Permit ip CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00369
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/22/2009
Parcel: 2S 111 DC07200
Jurisdiction: Tigard
Site address: 9410 SW BRENTWOOD PL
Subdivision: SUMMERFIELD NO.9 Lot: 492
Project: Jarnagan
Project Description: Add A/C Must maintain a 3' rear and side yard setback
Owner: FEES
JARNAGAN, HAROLD G Description Date Amount
9410 SW BRENTWOOD PL Air Conditioning or Heat Pump 07/22/2009 $14.00
TIGARD, OR 97224 12% State Surcharge - Mechanical 07/22/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 07/22/2009 $58.50
Contractor:
COLUMBIA HEATING & COOLING INC
PO BOX 230397
TIGARD, OR 97223
PHONE: 503 - 624 -2704
FAX: 503 - 598 -0270
•
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: of irl L/i t'U// J kfAXal Permittee Signature: o eL2rfJ tiLJ
.
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 T�J
• . e ' EI 9 ED ' : c c ., Y F , - . i ;.' • Mechanical Permit Application 1 oR';ol I is > SL ui mm ,tl .
Received Permit N [�
City of Tigard Date/By: Ee' / -0031
• 13125 SW hall Blvd., Tigard, OR 97223 U l _ 2 2 2009 Plan Review
* • P hone: 503_6394171 Fax'. 503 598.1960 DaleiBy: Other Permit:
; T I GARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Read -Intl 55 See Page 2 for
Internet: www.ligard- or.gov Noufi Supplemental Information
BUILDING DIVISIO • -
TYPE OF WORK •! COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
� RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
.rJ 3 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special irforrnatiwr use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. Ea. Total
. JOB SITE INFORMATION AND LOCATION Lleating/caoling
Air conditioning or heat pump
Job site address: j Q /lQ/> r Q� (requires site plan showing placement) ' t 14.00
City /State /ZIP: - (0,41. $1. iI AA Furnace 100,000 BTU (duets/vents) 14.00
Furnace 100,000 +BTU (duets/vents) 17.90
Suitedbldg. /apt. no.: 1 Project name: Gas heat pump 14.00
Cross street/directions to job site: . Ductwork 14.00
Hydronic hot water item 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Flucivent for any of above 10.00
Subdivision: Lot no.: 10.00
Other:
Tax map /parcel no.: Other fuel appliances__
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
C �/G Flue vent for water heater or gas
fireplace 10
Log lighter (gas) 10.00
Wood/peilet stove 10.00
Wood fireplace/insert ' 10.00
Chimney/liner /flue/vent 10.00
❑ PROPERTY OWNER TENANT
- Other: 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City /State/ZIP: Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: ( ) Fax: ( • ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Other: 1 10.00 I
Business name:
Fuel piping
Contact name' � i b r $5.40 for first four; 81.00 for each additional
Furnace, etc.
Address:
Gas heat pump
City /State/ZIP: Wall/suspended/unit heater
Phone: S )6 7 t .- -i y( Fan.. 63) S t 8'- 6D-7 0 Water heater
C Fireplace
E -mail: Range
CONTRACTOR Barbecue I
Business name: (1,3 l (.v'' b / r. -e-- AI / 1-o.Dl! (.... Clothes dryer gas ,
Other:
Address: q4 1� o X ) 3 0 3 9 1 0 ! MECHANICAL PERMIT FEES`
City /State/ZIP: - f/ v ,7 R ,) .1 77;2- S I Subtotal
Minimum permit fcc (572.50)
Phone: (51. 6 . .2 LI -- - 7a 4/ I Fax: ( ) �9 e -� r 1 )- - 7 Plan review (25% of permit fcc) _
CCB lie.: rit j 5 ! r •
S late surcharge (32% of permit fee)
TOTAL PERMIT FEE
This permit application etpires if a permit it not obtained within i8tt
Authorized signature: days after it has been accepted as complete.
Print name: R Aff / 1_ / , Date: / ttt 1 6 ' Fee methodology set by Tit-County Building Industry Service Board
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HEATING & COOLING, INC.
P.O. BOX 233397 • TIGARD, OR 97251
(503) &24-2704
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ADDRESS:
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