Permit CITY OF TIGARD MECHANICAL PERMIT
13 " : COMMUNITY DEVELOPMENT Permit #: MEC2009 -00267
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/08/2009
Parcel: 25111 DC01300
Jurisdiction: Tigard
Site address: 15900 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 460
Project: Turner
Project Description: Replace gas furnace.
Owner: FEES
TURNER, THOMAS G & ROSE M Description Date Amount
15900 SW ALDERBROOK CIRCLE Furnaces < 100K BTU 06/08/2009 $14.00
TIGARD, OR 97224
12% State Surcharge - Mechanical 06/08/2009 $8.70
PHONE. Minimum Fee Adjustment - Mechanical 06/08/2009 $58.50
Contractor:
BEN'S HEATING & A/C
PO BOX 80607
PORTLAND, OR 97280
PHONE: 503 - 233 -1779
FAX: 503 - 651 -3345
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: trz_ 4 Q l Permittee Signature: C am- A
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.
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H� � - City of Tigard �� J Perm,t 140.1110266 41,1 '' saj` q 13125 SW Hall Blvd., Tigard, OR 97Y2 �� i., Pl R ev i ew Other Permit,
f r Phone: 503.639,4171 Fax: 503.598.196QJUN 0 4 2. 0 0 9 Dale/By: �'b '00.
im, Inspection Line: 503.639,4175 :' [ (. A K 1 Ins � Dale Ready/By. Id See Page 2 for
tnremet www,tigardor.gov ���p Notified/Method: Supplemental Information
CITY._
na;' ,?':' 9 �'l' ".' ^t�;;.." ''u 0... CIAL.FEE +:''CHEDULE.,= • USE CHECKLIST
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0 Ncw construction KAddition/alteratlon /replacement Mechanical permit fees* arc based on the value of the work
pertbrmed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, Tabor, overhead, and profit.
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�. CATEGORY' QF` C"' Q '``.'�,:' r�rs,. a }::,,:,�.�.,,�. ,. _, Value-
zr ''lgRES41OENtIAL / SYSTEMS
:: I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. _ Ea. I Total
• • JOE SITE INFORMATION4ANII tEICATIOI+i, V;,,',H.- 1,,,t;.t Heat}ng/crtUling
-- - Air conditioning or heat pump
}ob Site address: ' s , e, ,. a , t Cs r (requires site plan showing placement) 14,00 Mill
City /State/ZIP: - fir , 0 L / .2$4 Furnace 100,000 BTU (ducts/vents) I 14,00
Furnace 100,000+ BTU (ducts/vents 17.90
Suite/bldg. /apt. no.: I Project name: Oas heat . ump III 14,(x)
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: Flue /vent for any of above 10.00 • L Lo no.: Other: 10,00
Tax map /parcel no.: Other fuel appliances_
- . ' ,.�.b;,2.at i Water heater 10,00 -
D.ESCRIPTIpiV OF WORK ;.,t „ .r 4 r
Gas fireplace 10.00
4 - I 4 x 4 I .....,A r � r Flue vent for water heater or gas
—
fireplace 10.00
w f _ Lo: li_hter :as 10.
Wood/.ellet stove 10.00 Wood tireplacc/insert 10.00 IIIIII
Chimney/liner/flue/vent 10.00
PROPERTY OWNER D:. TENANT::'":.p,, }; , ',, 10.00
_ I ,. Other:
Name: ! t` »e e, Environmental exhaust and ventilation
Range hood/other kitchen
Address: ; -,,) Meier •istcc Ctr equipment 10.00
City /State/ZIP: � h K Clothes dryer exhaust 10.00
}1( 9 Single -duct exhaust (bathrooms,
p }tone, 3) o q zr'r Fax: ( ) toilet compartments. utility rooms) 6:80
'•'� :; Attic/crawlspace fans 10.00
D APPLICANT , • .: (� ' C ANTAC 'L;a�E1tSAN:.:;: " — -
Other: 10.00
^ I3usinesr name: a�t� #/ 1- L L G Fuel thin:
Contact Itause: C I t� ,( e -�.. �y S1.40 for first four; SI.00 for melt additional
Purace, etc.
Address:
Cat heat .um.
City /State/ZIP: Wall /suspended /unit heater
- Phone (57/31 313- •r3 9,0 Pax:: 07/) 6 3 - '33 y r- P Water heater
E -mail: Range •
_ CONTRACTOR Barbecue
Clothes d er - as
Business name: t u We t - 4 - 4 1 1'r . . t b. i \ MIM
Oth er:
Address: er d
Cit) /Stale/ZIP: f 0 d4 971g-0 Subtotal
-- Minimum permit te e ($72.50) •
ne: (,..0)_? ) ,,9_33-075' Fax: (.3--0 p 2) d,,,r/ -13 1"...r Plan review (25% of pennit tee)
l CCI) lie.: „. 9 , 1 ` State surcharge (12% of permit tee)
L 1- I ' � TOTAL PERMIT FEE : -74
s
IJ .1 . wa Thi>r permit a pplication expire If a permit it not obtained within 100
Authorized St nature: ' days after It has been accepted as complete.
w. Print name t Q ` b A t a c:
• Foe methodology sat by Tri- County' Building Industry Serv Upard
1 UiulldinOWPorn \t F 7 C- PermhApp,dec "0065 440.46177 (1IIOVCOAUWP,a)
T00l 2IIVVONI.LV H - SIQ33 5fi££TSt0£05 XY3 T£:£T OOOZ /60/90