Permit CITY OF TIGARD MECHANICAL PERMIT
a ... COMMUNITY DEVELOPMENT Permit #: MEC2010 -00554
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2010
Parcel: 2S112CD07300
Jurisdiction: Tigard
Site address: 15838 SW 76TH AVE
Subdivision: PP1994 -100 Lot: 1
Project: Smith
Project Description: Furnace replacement.
Owner: FEES
SMITH, ROBERT W & JUDITH C TRUST Description Date Amount
15838 SW 76TH AVE
TIGARD, OR 97224 Furnaces < 100K BTU 11/03/2010 $46.75
12% State Surcharge - Mechanical 11/03/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 11/03/2010 $43.25
Contractor:
FIRST CALL INSTALLATION COMPANY
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 231 -3311
FAX: 503 - 557 -0919
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. Rnn 332.2344
Issued By: " . _ 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.
NOV-2-2010 08:44A FROM: ® TO:5035981960 P.1
Mechanical Permit Application c ` , � � i ( i u 4tl l l(1 1 I, ".1., Ci of Ti and ' 10 Receives g Date/By: II I _ /t) l 7 T II • 13125 S Hall Blvd., Tigard, OR 972 5 ' '`� ��` • Phone: 503.639.4171 Fax:503.598.
`` Q � \, r\ : Other Permit: •
Inspection Line: 503.639 `` ONE ���
Nth: B
t I ,� I: I O Date Ready/By: See Page 2 for
Internet www.tigard -or.gov O\ \ ` _ ` O Notified/Method: 'f-Z- Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE .-. USE CUECIadST
❑ New construction ® Addition/alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the.neerest dollar) of all
❑ Demolition
❑ Other: mechanical materials, equipment, labor, overhead, and profit.
.CATEGORY OF. CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
0 I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special Wormatfon use checklist
1:1 Multi-family ❑Master builder 0 Other:
Description 1 Qty. 1 Ea. 1 Total
JOB SITE. INFORMATION AND LOCATION Heating/cooling
Job site address: f � b n� conditioning
n
(requires site plan showing placement) 46.75
City/State/ZIP: - re q-722q-722.4 � . Furnace 100,000 BTU (ducts/vents) 1 46.75 Zt [
y Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Sy11` Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
1lLdronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
.in•wall,in -duct suspended, etc. 46,75
Subdivision: I no.: Flue/vent for any of above _ 23.32
Lot Other. 23:32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23:32
Gas fireplace 33.39
Flue-vent for water heater or gas
1 n ty /I_ fireplace 23.32
611 (�) Log lighter (gas) 23.32
Wood/pellet stove 33.39
-Wood fireplace/insert 23.32
A PROPERTY OWNER 1 ❑ TENANT Chimney /liner /flue/vent 23.32
�� 6m 1
Other 23.32
Name: Environmental exhaust and ventilation
Address: Qq�y� pv'� Range hood /other kitchen
Vw r tv equipment 33.39
. City/State/ZIP: Clothes dryer exhaust 33.39 ,
Single -duct exhaust (bathrooms,
Phone: (50 ) 5 - (,15 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Altic/crawlspacc fans 23.32
Other. _ 23.32
Business name: Tri Coupty Temp Control Fuel piping
Contact name: Diane Mason $14.15 ror first four; S4.03 for each additional
Address: 13150 S Clackamas River Drive Furnace etc.
Gas heat pump ,
City/State/ZIP: Oregon City, OR 97045 Wall/suspended/unit heater
Phone: (503) 557.2220 f Fax: : (503) 557.0919 Water healer
_ . Fireplace .
E -mail: Range
CONTRACTOR Barbecue ,
'Business name: First Call Installation Clothes dryer (gas)
Other.
Address; 13150 S Clackamas River Drive MECHANICALPERMITf*ES•
•
City/State/ZIP: Oregon City, OR 97045 Subtotal
Minimum permit fee ($90.00) qp,C/L)
Phone: (503) 557.0230 Fax: (503) 557.0919 Plan review (25% of permit fee)
V
State surcharge (12% of permit'fee) 1
CCR lie.: 182714 �/�
`� TOTAL PERMIT FEE 1Q ' W
This permit application aspires if a permit is not obtained within 180
Authorized signature: . + • days after It has been accepted as complete.
�nt name: Diane Mason I Date: 111/1 (D • Fee methodology set by Tri- County Building Industry Service Board
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