Permit ,, CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00457
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/31/2009
Parcel: 1 S 133 DA09300
Jurisdiction: Tigard
Site address: 11156 SW 130TH AVE
Subdivision: CASTLES AT BRITTANY Lot: 23
Project: Johnson
Project Description: Replace furnace. Air conditioner add -on. Must maintain 3' rear and side yard serback
Owner: FEES
JOHNSON, MARGERY EATON Description Date Amount
REVOCABLE LIVING TRUST, BY MARGERY Air Conditioning or Heat Pump 08/31/2009 $14.00
EATON JOHNSON, 11156 SW 130TH AVE Furnaces < 100K BTU 08/31/2009 $14.00
PHONE: 503 - 524 -6314 12% State Surcharge - Mechanical 08/31/2009 $8.70
Minimum Fee Adjustment - Mechanical 08/31/2009 $44.50
Contractor:
GRESHAM HEATING
1560 NW 3R.
GRESHAM, OR 97030
PHONE: 503 - 667 -7594
FAX: 503 - 667 -3769
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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: J4 L1l Permittee Signature:
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 IOU OFFICE I'' L rf
hr .:,„,,...„...,, : R UPI City of Tigard F ' _ I! Permit No.: C yq- 004110 1 3125 SW Hall Blvd., Tigard, OR 97223 " 1 y
Plan Review
Phone: 503.639.4171 Fax: 50 200 (1 D,,�g Other Permit:
T'I G iR D Inspection Line: 503.639.4175
AUG 2 J Date Ready/By: &I see Page 2 For
Internet: www.tigard- or.gov
CITY OF TyGNRD orifled/Method: Sapplenentat Information
TYPE OF "WILDING UIVlbic,m COMMERCIAL FEE* 'SCHEDULE - USE CHECKLIST
['New construction Addition /alteration /replaeemcnt Mechanical permit fees' are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
CATEGORY OF CONSTRUCTION Value: 8
dwelling ❑Accessory building L. EQUIPMENT / SYSTEMS FEES*
and 2-family g ❑ CommerciaUindustrial
For special mforrnarion use checklist.
❑ Multi fami ❑ Master builder ❑ Other:
Description I Qty. Fa. ( Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
lob site address / I j Air conditioning or heat pump I / j
l /. l 5 L.& r � (requires site plan showing placement) I 14.00 —1
City /State/ZIP' Ri -iand ()72__ 87223 Furnace 100,000 BTU(doom/vents) / 14.00 / I--- /
Furnace 100,000+ BTU (ducts' vents) 17.90
Suite/bldg. /apt. no.: I Project name: `Oh n 5 Gas heat pump I4.00
Cross street/directions 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
Flue /vent for any of above 6.80
Subdivision: Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK • Water heater 10.00
Gas fireplace 10.00
1� �� Flue vent for water heater or gas
fireplace 10.00
/1-1 —On Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
Ig PROPERTY OWNER 0 TENANT Cttimneylliner /YlueJvent 10.00
Other: 10.00_
Name: If Q,rq q f r)11 5U Environmental exhaust and ventilation
l �/ Range hood/other kitchen
Address: 1 5 � _ } .4 th equipment 10.00
City /State/ZIP: �� r fl a �� C 7 , 9,9_ Clothes dryer exhaust 10.00
�') / � Single -duct exhaust (bathrooms,
Phone: (66 2/. 5 - LI 3 i / f Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT 1/ ❑ CONTACT PERSON Attic/crawispace fans 10.00
Other: 10.00
Business name: Fnel piping ,__
Contact name: $5.40 for first four; Sl.00 for each additiona
Address: Furnace, etc.
• Gas heat pump
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City /StateJZlP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E-mail:
Range
CONTRACTOR Barbecue
Business name: a .' a di s 114 * , i ' .+,, f • A ' , 1 , I Clothes Cr
Address:
l C) N VJ Oilier.
MECHANICAL PERMIT FEES*
City /Stat ell � OC�' 0 I 010 Subtotal
Phoo� ( �/ 0 �d D (J�
3 l -1 5Q v I Fax: ( 'r? -3R / Minimum permit fee ($72.50)
Plan review (25 %ofpermit fee)
CCB lie.: f 1 y t / /f it o Slade surcharge (12% of permit fee) - p -
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v TOTAL PERMIT FEE O
This p erdsit application expires if a permit is not obtained within ItttI
Authorized signature: days after it bas been accepted as complete.
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V 69L£ L99 6uRe9H ttleysei e££:60 60 9Z 6nV
Aug 28 09 09:34a Gresham Heating ' 503-667-3769 p.2
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