Permit CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT MECHANICAL
MEC2009 -00144
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/02/2009
Parcel: 2S112BCO3100
Jurisdiction: Tigard
Site address: 14705 SW 83RDAVE
Subdivision: c HAMBACH PARK Lot: 15
Project: Whitlow
Project Description: Install 20 feet of gasline to range.
Owner: FEES
WHITLOW, LEONARD A III & Description Date Amount
WHITLOW, CATHERINE C, 14705 SW 83RD AVE Fuel Piping 04 /02/2009 $5.40
TIGARD, OR 97224 12% State Surcharge - Mechanical 04/02/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 04/02/2009 $67.10
Contractor:
KOEHLER CONCEPTS LLC
10772 SE HWY 212
CLACKAMAS, OR 97015
PHONE: 503 - 650 -9550
FAX: 503 - 650 -1220
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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
D
Issued By: CAI A . A 4 2 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.
,�. pr._ 01 2009 10: 12FIM 503 - 650 -1220 p. 1
echanical Permit Applicati 1' n�`11I'/(I� D FOIE OFFICI IISL ONI.1
?. �� _ V Received Permit No.: ■ • Gr
City of Tigard
Dare/BY: d `1 V r
• 13125 SW Hall Blvd., Tigard, OR 97223 2009 Plan Review other permit:
' a . Phone:' 503.639.4171 Fax: 503.598.1960
APR 1 DatelBy: 1 C`ZOOQ .6(..) l 4S
' ---....2 Inspection Line: 503.639.4175 pate Ready/By: ma: :Nee Page 2 for ..
r [ Gn > Internet: www.tigard- or.gov CITY OF TIG ARD Notified/Method, 7 I ei Supplemental information
• I '.� ,} t l A Y. iT- -� l KV • 'i ✓" 1 ' . IF Mors •
i I < 11[1 rv' St s r . :fi I f ii "1 1 i„ 1 l +A, It ! l i.i J ., `g 1 u • I :1 Xk : f 2 JL t :� , ,: �F § ;.'"141): , : P I f Pa y t� + � s • • .: t y�,�R Y r.,. ?.ra�.> I +._ r,u t u1c`,xv..f.r :h :; r, r.�.s �,.
;II New construction . 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
I■ Demolition ❑ Other mechanical materials, equipment, labor, overhead and profit
Value: ' ,
� (, a? r .+�.' , r4,�7` �i:IV -t t -T,I -aPt y s�a r .4 :41; a:, •r 3 I 1 �. °i i,: A cit - .1 fits n : ` 4 g : t> > 5 z r - .r _. ;�
a 1ii ';lxrintr.9 . rs.�i- n1,1,1,,✓taliasanv..i.,, - ithei= ..tcy.4 ' :i ilf:Ndn.i,Ak':6 a+r1'4 >i) L� 1, egrAFFa El l a rA " lit 1 + � r { : -- i Y i ' ,, 4. - ,'S
i
i
1. and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building „' '� ' ' �" °''( "` c .�� i, . a�.c 4�' :r
For special ir ∎12 ali0n use checklist.
■ Multi family ID Master builder ❑ Other: " ' Description I Qty. I Ea. I Total
x �i ,st a 1 t Rrt.; " 8sa���azV 1 =�r 5gi(� "1 lti`r ?kr a . .. rel t ji' �r+.tq V : . " k,ra e Cc-'ai ii' Er :.+('•«irr at:7 ;.-1 - - 'z i ,1 t s s it af�:�: :..r 5 .€f i?a . .f:2 ` Ial } Heatingkwling
.
