Permit el CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00663
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2010
Parcel: 1 S133DC09600
Jurisdiction: Tigard
Site address: 13175 SW SHORE DR
Project: CHRISTENSON Subdivision: WINTER LAKE Lot: 24
Project Description: Gas furnace replacement
Contractor: ABLE HEATING & COOLING Owner: CHRISTENSON, CHRIS & EUNICE M
8900 SW BURNHAM F -5 13175 SW SHORE DR
TIGARD, OR 97223 TIGARD, OR 97223.
PHONE: 503 - 579 -2250 PHONE:
FAX: 503 - 620 -3980
FEES •
Specifics: Description Date Amount
Furnaces < 100K BTU 12/21/2010 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/21/2010 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/21/2010 $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
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued By: Permittee Signature: / +
irAndmi
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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 Application
FOR OFFICE I :SE ONLY •
City of Tigard ��
Date/13y: f r. C,1 Permit No.: V it y
114 e t Da[e 1 C IC �`- !
13725 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Datc /Bv: Dater Permit
T I GA R p Inspection Line: 503.639.4175 � � t . �`% Date Ready /By: ��s >d Sec Page 2 for
Internet: ‘vww.tigard- e rnr.gov YYY Notified/Method: - p Supplemental Information
TYPE OF WORK \ * e ii. 1S.- COMMERCLAL FEE* SCHEDULE - USE CHECKLIST
edition /alteration /ree ct �v� p Mechanical Indicate fees* ate based on to of the work
❑ New construction
��ti performed. Indicate the value (rounded to the nearest dollar) of all
Demolition l: Other: AV l • mechanical materials, �guipmcnt, labor, overhead, and profit.
y3 Value: $
CATEGORY OF CONSTRUCTION
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
i.2' and 2- family dwelling Q Commercial /industrial 1::] Accessory building For special information use checklist
❑ Multi- family ❑ Master builder ['Other: Description , Qty. Ea, I Total
JOB SITE INFORAL#T[ON AND LOCATION Heating/cooling
Air conditioning
Job site address: \,•Vn „ - c � J\ VOL._ C (' \ k r (requires site plan showing placement) , 46.75
City;SlalefZlP: ` Furnace 100,000 ` 46.75 .
P - - - Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: Pro ect name: \ ''! - 1 ��� E: Heat pump 61.06
Cross street/directions to job site: \ Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hvdronic) 23.32
Unit healers (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flueivent for any of above 23.32 •
Subdivision: Lot no.: Other. 2332
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
n � r \^ &` * v 1 (L,4 ,hP C Flue vent for water heater or gas
C fireplace 23.32
Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace/insert 23.32
Chimney /liner /flue/vent 23.32
tj .1ROPERTY OWNER 0 TENANT Other: 23.32
Name: E Environmental exhaust and ventilation
�i -'�� t'� N���� 1S Ranee hood/other kitchen
Address: ,. `�� ,. s l ,r ��� -(',, F. C' ‘v) E. equipment 33.39
City / State/ZIP: k 1�iir • Clothes dryer exhaust 33.39
A«
r
Single -duct exhaust (bathrooms,
Phone: (" x ) 5 1� -��1(� Ir ax: ( ) toilet compartments,
fat 23 32 partments, utility rooms) 23-32 I
"71
J Ai'k'Lt(A 1 Cl CONTACT -PERSON 23.32
Other:
Business name: Fuel piping
Contact name: 514.15 for first four: 54.03 for each additional
Furnace, etc.
Address: Gas heat pump
City /State/ZIP: Wall/'suspended/tmit heater _
Water heater
Phone: ( ) Fax: : ( ) Fireplace
E -mail: r Range
CONTRACTOR Barbecue
(�
_ Clothes dryer (gas)
Business name: p L ( �, k ry Z, Qjo (1t , 1 Y1 J W , n • Other:
Addre: '�+0 W, y)s �� y ' k -y MECHANICAL PERMIT FEES*
CityJState/2.u':� "` t� �� a� Subtotal
w -- 1 Mi nimum permit f ee ($90.00) LAC) �-
Phone: ( -} I � , Ac. -s -c\ i Fax: (51'y; l,, , _... 0 1 Plan review (25% of permit fee) + . V T
CCI3 lic.: \� W
State surcharge (12% of permit fee) .
- TOTAL PERMIT FEE ')(} ,
This permit application expires if a permit is not obtained within 180
ce-- days bum accepted as complete.
Authorized signatur : ., -1 (A.-.91=4"4-.... i�, s after it has b
y
Fee methodology set by Tri- County Building Industry Service Board
Print name: \e , �;' ,, L1 F D ate: _ M a •
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