Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00634
13125 S Hall Blvd., Tigard O R 97223 503.718.2439 Date Issued: 12/07/2010
TIGARD Parcel: 2S104CD09600
Jurisdiction: Tigard
Site address: 13730 SW TRACY PL
Project: Chelf Subdivision: HILLSHIRE ESTATES NO. 2 Lot: 95
Project Description: Replace gas furnace.
Contractor: GRESHAM HEATING & AIR CONDITIONING Owner: CHELF, WILLIAM & TRACI
1560 NW 3RD ST 13730 SW TRACY PL
GRESHAM, OR 97030 TIGARD, OR 97223
PHONE: 503 - 667 -7594 PHONE: 971- 563 -9538
FAX: 503 - 667 -3769
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/07/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/07/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/07/2010 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
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
Utilit ification Cen _ . Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
o irect questions to OUN► .y •:l 503.232.1987 or 1.800.332.2344.
Issued By: Permute Signature: JI0 `- , i
Call 503.639.4175 by 7:00 a.m. for the next available inspect date.
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 licatio RF .S I D .' O x OFFFc r• l S ONL �
1111 City o €Tigard DE `� 2010 n Received / �I� / Permit No.: WolO"
a 13125 3125 SW Hall Blvd, Tig OR 972 2 3 p Review _ '. Phone: 503.639.4171 Fax 503.548. OF T I patty. Other Permit:
Inspection Line 503.639.4175 I l T CARD Date Ready/By. !nets $a Page for
Tic:1 D Toone!: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplementallnformation
TYPE OF WORK COMMERCIAL FEE` SCHEDULE – 135E CFIECKLISI'
['New construction Ad dition/alteration/replacement Mechanical permit fees' are based en 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
- and 2- family dwelling ❑ Co mmercial /industrial ❑ Acce ssory building
For special information use checklist
❑ Multi- family ❑ Master builder 0 Other. Description I Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address I T� ()la (re�lira itioning or heat p ro
pump
L�
site plan ' showing placement)
14.00
City/Staten P: c s r �` I n P ' � t J F, I 122 Furnace 1 00,000 BTU (ducts/veins) i 14 111 4
Furnace 100,000+ BTU (ductstven ts) 17.90
Suite/bldg./apt. no.: I Project frame: (11-e I . " - Gas heat pump. 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric), '
in -wall, in -duct, suspended, etc. 14.00
Flue/vent for any of above 6.110
Subdivision: 1 Lot no.: CMher. 10.00
Tax map /parcel no.: Other fuel appliances
DESC • 1 • • N OF WORK Water heater 10_00
Gas • . lace 10.00
•--e 00 r . - it� _ Flue vent for water heater or gas
■ fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00 .
Chimney/1incr /fluefvcat 10.00
PROPERTY OWNER , + ❑ 'TENANT Other. 10.00
Name: Hit( ( L' f f Environmental exhaust and ventilation
.— � Range hood/ather kitchn
Address: L P / ' ' equipment 10,00
City/Slate;/71P: - / /l' ` Clothes dryer exhaust 10.00
v " `' `/ �f � �) Single -duct exhaust (bathrooms,
Phone: (77/) '5 G -E . Fax: ( ) toilet compartments, utility rooms) 6.80
0 APPLICANT ❑ CONTACT PERSON Attic/crawlspaoe fans 10.00
Other 10.00
Business name: Fuel piping
Contact name: S5A0 for first four; $1.00 for each additional
– Furnace, etc.
Address:
Gas heat Pu'l'p
City /State/ZIP: Wall/suspended/unit heater
Phone: ( } ) / / ! ,p� i Fax : : )
Water heater
Fireplace
&mail: ()/ / 11 6� J/47 7I/ t r `•l(' ` / Range
CONTRACTOR Barbecue
Business name:
B
•
usiness ` Clothes dryer (has)
J � y� �, A 0 ! 0l ` - i 1 J. • i , O Other
Address: Iwo i V Vv -3 �� MEt�ANIf:AI. PER1191T FEES* 1 ,
CitylStatelLlP: �
I 02 C () Subtotal ` /J ( D °� st
2 Minimum perm fee (572.50) –., L d
Phone: (50 1 in -� ' (� �J1f _ Plan review (25% of permit fee) _
CCD lic.:
Z 3 1 i /2-_
State surcharge (1 of peons fee) E i
TOTAL PE RMIT FEE ��
This permit application expires if a permit is not o . .' , , wit. . t: t sO
Authorized signature: days alter it has been =eland as complete. DOi 1/
l'd 69L0 buiiBeH weysea j d09 :1,0 01. 90 oe0