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Permit ,, CITY OF TIGARD MECHANICAL PERMIT " COMMUNITY DEVELOPMENT Permit #: MEC2009 -00463 • TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/02/2009 Parcel: 2S111DB12400 Jurisdiction: Tigard Site address: 15275 SW 94TH AVE Subdivision: SUMMERFIELD NO.12 Lot: 651 Project: VanKleek Project Description: Replace gas furnace Owner: FEES VANKLEEK Description Date Amount 15275 SW 94TH AVE Furnaces < 100K BTU 09/02/2009 $14.00 TIGARD, OR 97224 12% State Surcharge - Mechanical 09/02/2009 $8.70 PHONE: Minimum Fee Adjustment - Mechanical 09/02/2009 $58.50 Contractor: COLUMBIA HEATING & COOLING INC PO BOX 230397 TIGARD, OR 97223 PHONE: 503 - 624 -2704 FAX: 503- 598 -0270 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: { j N I Permittee Signature: pt,_ afP (/ ,ll`- Lt_rob. 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. i i cationp r '� FOR orl Ic 1 '51 ONLY Mechanical Permit A pp p , � d !� r !s-' " Received Permit No ((! Ci r� l b V 1�� �' City of Tigard DateBy: f • 13125 SW Hall Blvd., Tigard, OR 97223 1 ' Plan Review Ocher Permit: I n Phone; 503.639.417 Fax: 503.595.1960 SEp 0 i 6atdi3y Information f.p •Onto Ready/By- 7.6 1 93 Set Par for T l G.A'li0 1nten ction Line: 503.639.4171 �l O P trt® Notiiicd /Method: ..l Internet. www.t or.g 0� ! Supplement C oarl. X11 \i \S,O1 , E OF WORT{ a- to v ..COMMERCIAL FEE* SCHEDULE- - 11SE CHECKLIST Mechanical permit fees` are based on the value of the work © New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Oth er: mechanical materials, equipment, labor, overhead, and profit. ❑ Demolition Value: $ CATEGORY OF CONSTRUCTION • RESIDENTIAL EQUIPMENT ! SYSTEMS FEES* and 2 - family dwelling 0 C o mmercial /industrial ❑ A ccessory building For special information use checklist. ' ❑ Multi - family ❑ Master builder ❑Other: Description I Qty. Ea. ` Total JOB SITE INFORMATION AND LOCATION Heating/cooling Air conditioning or heat pump 14.00 Job site address: / 5 0). 7 5 �� f� ,x (requires ate plan showing placement) Furnace 100,000 BTU (ducts /vents) 14.00 City/State/ZIP: Furnace 100,000+ BTU (ductsiveats) 17.90 Project name: s heat „ tun 1 4.0 0 Suite/bldg./apt. 1apt. no.: Ga J Cross street/directions Duct work I4 04 ditro lions to job site: - H dronie hot waters 'stem 14.00 Rcsidentird boiler (radiator or 14.00 hydronic) Unit heaters (fuel -type, not electric), 10 00 in -wall, in -duct, suspended, etc. Eloquent for any of above 10.00 Subdivision: Lot no.: Other: j 10.00 Other fuel appliances Tax map /parcel no.: Water heater 10.00 DESCRIPTION WORK Gas fireplace 10.00 40...fl- C.f e . Flue vent for water heater or gas 10.00 fire • lace Lo_ li: ter as 10.00 Wood/lend stove - 10.00 Wood fir ,lacelinscrt 10.00 • _ _1000 ❑ P • OPERTY OWNER 1 0 TENANT 10.00 Environmental exhaust and ventilation Name: L Range hood/other kitchen 10.00 e.ui�tnent _ Address: Clothes d er exhaust 10.00 CitylSurtclZiP' Single -duct exhaust (bathrooms, 6.30 Fax: ( ) toilet corn r . • ems, utili rooms) Phone: ( ) 10.00 Atticicrawls.acefans III 10.00 El APPLICANT ❑CONTACT PERSON Other: Business name: Fuel ruin: I S5.40 for first four: $1.00 for rack additional Contact name. , . K A r 12=1,1 NM Address: Gas heat . . Wall/sus - dedhrttitheater ��� CitylState/ZIP: W ater h eater 3 )� Fax: :c3 >S 6 , , _ Phone' � ► Range _ E - mail: Barbecue • CONTRACTOR Clothes a - r :as) IIIII Business name'. (11.1)10,.” b' 6_, 1-1 • / - e rob . Other: Mi.. MECHANICAL PERMIT FEES Address: J OX . 0 3 6 Subtotal ---77 U ,„ ' City/State/ZIP: , 2 t^ 1 2,1 / Minimum permit fee ($72.50) � �j 4 y - 2- 7 iL . Fax: ( 561 ) g f '' 63-"76 Plan review (25% of prrrrrit fee) Phone: (,,.7 U a) CCB lie.: t h 3 S / _ p State surcharge (12% of permit fee) TOTAL PERMIT FEE . , -TV i ',A 'Ibis permit application expires if a permit iS not obtained nitlriu 155 /-] days after it has been accepted a complete. Print. name: Authorized signature: Lam' 9 l 1 . Fee methodology act by Tri Building Indoslr r Scrs We Beard /2 ate: p .... .-_..,•."..•.n--n, doe 09106196 440 -46177 a Ug2.1COMIWEB) Z OLZO 6uHoo0 /6u!TeaH eigtunloo e9:80 60 1.0 des