rA^A.
PI * Furnace I00,000 BTU (duetshents) 1 46.75
Suitabldg. /apt. no.: r project name: Furnace 100,000+ BTU (duets/vents) 54.91
', Heal pump 61,06
Cross street /directions to job site: Duct wort:
23.32
Hydronic hot water system 2332
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in-duct, suspended, etc. 46.75
Subdivision: f Lot no.: Flue/vent for any of above I 23.32
Tax mapiparcel no.: Other: 1 23.32
Other fuel appliances
DESCRIPTION OF WORK • Water heater 1 23.32
,p - e EX 4 ' �s 4-- Gas fireplace 33.39
` I �L - APO Flue vent for water heater or gas
fireplace _ 2332
Log lighter (gas) _ 23.32
Wood/pellet stove 3339
Wood fireplace/insert • 2332
%J L OPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 23.32
Nam�e: ^ Other. _ 23.32
• ` \N13 IN\ANS , ' 4 .iti,IN U A.1.4. C% �4...0 Environmental exhaust and ventilation
Address: 1 /I ` � V t` 1 ` k4` v . ) i , � C ` Range hood/other kitchen
K rTl (11►, `} . . equipment 33.39 _
City /State/ZIP: T� � y � Ca Clothes dryer exhaust 3339
Phone: �t. G,' C7, 7� 0 1 Fax: ( ) Single -duct exhaust (bathrooms,
1 toilet compartments, utility rooms) _ 23.32
•
❑ APPLICANT ❑ CONTACT PERSON Atticicrawlspace fans 23.32
Business name: Other: 23.32
Contact name: Fuel piping
' S14.15 for first four; 54.03 for each additional
Address: Furnace, etc.
City /State/Z1P: Gas heat pump
Wall /suspended/unit heater
Phone: ( ) , Fax: : ( ) Water heater
E -mail: Fireplace
Range
CONTRACTOR Barbecue
•
Business name: LE ......714.1. p. c r L - Clothes dryer (gas)
Other
eSnon, dress • 03 iw� c-- MECHANICAL PERMIT FEES* y /State/ZIP: �-, A .,A � Subtotal
Phone: (RA S/l — 1 �� ( Fax: (t , ,z %a �t� Minimum permit fee (590.00) �(1
� q ^ c 11 � i � I t l Han review (25 %afpettnit fee)
CCB tic.: �--� 10
State sureharge(12%of permit fee) \D,CKC
TOTAL PERMIT FEE \C • S(0 I ✓
Authorized signature This permit application expires if a permit is not obtained within 180
q days after it has been accepted as complete.
I Print name: , �� ' �•, - I Date: 1 e -�h_ t • Fee methodology set by Tri•County Building industry Service Board
I:1&: ild'mglPettnitsJ�C -Pe ,d oe ID/01109 440 4617T(IIrO2/COM %Y5B)
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