Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00413
T [GAB O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/11/2009
Parcel: 1 S134DA05400
Jurisdiction: Tigard
Site address: 11310 SW 105TH PL
Subdivision: NODAK Lot: 2
Project: Mills
Project Description: Replace gas furnace, add a /c.
Owner: FEES
MILLS, DONALD R AND NANCY ANN Description Date Amount
11310 SW 105TH PL Air Conditioning or Heat Pump 08/11/2009 $14.00
TIGARD, OR 97223
Furnaces < 100K BTU 08/11/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 08/11/2009 $8.70
Minimum Fee Adjustment - Mechanical 08/11/2009 $44.50
Contractor:
HEAT RELIEF CO
13122 NE DAVID CIR # 800
PORTLAND, OR 97230
PHONE: 503 - 261 -9915
FAX: 503- 261 -9814
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
or direct • - - ions • •UN = c. ing 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signatu
-
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.
•
Mechanical Permit Application FOR OFFICE USE ONLY
Received
of Tigard and ^a Permit `� g Date /By: I mt✓ 1 A P itN
- Hit • „ ll 1 r
'
_ Date /By:
` 13125 S W Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 an Review Other Permit:
D
TIGARD Inspection Line: 503.639.4175 Date Ready/By: luwu' H See Page 2 for
Internet: www.tigard -or.gov Notified/Method: i el l(: Supplemental Information
e # R ' 1 l '0” t t as 4 ,
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.
YNW Value: $
1 - an d 2-family dwelling Commercial/industrial t ` _. e 1
❑ y g ❑ 0 building ~ b
®Multi- family ❑Master builder For special information use checklist.
❑ Other. Description I Qty. I Ea. I Total
o i °e a It f e
HeatinpJcooling
!� D 51 _ I '' �— Air conditioning or heat pump
Job site address: �/ 4) //}
/ tJ� (requires site plan showing placement) / 14.00
City/ State/ZIP: v 1,e Furnace 100,000 BTU (ducts/vents) 14.00
a6 ,/, 9 Fumace 100,000+ BTU ( ducts/vents) / 17 J . C Suite/bldg. /apt. no.: Project name: /
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: I Lot no.: Flue/vent for any of above 10.00
Other. 10.00
Tax map /parcel no.: Other fuel appliances
ic e '°°k�# ' t r a , ° s S' �s
t i of ' S e r . , Water heater 10.00
x � myzx � G85 fl[eplaCe 10.00
.1 ,/ ,// / �-- Flue vent for water heater or gas
' ' %° fireplace 10.00
W / �// I/EM/F Log lighter (gas) 10.00
��/ /L�_� Wood/pellet stove 10.00
Wood fireplace/insert 10.00
~� Chimney /liner /flue/vent 10.00
te � a t z� de f . . Other 10.00
Name: p 6y1, 1 4 Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/ State/ZIP: . :04p "4 , Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
, , h t ( , r • t t r t tk fi a � i� fie , Attic /crawlspace fans 10.00
Business name: HEAT RELIEF Other: 10.00
Fuel piping
Contact name: MARK DEFRANCISCO $5.40 for first four; $1.00 for each additional
Address: 13122 NE DAVID CIR DR # 800 Furnace, etc.
Gas heat pump
City /State/ZIP: PORTLAND, OR 97230 Wall/suspended/unit heater
Phone: (503) 261 -9915 I Fax: : (503) 261 -9814 Water heater
Fireplace
E -mail: Range
q "s ' gr! „. ":N , ' , ) , ” ' ? ,177r7"6.7.74 c 4 s v ;r` �:„ :j if' Barbecue
Business name: HEAT RELIEF Clothes dryer (gas)
Other:
Address: 13122 NE DAVID CIR DR # 800 q ,x . t) ai "
Subtotal
City/ State/ZIP: PORTLAND, OR. 97230 Minimum permit fee ($72.50) q . J'
Phone: (503) 261 -9915 Fax: (503) 261 -9814 Plan review (25% of permit fee)
CCB lic.: 122424 State surcharge (12% of permit fee) 8 no
TOTAL PERMIT FEE 'r, go
r �, c �� This permit application expires if a permit is not obtained within 180
Authorized signature: i� ,_, , days after it has been accepted as complete.
Print name: MARK DEFRANCISCO Date:
s Fee methodology set by Tri -County Building Industry Service Board
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FEET TO FRONT PROPERTY LINE
ADDRESS: //3/0 /6),5 PIA_ at
PLEASE REFAX APPLICA'ION7 WITH SITE PLAN