Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00194
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/04/2009
Parcel: 2S102DB04000
Jurisdiction: Tigard
Site address: 13543 SW CHELSEA LP
Subdivision: Lot: 0
Project: Ericson
Project Description: Install furnace and air filter.
Owner: FEES
ERICKSON, ERIC & KATHRYN Description Date Amount
13543 SW CHELSEA LOOP Furnaces < 100K BTU 05/04/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 05/04/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 05/04/2009 $58.50
Contractor:
OHAC INC
PO BOX 241
DUNDEE, OR 97115
PHONE: 503 - 538 -2953
FAX: 503- 691 -8556
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
r-
, cciAl
U Issued By: Permittee Signature: \ pp l.� On
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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04/.29/2009 12:25 503-691-8556 OREGON HEATING PAGE 01/02
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Mechanical Permit Applicatio
D RECEIVED ' '' ' - . : FOR OFFICE USE ONCY
' . City of Tigard Received i i A9 69 r
Date/By: 7 Jr Permit No.: Hieeky) 9 19,
II . 13125 SW Hall Blvd., Tigard, OR 97223 pl Review
Phone: 503-639.4171 Fax: 503.59 an 8.1960 APR 2 9 2009 Asto/E1y: Other Permit:
Inspection Line: 503.639.4175
TiciARD Date Ready/By: Jurif l?1 See Page 2 for
Talmud: www.tigard-or.gov
CITY OF TIGARD Islodfloct/Mtthead;
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Mechanical permit fees* are based on the value of the - work
0 New construction rgi Addition/alteration/replacement
p Indicate the value (founded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials • ani meat, labor overhead, and I rofit
li? if r■I ..*. rivr P Tiii '; '..■*Va"1 IiI f /II! i ri; ii , , i1 i value: $
Wil . 3 1 , , !; -,t. il 'g i :I a` ..i . • ..,, , • : ,31x;.! P. ;;q1,t , ,n A II; ''.1c•IjIr , ,', ' ' • ' ' • • • , • rto,r ; 1 . w:1":,..; L ',Rig' ,-,,, .; . ' - ,s , w'R,
u 1- and 2-family dwelling 1:1 Commercial/industhal 0 Accessory building
For special information use checklist.
[.] Multi-family 0 Master builder 0 Other. Description Qty. Ea. Total
I Pp !li 41011•111l4t riAlr f qi■ . ' !!g MIMI 'f LT f 1 :012(fl , Ii : 11 1 11 I 01Y q iA3 qit Heathl cadin:
,; i tn , , Tlft . . `• e 1„ .!, i ,.. ,, , It. s rio. , ,..-., , .. t . s , 0 , , i Li ..:. L '....1.i
Air conclitioninz or heat purnp
Job site address: \ ..5z..4 5 '3 vj 0 k.,-._9 • re.uires site dal] showin: .laccruen 14.00
City/State/ZIP: —Wcy-82-___M Q 2) . Furnace 100 000 BTU (dnets/vents) R 14.00 14,00
Furnace 100,000+13TV (ductqvantz) 17.90 M
._... .
Suite/bldg./apt. no.: Project name:
Gas heat . tn. 14,00
MI
- . --
Cross street/directions to job site: Duct work 10.00
. . Hydtonic hot water system 14.00
Residential boiler (radiator or
h dmoic 14.00 •
— Unit heaters (fuel-type, not electric),
in-wall, in-duct. sus. end:2 etc. 14.00
Flue/vent for ‘ . of above 680
Subdsion: Lot no.: ..
Other, 10,00
Tax map/parcel no.: . Other fuel a ..liancas
1E11, . Mg j i REMO Water ii5atzr 10,00
Gas firTlace 10,00
a U. Ilk 4, 111 1r . 1 . - — Flue vent for water healer or gas
Eire . lace 10.00 E
Log lighter • as 10,00
Wood/ ellet stove III 10.00
Wood fi .lace/insert 10.00
I r .$. a' :‘ . prieftql(fiRril,b ffcfq figifisitipit . Ctimir diner/flue/vent
, I f i l il ti :t.,;, .4 " : ' gaggyrii.,ir ,,,,,,,, , „., . a., • , „„,„c.„,4,,,,,....i.tii.‘ Vitiii If MI It tit Other, 10,00
10.00
_
Name: .. , lc , c C Environmental exhaut and ventilation
Range hood/other kitchen
AddreSS: t'/,_L-3 eAngsli.A.). •
..ui•tvent 10.00
City/State/UP: • . cloth. • er exhaust IMII 10.00
Single-duct exbausr (bathrooms, I •
Phone: (533) .3 . _ tii - Fax ( ) toilet com.artments utili rooms 6.80
MI, ffity : Efglr", '11:, ZURITnll. i c. :1 1 i tni•nCi llign,Ryteltraf,Mr1 '. - pt . PP,
E IEE Atticicrawl . ace fans 10.00
IMMilThlili t'n. Milltifg11 'Ilitillaill., 'il . n Iik''• :111/411/5,1106eititiliteabla 'LI i -,' ,), , Wil .
Other _ 10.00
—
Business name: * s ei . e. ' . e c
Fuel ,i . in: .
Contact name: ''R $5.40 for first four $1.00 for each additional
AddrG56: R) hc)X DA( .
. Furnace, etC.
Gas heat punap MIIIIIIIM
City/State/ZIP: )r\( 91 i t5 Wall/sus. nded/unit heater 11111111111
Phone: (5a3) t i e _ ci 6 ot 9
Fa7c: . (3)6c l - Fs 5. 5 0 Water beater
Fir • .lace 1111011111111111
E-mail; . .
MREMMIIMII III=
. 7 , .1 , , IN I. ,,p z , i ..,
! , .,, ;..i ;
p i;;F T:qt ',i1' '.7t,r,'im FIR. , i '' ! lt TH li I. i Barbecue
■ v ! • f1 .' ' • „ ,t ! t. ,i it , , iti.l. . ' c a", .. c„,
Clothes dt 'er • PIZ
Business name: yrt.. %c 4- r . 1st c I .
Address: mk s ... . . • i r iL ,ii ' ..4.61v 1 ',, ", 44 `::‘ 4 ' 1 '1
City/State/ZIP: T)Qrjaff_. C11115 Subtotal - 00
Minimum permit
Phone: ( 5( . . CP11 q 6otct . I F ax: ( - 55 (-) Plan review (25% of petmit fee)
CCB lie.: ‘---, a \ • ra -- State surcharge (12% of permit fee) ';',, ,113 ,
x ) --
\__ j jL, lb TOTAL PERMIT FEE
Authorized signature: ill lit . This permit application expires if P permit is not obtained within 180
days after it has been arrepted as comp)ete.
[ Print name: "g(v3hci 54 4 Date: 14.- QC/ _ m a Pee methodology set by Tri-Conety Building Industry Service Board
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