Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00539
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/13/2009
Parcel: 1S136CA03100
Jurisdiction: Tigard
Site address: 11215 SW 79TH AVE
Subdivision: FRIENDLY ACRES Lot: 18
Project: Sheldon
Project Description: Gas piping
Owner: FEES
SHELDON, MELINDA L & DUANE C Description Date Amount
9610 SW HILLVIEW CT
TIGARD, OR 97223 Fuel Piping 10/13/2009 $14.15
12% State Surcharge - Mechanical 10/13/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/13/2009 $75.85
Contractor:
PORTLAND MECHANICAL CONST INC
2000 SE HANNA HARVESTER DR
MILWAUKIE, OR 97222
PHONE: 503 - 656 -7400
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: M AV Permittee Signature: A l Y
w
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
• 10/09/2009 14:51 5036550620 FMC GROUP PAGE 02/03
. Mechanical Permit Application FOR OFFICE USE ONLY
! i - etved
71 City of Tiga CEPV I Permit No.:
13125 SW Hall Blvd., Tigard, OR 9722 ► ateBy: A f ' os 3
Y ` Plan Review
Phone: 503.639,4171 Fax: 503.598.1960 0 C T U 9 20 ii • Date/By: Other Permit:
T LG A 1 D Inspection Line: 503.639.4175 i Date Ready/By: 7ur s:
Internet: www.tigard- or.gov El See Page 2 for
CITY OF TIGA k I, otified/Method: Supplemental Information
tElat ill pia . s�7
' � >: . ; i# t � d t � ' h 6r , § �. 7a 2 i a t d ci a q
`tea. nxaxu a '., i., - e`nt�i t$j "A, ^y :h
Mechanical permit fees* are based on the value of the work
® New construction El Addition /alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
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_ : � i. �i rg � • s • s..
.v -lp., ' 5941E 'b g . e xi .*, {,.:
a ® 'Ala y sly. �._ �. ra, s � . «, ..t. � � t• c Value $
1- and 2-family dwelling M
g ❑ Commercial/industrial 0 b uilding � z a 41;! i
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description i Qty. I Ea. I Total
. r ' a- 3....,,i,„,,..,-__,,,,g?. 4, S k
� s r� ° . : �i�9 F ��, , . 245 • ' . � t
. Heatinp,/cooling
n: �a
Job site address: 11215 SW 79 Avenue Air conditioning
(requires site plan showing placement) 46.75
City /State/ZIP: Tigard, OR 97223 Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54,91 ;t
Suite/bldg. /apt. no,: I Project name: Sheldon Residence Heat u i.
P mp 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, etc. 46.75
I Lot no.: Flue /vent for any of above 23.32
Subdivision:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
tc' 1 r .4 '-' '� er c a rm tiY '7.' _ „
��� , - , t_ . �;1 ' Water heater 23.32 Gas fireplace 33.39
Relocate less than 50ft gas piping for NW Natural Gas. Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
4.1. i A a to i i _ „: 4 ',,,,A<,.. `r t ;;,..,< Chimney /liner /flue/vent 23.32 - --
in , - ' 1 Other: 23.32 ..
Name: Sheldon Residence Environmental exhaust and ventilation .
Address: 11215 SW 79 Avenue Range hood/other kitchen
equipment 33.39
City /State /ZIP: Tigard, OR 97223 Clothes dryer exhaust 33.39
Phone: ( ) Fax: Single - duct exhaust (bathrooms,
( ) toilet compartments, utility rooms) 23.32
., - i � , " , � 1 , Ito , -, o ., e : t t� r`�; • 9 q . ,. 11 ;i Atticicrawlspace fans 23.32 .
Business name: Portland Mechanical Contractors
Other: 23.32
Fuel piping
Contact name: Kevin Miller $14.15 for first four; 84.03 for each additional
Address: 2000 SE Hanna Harvester Drive Furnace, etc. 1
Gas heat pump .
City/State /ZIP: Milwaukie, OR 97222 Wall /suspended/unit heater -
Phone: (503) 656 - 7400 I Fax: : (503) 655 -0620 Water heater 1
Fireplace
E-mail: kmiller @pmc -g.com
Range 1
G igi al r l i . €r i . P, O : ' 41411 : < , ill Barbecue -
Business name: Same as above. Clothes dryer (gas) 1 - Other: —
Address; „z
v �•
r r v 'i: tit i'I ° " ,,,'. V )P
City/State /ZIP: Subtotal 14.!5
Minimum permit fee (590.00) 90.00
Phone: ( ) Fax: ( ) ..
Plan review (25a.4 of permit fee)
CCB lic.: 151807 State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80
Authorized signature: I +• .' This permit application expires It a permit is not obtained within 130
..�. L�i.� �c. __ / t days after it has been accepted as complete.
Print name: Stephanie Taylo a ate: " Fee methodology set by Tri -County Building industry Service Board
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