Permit CITY OF TIGARD MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2009 -00289
T EGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06!17!2009
Parcel: 1 S134DB04300
Jurisdiction: Tigard
Site address: 11085 SW 109TH AVE
Subdivision: CARNAHANS ADDITION Lot: 5
Project: Brahm
Project Description: Replace furnace and a /c.
Owner: FEES
BRAHM, STUART R & SHARON W Description Date Amount
11085 SW 109TH Air Conditioning or Heat Pump 06/17/2009 $14.00
TIGARD, OR 97223
Furnaces < 100K BTU 06/17/2009 $14.00
PHONE. 12% State Surcharge - Mechanical 06/17/2009 $8.70
Minimum Fee Adjustment - Mechanical 06/17/2009 $44.50
Contractor:
THE HEATING SPECIALIST INC
9300 NE HALSEY ST
PORTLAND, OR 97220
PHONE: 503 - 257 -7000
FAX: 503 - 257 -7702
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 No • - • enter. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. ou may obtain a copy of the rules
or di t questions to O k • • lin: 503.246.6699 or 1.800.332.2344.
Iss ed By: , _ ; Permittee Signatu : iJ "pi f ea"
• 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.
-`- ' F;om:The Heating Specialist 503 257 7702 06/15/2009 09:13 #646 P.001/003
RECEIVED
Mechanical Permit Application FOR OFFICE tISE ONLI
City of Tigard JUN 15 2009 Received
71 = ° 13125 SW Hall Blvd., Tigard, OR 97223 Phi — J i� •
Phone: 503.639.4171 Fax: 503.598.1 96Ty OF TIGAI V Other Permit:
at Inspection Line: 503.639
T 1 GA RD D
Date e Ready/By: 0 See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Ilin Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - CHECKLIST
El 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
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value; $
AL I and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
For special information use checklist,
❑ Multi-family ❑ Master builder ❑ Other: Description
Qty. Ea. I Total
. JOBSITE INFORMATION AND LOCATION? . Heating/cooling
Job site address: 1 l CY !� A) W 1 -ti. Air conditioning
(requires ite p ing or heat p camp ) i
u l� r uires site plan showing placement) 14.00
City /State /ZIP: ' "t,91,� u -, - Furnace 100,000 BTU (duets/vents) I 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt.no.: Project name: �re1 1�. Gas heat pump 14.00
Cross street/diredions 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),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.:
Flue/vent for any of above 6.80
Other: 10.00
Tax map /parcel no.:. Other fuel appliances
DESCRIPTION OF WORK', Water heater 10.00
Rail, �, �I Gas fireplace 10.00
z..44.... � ,Btr P C L- + 1 ✓ 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 kr_PROPERTY OWNER . ❑ TENANT ' S Other. 10.00
Name: `i3r- -ak(„„ Environmental exhaust and ventilation
Range hood/other kitchen
Address: � 5 C � ` , 1 \ B ' a l� equipment 10.00
City / State/ZIP: ' � k ovs Q ' 1 be,, 9'19-93 Clothes dryer exhaust 10.00
Fax: Single -duct exhaust (bathrooms,
Phone: (
��) 7 go - 3h-7 3 ( ) toilet compartments, utility rooms) 6.80
gLAPPLICANT "❑ CONTACT PERSON Atticfcrawlspace fans 10.00
- „ Other: 10.00
Business name:
1 X10, -tv c t C Ac'�� �b'�, i - Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: 1300 l l Furnace, etc.
Gas heat pump
City/State/ZIP: ? p r-k-` N_81. r c-:41 A -7 aao Wall /suspended/unit heater .
Phone: (503) r 7? cc0 Fax:: ( ).2s _ 7 7 _ Water heater
Fireplace
E -mail:
_ Range
CONTRACTOR Barbecue
Business name: Clothes dryer (gas) .
Other:
Address: MECHANICAL PERMIT FEES*
City /State /ZIP: _ Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( ) Plan review (25% of permit fee)
-
CCB lie,: 6 (11 (p .,_g State surcharge (12% of permit fee) 6-7 U
TOTAL PERMIT FEE 8 1 .c9
Authorized signature: This permit application expires if a permit is not obtained within 180
_ days after it bas been accepted as complete.
Print name: 'ry_, ■ Date: (t-5 / O / ` Fee methodology set by Tri -County Building Industry Service Board
ll\auildineermiti'MEC- Permitpp th 01/19/07 440.4617T (11/02 /COM/WEB)
ti Prom:The Heating Specialist 503 257 7702 06/15/2009 09:14 11646 P.003/003
Job Name Job #
Address ` (0 V S l" 1 dc Date b l / Oc
City, State Zip t \ l ■p r ( RC
2:1
s
A