Permit n CITY OF TIGARD MECHANICAL PERMIT
s COMMUNITY DEVELOPMENT Permit #: MEC2010 -00534
Date Issued: 10/27/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S 27/201 0700
Jurisdiction: Tigard
Site address: 12098 SW WESTBURY TER
Subdivision: Lot: 0
Project: Coon
Project Description: Replace gas furnace, install gas piping and gas log set.
Owner: FEES
COON, MARYANN R Description Date Amount
12098 SW WESTBURY TER Fumaces < 100K BTU 10/27/2010 $46.75
PORTLAND, OR 97223 FlueNent For Any of Above 10/27/2010 $23.32
PHONE: 503 - 524 -7176 Other, Fuel Appliances 10/27/2010 $23.32
Fuel Piping 10/27/2010 $14.15
Contractor: 12% State Surcharge - Mechanical 10/27/2010 $12.90
TRI COUNTY TEMP CONTROL INC
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 557 -2220
FAX: 503 - 557 -0919
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $120.44
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 Ely :/t_ Signature: ,qA "970/04 je 776//
//// � 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.
OCT -26 -2010 12:22P FROM: TO: 5035981960 P.1
Mechanical Permit Anplication i , , i; , , 1 „ 1 1 , 1 , ,. 1
City of Tigard �� / D a 7 /0 �i I�etoit No. � L'o20 - 0 S �/
13125 SW Hall Blvd., Tigard, OR + �` /tom � 0 -
Phone: 303.639.4171 Fax: 503.598.1 �� 10�'" Other Permit:
In
Inspection �d�9ov7s OC\ 1b �O ` ikte Ready/By:
III , � Supplemental lluforaadea
e � fnedlMallrod: l
TYPE OF mom G�'(`l``NGO COMMERCIAL FEE* SQIEDULE — • USE CHE�.IST
❑ New construction 21 Additlon/alterndtm/re ld ft Mechanical permit foes• are based on the value of the work
❑ Demolition ❑ Other: performed Indicate the value (raided to the nearest dollar) of all
mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONST1tucrioN Value: S
® 1 • and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building h2ESI WWrIAL EQUIPMENT / SYSTEMS FEES*
❑ Multi-811161y ❑ Master builder ❑ Other • For p etrol Wornar /°,t t`°° °qe
Description 1 Qty. 1 Ea. I Total
• JOB -SrrE INFORMATION AND LOCATION Headrodeoelloa
Job site address: Wp Air conditioning o
�({ W I' M / Air ices
y stamina placement) a6.73
City/State/ZIP: T q 1 Furnace 100,000 BTU (daotehenta) I 46.75
Furnace 100,000+ BTU (duate/vente) 54.91
Suite/bldgJapt. no.: I Project name: _ first 61.06
Cross street/directions to job site Duct work 23.32
Hydronic hot water st�aatteemm 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (Ibet-type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 1 2332
Subdivision: I Lot no.:
Other. 23.32
Tax map/parcel no.: Other 1t1N es applianc -
��]],,�� DESCRIPTION OF WORK Water heater 23.32
• �f� i) J P (1) �1Q A l o Q r 11 t Flue ven for water heater or gas 33.39
a -] t� ]'} i t ' 4' invite) fireplace 23.32 .
• I �/� l �+ t t Log lighter (gas) 23.32
l F 1 i) D Wood/Pellet stove 33.39
Wood fireplace/insert 23.32
OWNER ❑TENANT Chimney/liner /tl t 23.32
. Other: I �jQ [ 23.32
Name: M� Envlr0 exhaust and veadladon
Range hood/other kitchen
Address:
equipmrnt 33.39
City/State/ZIP: Clothes dryer exhaust 33.39 ,
Phone: ) (�J Fax: ( )
S24 Ili Single-duct exhaust (bathrooms,
toilet commitments, utility rooms) 23.32
® APPLICANT 0 CONTACT PERSON Attic/crawtsnacc fans 23.32
Business name: Same u contractor Other: _ _ 23.32
Fuel piping
Contact name: Dose Mason 514.15 for first four, S4.03 for each addldosal
Furnace, etc.
Address: Gas heat pump ,
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace 1
E-mail: Range -
CONTRACTOR Barbecue
Business name: Tr' County Temp Control
Clothes dryer (gas)
Other.
Address: 13150 8 Cbckaa's River Drive MECIIANICAtL PERMrT FEES*
City/State/ZIP: Oregon City, OR 97045 Subtotal
Phone: (303) 337.2220 I Fax: (503)357.0919 Minimum permit fa ($90.00) ,
Plan review (25% of permit fee)
CCB tic.: 72623 State surcharge (12% of permit foe)
TOTAL PERMIT FEE I �o s 44
Authorized signature:
This permit days Iterr It be s scented 11 complete.
within Leo
I Print name: D ( + Moon 1 Date: I012141 D • Fee malhodololy.ra by Tri County Budding Industry Service Board
h:vWadlasTarntoM C-P.muAppdoc 10/01/09 eeed6trr(1IIDWOM/W ®)