Permit p CITY OF TIGARD MECHANICAL PERMIT
I N I/ . COMMUNITY DEVELOPMENT Permit #: MEC2009-00093
T f GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/10/2009
Parcel: 1 S 133DD13000
Jurisdiction: Tigard
Site address: 11817 SW 126TH PL
Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 167
Project: Teasley
Project Description: Replace furnace.
Owner: FEES
TEASLEY, BRUCE H & JODY L Description Date Amount
11817 SW 126TH PL
TIGARD, OR 97223 Furnaces < 100K BTU 03/09/2009 $14.00
FlueNent For Any of Above 03/09/2009 $6.80
PHONE: 12% State Surcharge - Mechanical 03/09/2009 $8.70
Minimum Fee Adjustment - Mechanical 03/09/2009 $51.70
Contractor:
TRI- COUNTY TEMP CONTROL
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 557 -2220
FAX: 503- 557 -0919
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 699 or 1.800.332.2344.
Issued By: f Permittee Signature: g ovtlii ,„
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
' MAR '4 -2009 12:07P FROM: TO:5035981960 P.1
Mechanical Permit Applic ' 1��� l OR MA I( 1 I �I 0\11
" Received
City of Tigard g Date/By: • Li ' 4'9 /1 Permit No.: ' *II - • • r•
13125 SW Hall Blvd., Tigard, OR 9 CO
0 Phone: 543.639.4171 Fax: 503.59$ ,.1 1 � ' Plan Review
• Date/By: Other Permit:
111. A RI) inspection Line: 503.639 , ; , m : " 0 Date Ready/By: 0 See Page 2 for
Internet: www.dgard or,gov 1 \V \S.\ Notified/Method: Supplemental Information
TYPE OF. WORK COMMERCIAL FEE" SCHEDULE •- USE CHECKLIST
❑ 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: $
1 an d 2-family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEF�S*
® y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family 0 Master builder 0 Other:
Description I Qty. - I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 1S 1 8W f .6 �- P k 1L C Air conditioning or heat plump
l (requires site plan showing placement) 14.00
City/State/ZIP: Tigard, OR 611 Furnace 100,000 BTU (ucts/vents) ! 14.00 _
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: ] Project name: Gas heat pump _ 14.00
Cross street/directions to job site: Duct work 10.00 _
Hydronic hot waterystem 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 I , 6.80
Other: 10.00
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00 itoaccfurnur„ • Gas tel 10.00
Flue vent t for for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00 .
PROPERTY OWNER I N TENANT O t h er: /liner /Oue/vent 10.00
Other: 10.00
Name: braCl✓ Twity Environmental exhaust and ventilation
Address: ',1, Range hood /other kitchen
equipment 10,00
City/State/ZIP: Clothes dryer exhaust _ 10.00 -r
120.421)6 Fax: ( ) Single-duct exhaust (bathrooms,
Phone: ( ) . toilet t compartments, , utility lity rooms) 6.80
S. APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name: Same as contractor
_ Fuel piping
Contact name: Diane Mason $5.40 for first four; $1.00 for each additiona
Furnace, etc.
Address:
Gas heat pump
City/State/ZIP: Wall /suspended/unit heater
Water heater
Phone: ( ) Fax: : ( ) -
Fireplace _
E -mail: Range
CONTRACTOR Barbecue
Business name: Tri County Temp Control Clothes dryer (gas) _ -
- Other _
Address: 13150 S. Clackamas River Drive . PERMIT FEES"
City/ State/ZIP: Oregon City, 97045 Subtotal
Minimum permit fee ($72.50)
Phone: (503) 557.2220 Fax: (503) 557.0919 Plan review (25% of permit fee)
CCB lic.: 72623 State surcharge (12% of permit fee) / 11 . 24
l)
�-C
TOTAL PERMIT FEE
y� /�� This permit application expires if a permit is not obtained within ISO
Authorized signature: '�"a'ci' -___. tr j days after It has been accepted as complete.
Print name: Diane Mason Date I4l, ' Fee methodology set by Tri- County Building Industry Service Board
I:U luilding \Permite\MEC- PermilApp.doc 01/19/07 440.46177 (11/02/COM/WE11)