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Permit CITY OF TIGARD MECHANICAL PERMIT COMMUNITY DEVELOPMENT Permit #: MEC2009 -00260 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009 Parcel: 25111 DD12000 Jurisdiction: Tigard Site address: 8550 SW AVON ST Subdivision: CHESSMAN DOWNS Lot: 46 Project: Brauer Project Description: Replace gas furnace. Owner: FEES BRAUER, ROBERTA LYNN Description Date Amount 8550 SW AVON ST TIGARD, OR 97224 Furnaces < 100K BTU 06/04/2009 $14.00 12% State Surcharge - Mechanical 06/04/2009 $8.70 PHONE. Minimum Fee Adjustment - Mechanical 06/04/2009 $58.50 Contractor: FOUR SEASONS HEATING & A/C INC. 1005 INDUSTRIAL PARKWAY NEWBERG, OR 97132 PHONE: 503 - 538 -1950 FAX: 503- 538 -0165 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 i . • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utilit •• • ification Center. -hose ru - e set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a so of the rules o .erect questions to OUNC b . , .fling 56 .4'6.6699 or 1.800.332.2344. • Issued By: • I i Permittee Signature: Apr Call 503.639.4175 by 7:00 a.m. for an inspection that b iness day. This permit card shall be kept in a conspicuous place on the job site ntil completion of the project. Approved plans are required on the job site at the time of each inspection. Mechanical Permit Application • , FOR O FFICE USE 01NLY . . City Permit No.: G e / `J of Tigard Received g Date/By: / ©Q ,,k/ e /r / ,� , W II III ° 13125 SW Hall Blvd., Tigard, OR 97223 ��`" Phone: 503.639.4171 Fax: 503.598.1960 Plan Review DateBy: Other Permit: TI GARD Inspection Line: 503.639.4175 Date Ready /By. �Juri M See Page 2 for / ( Internet: www.tigard- or.gov Notified /Method' C 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 ther: mechanical materials, equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES* For special information use checklist. I 4 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building Multi- family ❑ Master builder ❑Other: Description Qty. I Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: . 5 - 6 - 5� J� ly � 'Si" 0 Air conditioning or heat pump v / `` (requires site plan showing placement) 14.00 Cit /State /ZIP: - II frk 0 - q -1 Furnace 100,000 BTU (ducts /vents) / 14.00 / 7 , 06 r �� Furnace 100,000+ BTU (ducts /vents) 17.90 Suite/bldg. /apt. no.: Project name: ( 1A , U^ Gas heat pump 14.00 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 II 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 Gas fireplace 10.00 ;r. 0 sOb It . / / 4 .0� - . A �L14�.I 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 10.00 PROPERTY OWNER 0 TENANT Other 10.00 Name: °R 0 b' n br1A1 'e,, r' Environmental exhaust and ventilation Address: gSSO S GO U' St Range hood/other kitchen equipment 10.00 City /State /ZIP: , '\ f V £ 7 )_ a'- � Clothes dryer exhaust 10.00 I. Single -duct exhaust (bathrooms, Phone: (503) 31 - 4_3 7 Fax: ( ) toilet compartments, utility rooms) 6.80 APPLICANT ❑ CONTACT PERSON' Attic /crawlspace fans 10.00 Other: 10.00 Business name: Fuel piping Contact name: FOUR SEASONS-HEATING AND AIR CONDITIONING INC. $5.40 for first four: $1.00 for each additional Address: 1005 INDUSTRIAL PKVJY Furnace, etc. NEWBERG, OR 97132 Gas heat pump City/State /ZIP: p Wall /suspended/unit heater Phone: (S) 5 J 30 I ct .sQ Fax: : (s s38-_ 0 [ S Water heater Fireplace E -mail: Range CONTRACTOR Barbecue Business name: FOUR �p�� Clothes dryer (gas) ' FOUR SEASONS HEATING ©NG Other: - Address: AND AIR CONDITIONING, INC. MECHANICAL PERMIT FEES *, ' _ City /State /ZIP: 1005 INDUSTRIAL PKWY Subtotal NCWBCRG, R 97132 Minimum permit f e e ($72.50) ,„5-0 Phone: (Sod ) g 3 -1 q S G Fax: ( - ) 5 3,,,y- ,,y — 0 J 6'S Plan review (25% of permit fee) CCB lie.: "7 -7 I State surcharge (12% of permit fee) d''t ?0 �� p - TOTAL PERMIT FEE 8 I e Authorized signature\�� "�� c:----,\C.4.----.) This permit application expires if a permit is not obtained within Intl days after it has been accepted as complete. 1 • Fee methodology set by Tri -Count Building Industry Service Board Print name: 1 GI V� Q(J �t� tf� Date: Q� s> y y t'y I:\Building \Permits \MEC - Permit App.doc 01/19/07 44 -4617 (I t /02 /COM/WEB)