r , Air conditioning or heat pump
.b site address: /4/7 5 v/ 63 -- 4Vtc (requires site plan showing placement) 14.00
14 ity /State/ZIP: PO fL- /q , d OP-- 9-72_2_C, Furnace 100,000 BTU (duct rvents) _ 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
' uite/bldg. /ept. no.: I Project name: Gas heat pump 14.00
1 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),
i in -wall, induct, suspended, etc. 14.00
Flue/vent for any of above 6.80
ubdivision:
I Lot no.:
Other: 10.00
•
ax map/parcel no.: Other fuel appliances
„ s r i z 7•� x a c+ i:vr" lu r { I 'ip' t'lj p<
i Water heater L 10.00
. ' ' .y.-.,.. r tt 4n ii .,7 � �..rt: 1la' ' l me,' a _ h. isl a 1 i I l i t E tY H F t
r Gas fireplace 10.00 _
( 1► Flue vent for water heater or gas
fireplace 10.00
f 2 if d ^5 n& 1 ' or% Log lighter (gas) 10.00
P �J Wood/pellet stove 10.00
Wood fireplace/insert 10.00
'T: =in l i Tyr I I Prrs 7 a � '"*+ c u � 1 ili, f r F Era c. Bey, a a r2 t I II; * , j ; =4 Chimney/liner /flue/vent 10.00
';i'nr.. i,r:1• : , `!.sir..:, P_ w..t., tic rli „s?`:v,1 .?.lt , : -t ! r3 ' '?NNC: . i.leead . ' si tt _ Other: 10.00 _
ame: Lt_n Ng ) (Dk 1 .- ) Enviroonental exhaoat andveatilation
•dares: %ti S v.) W3r I E. Range hood/other kitchen 10.00
ity/State/ZIP: PO( - iv ∎ d d 2 9'7 2-2-Li Clothes dryer exhaust 10.00
( 3) 6,24- 41'7'
Single-duct compartments, exhents (bathrooms, oms,
•
: ;b Fax ( ) toilet compartments util rooms) 6.80
, ttV r r r- w Ic. bill TF , r ° ; r 744 , r w �'?,'7 M1Pr7I '�r4y Y I. Attic/crawlspace fans 10.00
. ;at
��� t t�� .rug v , •� h, . � a ,:a °LZ a... 1 , t'. ., --�i.t.,'ln1.l� ' .qt :`330rMlAt,,M` 0P J. tlilirk:r.�ic'x4, ari aii1 fill rir, .
�_ __ Other: 10.00
: usiness name: ti - ��<' W� -:.e y ' \-\..(_.. Fuel I t
pPng
ontact name: 55.40 for first four; 51.00 for each additional
0 --�-N7 CMG 7,\--1_ Furnace, etc.
ddress: \
Gas heat pump
ity/State/ZIP: C \\rte.- -N-.c... . Q C"1 d'( Wall/suspended/unit heater
'hone: tz l,,Lc _.eAr..e-13 I Fax: : ( (...eSO _`'ZZ) Water heater _
Fireplace
-mail: a� �. fbjl■� Range I
ti; lf,r ,f N:WO,* f rrlaIatitil I . r I e} r+ l y . ; .
1.41, :rvi4astskil :, eL han'/0.4;15s 1.1 .1LY.a ki ! P r n t
ra H , .
4 l sx.� i1;� � � � ' si � r1 �� l�1i�' ,k " . � Barbecue
it usiness name:
��_ Clothes dryer (gas)
�,P�� �D�CJ'P �� Other: 1
' r dress: f � a ro u vrr 1 ti, r �s. as�k16 PI < ' r l { )
� �Z�Z e l Z•� 1k.. s5 t... c lelo, msl:.;ina a.• r
ity/StaterZlP: c ) C,,p\ Subtotal
/ Minimum permit fee (S',2.50) 7Z. QC
I'hone: ( ) l ) .- -.'\SS(D I Fax: ( �) ( p0` K 0 Plan review (25 %of permit fee)
CB lie.: \ Z"1 State surcharge (12 %ofpermitfee) 1-71
TOTAL PERMIT FEE .8 I . 7.0
Authorized signature: --- -- This permit application expires if a permit is not obtained within t8C
days aPoer it bas lreerr acapred as complete.
' rint name: ,^ I Date: 4 - f .-. • Fee methodology set by Tri•County Building Industry Service Board
1Building \ParetAMEC•PenuhApp.dOe ni 7 400-061 rr(1 I/OLCOM/WEH)