Permit CITY OF TIGARD MECHANICAL PERMIT
>, COMMUNITY DEVELOPMENT Permit #: MEC2009 -00106
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/16/2009
Parcel: 2S 111 AB08600
Jurisdiction: Tigard
Site address: 14425 SW 94TH CT
Subdivision: PENROSE TERRACE Lot: 31
Project: Ferguson
Project Description: Replace gas furnace.
Owner: FEES
FERGUSON, DONALD W Description Date Amount
JULIE A, 14425 SW 94TH CT Furnaces < 100K BTU 03/16/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 03/16/2009 $8.70
PHONE. Minimum Fee Adjustment - Mechanical 03/16/2009 $58.50
Contractor:
BEN'S HEATING & NC
PO BOX 80607
PORTLAND, OR 97280
PHONE: 503 - 233 -1779
FAX: (503- 651 -3345
Type of Use: SF
Class of Work: ALT Type of Const: VB
Occupancy Grp: R -3
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
or direct quest' - to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued G� " "��l PermitteeSignature: � 1 - �
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.
ee Thical Permit Application
RECEIVE 1 FRt)4'i,'l(''E 'USE ONl_,l'
City of Tigard , UatelBy a 1"4, 09 y fe�Td/�a1�
Iutnil No i
• 13125 SW Hall Blvd., Tigard. OR 97223 Man Review --
11 Phone: 503.639.4171 Fax: 503.598.1960 MAR 16 200' Uete /By: Oilier Pe;nnt:
G
Inspection Lille'. 503,639,4175 Date Ready /by: to sec (No 2 For
Internet www.tigard•or,gov a .,N otified /Method: supplemental In fer mdrinn
CITY OF TIG _,......_ -
w'3UILD1NC DIVISION
TYPE OF WO COMMERCIAL FEE* SCIIP:DULL - USE ci-t :CKLIsT
Mechanical permit Fees* IAN based tin the value of the n 06,
❑ NOV consfnlcii0n 56 Addition /alteration /replacement performed. Indicate the value (rnundctl to the nearest dollar of till
❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead. and pro lit
. Value, $
CATEGORY OF CONSTRUCTION • -
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
+PIr I. and 2- family dwelling Commercial/industrial ❑ Accessory building For .special information u,eu checklist
❑ Multi - Family ❑ Master builder ❑ Other; Description Qt.. P.u. _ Total
JOB SITE INFORMATION• AND LOCATION ' - Ileating/cooling
Air conditioning or heat pump
Loh site Oddness: (requires site_llan showing plaeenteml I^(.(N)
City /Stott: /ZIP: W r r$Ar i 0 O g �� a Puntacc 100,000 1-3 l (dam/veins} I I1.() {)
Furnace 100.000+ Bill (duets/vents) 17.90
Suite /hldg- /apt. no.: Project name: Gas heat pump 1-I 00
Cross street /directions to job site: Duct work •r.._•, II 00
'—' Nydronic hot water 9y�ten1 14.00 _-
Residential boiler (radiator or
hydronic) T 14 00
Unit heaters (fuel -type. not electric), -
in -wall, in -duct; suspended. etc., 10,00
- - Flue /vent for any of above 10.00
Subdivision:
Lot no.: 1 1(00
Ot her: �•••- —,,.
Tas trap /pored nn.: Other fuel appliances „
DESCRIPTION OF WORK Water heater 10,00
III Gus fireplace 10.(10
It t r - Flue vent for water healer or }jab
-- fireplace I0.00
Log liAlitcr (gas) _ 1(1.00
Wood /pellet stove 11),00 _
wood fireplace /insert 10.00 _-
_ - Chi mney /liner /flue /vent 10 011
r PROPERTY" OWNER ❑ TENANT
- Other: _ 10.00
Name; 6c10 eii- , Environ mental exhaust and ventilat _-
Runge hood /other kitchen
Address; /iiiia Ski 91/ f equipment _ 111,1111 1 _
C'ily /Slate /Z r ii, 7- q la. V Clothes dryer exhaust 1(10(i
jingle: -data exhaust (bathrooms.
Phone: (.6741) 6'V_ �7 4g1 Fax: ( ) -- - -- toilet comportrOcttts_ utility rnuuu) (.kfl--- _ --... •
0 APPLICANT ® CONTACT PERSON Attic /crawlop thus 10.00
64, - - Other: 11).00
Business name: j JTr•,` j A Li...c.. Fuel pi loll
Contact name: C (u. ci r �u �or 4y $5,41) fur First four: Si 1(1 fu each uddilinnul
Furnace, etc.
Address;
-- Gas heal pump - _-___. _ -
C'ity /Stale /ZIP' wait /suspended /unit heater -!
Water heater
Phone: (57) 3) 3 1 3 3 y r v Fax:: (,SG 3 ) 6 1 - 33 y °..
Fireplace ,
I: -mail; Range .__. ___
_
CONTRACTOR Barbecue —
L1 Clothes dryer (gas)
Business Hanle: t $ r'jF ..y •fr A I(',' c r, 1 ' r 1 . L t Other:
• •
AddrOSS: e. / Q b L U 0 9 9 - NIECIIANICAL PERMIT FEES* -_
('it�Ititlee /ZIP; eop.+1ri,i0 • m(- 7 2a /r - - -- Subt01a1
M ininwm permit fee 01;72,5111 72 _
r I
Ill:: ( 5 . 9 3 3 - 17 9 7 _ fux: O'o 3) (,1'/ - .3 3 Y_ — Plan review (2;' W WC) _ •"-e-
.11 tic-: 6 yS - 5 , � Slate surcharge (12 %ofpermit feel _ j.70
ff - � TOTAI. PERMIT FEE t ( • 9•C� . J
~� fhi• p»e'n111 application expires it 1 permit is not obtained „ithin Ian
days after it him been accepted Authorized signature: b al t 111 li 1 • y �1` vl » a c��npMte.
�� ,a. Fruit e: . )a � e: • Fee mcthodaln>:Y !tut I,\ Tri -Coen lv liu,ldnp Inducuy' ti'i e cc Iin:ud
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I'Iluddiny I t.C•Pennil App doe ad/0010o 44(•46177 I I I riJCO3UW[a1
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