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Permit CITY OF TIGARD MECHANICAL PERMIT 2 :- . --' COMMUNITY DEVELOPMENT Permit #: MEC2009 -00264 1 3125 SW H all Blvd., Tigard O R 97223 503.639.4171 Date Issued: 06/05/2009 TIGARD Parcel: 1 S 134AC04200 Jurisdiction: Tigard Site address: 11068 SW BLACK DIAMOND WAY Subdivision: HARTS LANDING Lot: 13 Project: Kershner Project Description: Install gas furnace. Owner: FEES KERSHNER, JEFFREY Description Date Amount 11068 SW BLACK DIAMOND WAY Furnaces < 100K BTU 06/05/2009 $14.00 TIGARD, OR 97223 12% State Surcharge - Mechanical 06/05/2009 $8.70 PHONE: 503 - 579 -7367 Minimum Fee Adjustment - Mechanical 06/05/2009 $58.50 Contractor: THERMAL FLO INC 7236 SW DURHAM RD 100 PORTLAND, OR 97224 PHONE: 503 - 670 -8343 FAX: 503- 598 -6746 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressue: Total $81.20 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: 4 (1$?4)--se_____ Permittee Signature: ®Ar 1 9. 7 6 / 0 ,. e , r\j 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. • k 4 .06/02/2009 16:57 5035986746 THERMALFLO #0512 P 002/002 . . . Mechanical Permit Application ' . FOR OFFICE 1. °NIA' 14 City ©> Tigard . R., e Permit No.: ; RECEIVED 13125 SW Hall Blvd., OR 97223 Plan Review ., Tigard. 1 I :''. Phone: 503.639.4171 Fax: .503398.1960 j taie-y! Other Permit: lnsPection 1,ine: 503.639.4175 UN 0 3 2009 Date/By; T.IGARD Dale Retuty/ny: Jura,: Ell See Page 2 for Internet: wWw.tigard Notified/Method. Supplemental Information CITY OF TIGARD . ,..__ . . :... . ::;.,,,..,..::::.:,:., ..:;:::::.7: :.: .. .:.;:cc.im.N.F;:c.1.4::: . :ff W .....:OM::: :,:.:,.. Mechanical permit fees* are based 011 the value of the work 17 New conS %Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all 0 Demolition D Other: • mechanical materials, equipment, labor, overhead, and pmfit. _..... Value: S . .. , :... : ;.;:...: ,. •:Git E6cittv..: "... ' " " : :.:'''':-.:':::.-. L:.:: . . . - - .. ..................„......„.„.... ..... ,.,.. :.:..: F.Y•SITNI'FEES`.''''''' X 1 - and 2 dwelling, D Commercial/industrial 0 Accessory building For special information use checklist. 0 Multi U Master builder . 0 Other: Description 1 Qty. a. Total ' ' ' t . ..; 7 ..:: : 1 : • : :• : .:"-.:-.,' '::: . r ....................... {H37:gitE : , !114EifHtli1*:1101 . ..iiist1)::Ll)CkTIC 1: :: : :..: , : ::::::: .L., : :; : 'X.:. • Heating/cooling Air COrlditi011ing or heat pump ' Job site address: //6 Nile 16 glezaVadi 14/1_ (requires site plan showimplac-ernent) 14.00 City/State/ZIP: 7 04 giZZ 41 Furnace I 00,000 BTU (duets/vents) I 14.00 14- — Furnace 100,000+ BTU (duets/vents) 17.90 I Suite/bldg./apt. no.: Project name: 4 / ii,pa Gas heat pump ' 14.00 . — — Cross street/directions to job site: Duct work • . 10.00 - . Hydronic hot wale' system 14.00 • - Residential boiler (radiator or 7-kondiquidi, 6,00-01,- hydronie) ., 14,00 Unit heaters (ruel-type, not electne), " I 1 • in-wall, in-duct suspended, etc. 14.00 . ) . Flue/vent for any of above , 6.80 Other: Subdivision: Lot no.: . - . . . Oth 10.00 --- ._. ,..,_ .. . Tax map/parcel no 'Other fuel ap_ppancm; ••-•• • • • . . . — Water heater 10.00 -:';....::; ::::'•''' "' Uit;8041:PTION:■LO • .. •.... ‘.'•'•• '• - --,',..,.:„ ..... :.:::::::•:.. '';; . .. . ... .. ...... Gas fireplace 10.00 Flue vent for water heater or gas - • .f.4 Oa/ ao Ft/Yr/ace-1 fireplace Log lighter (vs) 10.00 10.00 • . - . Wood/pellet stove 10.00 I ._ _ Wood fireplacc/inscrt 10.00 _ , .. ..... .. ...., ..,„.„ .: .. ,:, Chimnev/lincr/flue/vent 10.00 ::,:'.'...:,..E.',:::,:.:1',■.:4-if:RO 6-64> / P.Eit.0".:0Y. ,:17.;'!.; '......,.:....".''''' "-"• " '. • .7:.... ....t ......:..,: . - .• . Other: I 10,00 -- Name: /!( ///'b /7 /14, t' - . . j & ut Win:Mant:al exhaust and ventilation . Range hood/other kitchen • Address: . 10.00 — . City/Statc/Z1P: — cf a-6 di:19(ft/Tte- ,.. Clothes drve, 'exhaust 10,00 Sinle exhaust (bathrooms, Phone: ooi 1.Fax: ( ) — toilet compartments, utility rooms) 6.80 ' - . ' — - • -''' Attic/crawIspace fans i ..... '..";:;,:;,;.:::.:..::,.'-" •:' ON„ ' 10.00 Other •I0.00 , Business name: Fuel piping Contact name: i 0/ rn 55.40 for.first four: SI.0O for each additional g I) • — Furnace. etc. Address: . ry I f . f) ' i . ■ / ' • ..— Gas heat pump City/State/ZIP: . • Wall/suspended/unit heater Water heater Phone: ( ) ' Fax: : ( ) . . Fireplace . E-mail: ler • orniarne me • cam, • — Range .- : ...:.. • • •..:::':.:. ':,-,.......,. L.:.:.:':.::_:-:::.:..::.::: •,,tdo,,tTRAerroit;::: ::,: .; -,.:.;.,•:.::.. .:::....!::.: :'::::::' ' Barbecue , ,;..,.......... . .._. j.... . Clotht: dryer (s'as) Business name: 7114P RC ile/ ' • Othex: Address: _ViEL__,CIV PE - 4 'e . ed, .,.._;ye_ --- ,.. .'....' - " FEES .!:. ' ' " - '...' ••• .., ...... .... 1 City/State/ZTP1 g, 411 fACc L. ._ _ Subtotal I /4- Minimum permit fee ($72.50) 1 12 .9b, Phone: lir aff If .. .4. Fax:. 1) )b70 fgb* Plan review (25% of permit fee) 1 C.C11 lie.: i . /: ,.. • . , - - . State surcharge (12% of permit fee) , gla . TOTAL PERMIT FEE i s a / J7e, This permit a pplicatiQ. expires ir St pormil is not obtained within iRti ,A ulborized signatu • days after it has been accepted as complete, /P141 1 Print narneiy eivie#16.,. te Date: of - 2-"elf 1 ,.. Fet. methodology set by Tri-County Buildtm: lndtt.stry Service l-loarcl