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Permit r CITY OF TIGARD MECHANICAL PERMIT III g COMMUNITY DEVELOPMENT Permit #: MEC2009 -00454 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2009 Parcel: 25111 BA09300 Jurisdiction: Tigard Site address: 14440 SW 97TH AVE Subdivision: PP1994 -052 Lot: 3 Project: harley Project Description: Install furnace. Owner: FEES HARLEY, ROBERT A Description Date Amount 14440 SW 97TH AVE TIGARD, OR 97224 Furnaces < 100K BTU 08/26/2009 $14.00 12% State Surcharge - Mechanical 08/26/2009 $8.70 PHONE: 503 - 927 -2923 Minimum Fee Adjustment - Mechanical 08/26/2009 $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. w Issued By: n Al . , I . Permittee Signature: f p APIp • 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. r ,r r L. Mechanical Permit ApplicKa ' ETVED FOR c)hrtca: .'St O■l.V : t Nermio. Li City of Tigard DatewBy: ,_� Received P i t �� a• 14 13125 SW Hall Blvd., Tigard, OR 97223: 5 2009 Plan Review Other Permit Q Phone: 503.639.4171 Fax: 503.598.196 DatelBy: • Inspection Line. 503,639.4175 Date R l3 See Page 2 for T ` ° Internet: www.tigard- or.gov CI OF TIGARD Notified/Method: Suppiementaf Information flUIIJ" NG DIVISION Mil TYPE OF WORK COMMERCIAL FEE` SCHEDULE — USE CHECKLIST r— 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 ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* O I- and 2- family dwelling ❑ Commercial /industrial © Accessory building For special information use checklist. Multi - family ❑ Master builder ❑ Other Description 1 Qty ' Ea. Total .1011 SITE INFORMATION AND LOCATION Heating/cooling J ob site address: � r' tiJ / ! r 17 9' y Air conditioning or heat pump (requires site plan showing, placement) 14.00 Furnace 100,000 BTU (ducve ts nts) l 14.00 City/State/ZIP: Furnace 100,000+ BTU (doccs/veats) _ 17.90 Suite/bldg.apt. no.: ! Project name Gas heat pump 14.00 Cross street/directions to job site: Duct work 14.00 14.00 i Hydronie hot water system Residential boiler (radiator or hydronicl 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 Other: 10.00 l Tax map/parcel no.: Other fuel appliances DESCRTPI [ON OF WORK - Water heater - 10.00 1000 l Gas fireplace Flue vent for water heater or gas fireplace _ 10.00 • Log lighter (gas) 10 00 - Wood/pellet stove 10.00 _ Wood fireplace/insert 10.00 Chimney/liner /flue /vent 10.00 [ PROPERTY OWNER ❑ TENANT Other. ` 10.00 Name: ,aO h / 7 w� 1 Environmental exhaust and ventilation Range hood/other kitchen Address: equipment 10.00 I . Clothes dryer exhaust _ 10.00 _ City/State/ZIP: Single -duct exhaust (bathrooms, Phone: ($ _3) 9 a . q 2 3 F ( ) toilet compar ments, utility rooms) _ 6.80 ❑ A p p s ❑CONTACT PERSON Attic/crawlspace fans 10.00 Other: I 10.00 Business name: Fuel piping Contact name:/ , R r b y $5.40 for first four; S1.00 for each additional Furnace, etc. lr Address: Gas heat pump City/State/ZIP: Wall/suspended/unit heater . �y 6 . 7 v Water heater Phone: r�'3 )�j� ' �D I Fax.. )S t �'' _Fireplace E -mail: Range . CONTRACTOR Barbecue , Q f C lo thes dryer (gas) B - usvress mme: ✓� 1(,10'') b / CC.. r 1 / ��.0"C7�1 d ' ' fir _ Other: Address: g 13 o X „23 0 3 9 -7 _ MECHANICAL PERMIT FEES' CitytStaterLIP: " / I R.4 0 ft, 97 ykI Subtotal Minimum permit fee ($72.50) Phone: V ,) b 2- 4 �- % - V $ ' I Fax: ( 8' �0 Plan review (25% of permit fee) 7 (e 3 5• Q r V State serrcharge (12% of permit fee) CCB lie.: / t TOTAL PERMIT FEE et. 20 This permit application expires if a permit is not obtained wlthia 190 Authorized signatttrt : days after it kiss been accepted as complete Date: (_/ 1 J 4 a a Fee methodology ret by Tfl•Count�• H d idiug lodaslr;' Service Baud Print name: Q r v�,tidina\Peemac ti/EGPmnitApp.doc 04, 440-4617T (1110 /C0 van Z'd V Q-9692C.%. CC at 14 6u!Ioo0 /6ui;B0H eigwnlo3 BCC :60 609Z 6nV