Permit •
CITY OF TIGARD MECHANICAL PERMIT
N , ` COMMUNITY DEVELOPMENT Permit #: MEC2009 -00467
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 09/03/2009
Parcel: 2S112CB00403
Jurisdiction: Tigard
Site address: 15200 SW 81ST AVE
Subdivision: Lot: 0
Project: Janes
Project Description: Replace furnace and air conditioner. Install gas fireplace insert. Gas pipe to fireplace. Must
maintain 3' rear and side yard setback
Owner: FEES
JANES, KEN . Description Date Amount
PO BOX 23399 Air Conditioning or Heat Pump 09/03/2009 $14.00
TIGARD, OR 97281 Furnaces < 100K BTU 09/03/2009 $14.00
PHONE: 503 - 624 -7133 FlueNent For Any of Above 09/03/2009 $6.80
Gas Fireplace 09/03/2009 $10.00
Contractor: Flue Vent for Water Heater or Gas 09/03/2009 $10.00
FIRST CALL INSTALLATION COMPANY Fireplace
13150 S CLACKAMAS RIVER DR 12% State Surcharge - Mechanical 09/03/2009 $8.70
OREGON CITY, OR 97045 Minimum Fee Adjustment - Mechanical 09/03/2009 $17.70
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 $81.20
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: ,4,E Pe rmittee Signature: 6, �
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.
SEP-2-2009 09:02A FROM: flE TO:5035981960 P.1
Mechanical Permit Application SEP 0 2 2009 i OR M i l t I i'II OM l
City of Tigard CITY OF TIGARf DateB Permit No.:
1111
U 13125 SW Hall Blvd., Tigard, OR 97223 :� 'JILI/ ) l�a 1 iew ✓G� L913��27 ev
-I " Phone: 503.639.4171 - Fax: 503.59. JIVISI0i I Date/By: Other Permit:
I I r. 1 R Inspection Line: 503.639.4175 " 4 Date Ready/By: lima: ® Sce Page 2 for
. Internet www.tigard- or.gov Notified/Method: Supplemental Information
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❑ New construction I Addition/alteration/replacement Mechanical permit fees' are based on 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.
Ya ? , i. .. �`: CA" : �torP e91∎5i.'R 7� `T.�41 'i c. , Value s
$
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1- and 2- family dwelling ❑ Commercial/industrial ld ❑ Accessory building For special i . ..' . alionuse checklist.
Multi- family ❑Master builder ❑ Other:
Description 1 Qty. Ea. Total
i gi..' `, ,, :l t1.Rfl S1T111 1Nr'QRM. 3IJ('1$ANI) LO( T1ON Heating/cooling
Job site address: J'�/3 Q lJ A I°J l V u O Air conditioning or beat pump
�5 (. 1J1} �`" '` 1 \ V it (requires site plan showing placement) I 14.00
City/State/ZIP: Port'!( (17224 Furnace 100,000 BTU (duets/vents) 1 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
_ Suite/bldg. /apt. no.: Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hxdronic 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
Subdivision: Lot no.: Flue/vent for any of above 1 6.80
Other: 10.00
Tax map /parcel no.: Other fuel appliances _
wet o■ r + tn�.� r �z a r x4 r v ti t Water heater 10.00
a tY 'a 2'1�.w }^' ��vh
�•� ?t -i L Y � :��� ��.7� r.
Gas fireplace 1 10.00
4 t Iacc +walla. q air c n cti 0riper Flue vent for water heater or gas
• 1 , �`�, 1 - 1 f _ fireplace , 10.00
1 I'7L1 6 l Log lighter (gas) 10.00
a I i Wood/pellet stove _ 10.00
T Wood fireplace/insert 10.00
�. Chimney/liner/flue/vent 10.00
` 4 ;. 7r« l ,tt? ' ?i .' li it ..I' :.. s... '.. Q.' ?C�11 ° i -
}<.. ��. +: r.. � .. Other: 10.00
Name: 1 r, r 6a aW Environmental exhaust and ventilation
Address: Range hoodlother kitchen
equipment 10.00
City/ State/ZIP: Clothes dryer exhaust 10.00
(b W _ I r l � t Single-duct omp exhaust (uti r rooms) o
' /"Q Fax ( ) toilet compartments, utility oms} 6.80
+, e . x $p ct r r <.� m,. f r deli va i c . � itivoi } �'( ['iPiq ( Attie/erawispace fans 10.00
Other: ]0.00
( Business name: Tri County Temp Control Fuel piping
i Contact name: Diane Mason $5.40 for first four; $1.00 for each additional
CV F Address: 13150 S. Clackamas River Drive Gas heat pump
j City /State/ZIP: Oregon City, OR 97045 Wall/suspended/unit heater
Phone: (503) 557 -2220 Fax:: (503) 557 -0919 Water heater
Fireplace I
E-mail: Range
Sr L 7S J7 .r o Y_.J_Ot Y. '
PP Barbecue
Business name: First Call Installation Clothes dryer (gas)
Other
Address: 13150 S. Clackamas River Drive Slid AN( A P,011 + ,19 &
City/State/ZIP: Oregon City, OR 97045 Subtotal
Minimum permit fee ($72.50)
Phone: (503) 557 - 0230 Fax: (503) 557 -0919 Plan review (25% of permit fee)
CCB Iic.: 182714 State surcharge (12% of permit fee) a 1 n h
TOTAL PERMIT FEE [�J
T his permit application expires if a permit is not obtained within BM
Authorized signature: days after it has been accepted as complete.
Print name: Diane Mason Date: • Fee methodology set by Tri -County Building Industry Service Board
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_ PLEASE REFAXAPPLICATION WITH SITE PLAN. ° �
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