Permit t � Y
CITY OF TIGARD MECHANICAL PERMIT
` F'� COMMUNITY DEVELOPMENT Permit #: MEC2009-00197
Date Issued: 05/05/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102DB03800
Jurisdiction: Tigard
Site address: 13473 SW CHELSEA LP
Subdivision: Lot: 0
Project: Forbes
Project Description: Install furnace.
Owner: FEES
FORBES, MARTIN T & Description Date Amount
CAROLYN M, 13473 SW CHELSEA LP Furnaces < 100K BTU 05/05/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 05/05/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 05/05/2009 $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
'^ � n 1
Issued By: /�}� M \Q t J \nI} r n n � Permittee Signature: \V
CYA
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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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05/01/2009 09:28 503- 691 -8556 OREGON HEATING PAGE 01/02
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Mechanical Permit Appb Cat1O11 A, A;., ,.. p FpR.OFFICE USE Uhl .1(..• ^.
13125 of rig rd M AY 0 1 2 009 Received 5• I.09 PermitNo.I' OZOC 7 49.1 2
' ", , 13125 SW Hall Blvd., Tigard, OR 9722 plan Review
. ' pboue: 503.639.4171 Fait: 503.598,1960 pate /gy. Other Permit:
7..i G..A.Rb Inspection Line: 503.639.4175 CITY OF TIGARD Data Ready /Hy: JVY13: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DiVISIOI\ Notatied "Ti Supplemental Information
n. "r^ c•. a R „a o-: r, py ,r r }• ., , r ty r tV : n r , V,' I �r, P e r ;> r ,d s of 0 t +r n eJ p e�.
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Mechanical permit fees" are based on the value of the work
❑ New construction lizI Additionlalteratian/replacernert p Indicate the value (rounded to the nearest dollar) of all ,
ID Demolition 1:1 Other: mechanical materials, equipment, labor, overhead, and profit. I
lop i� l'V P V A «t a; ...,. d ,.rrr a , ; • 1 i 17, :i o i dl 1 rs ,I Value: $
P ; , �i 1# lr t.1i.8li oI! i 7" ,Ii .qtr .. o' i +, I�111:,ilr`,41„ f{il �
, �'; Il; . j!:dlaV�1 � �.,: t i. � ` o i + � } ■ 1 f 1111, P P ); — •P }; ;01 i , 1► ; ; � , I a T ; '0 PSS ��
�r�fttiF � { 1 Lro1 V ., �a.d• n eie, r. ,,.n4, , ..d7t,. t P„ .v.,��1,ro e�io a ,a, c r r 7f. 8, r !. "' � !, I ! � r � .p$' I lI
i It�
j:71- and 2- family dwelling ❑ Commercial /industrial 0 Accessory building t.4 ttli,lrt„u;' a I{r ' rR LW? ' ,. �� n �•
For special infore'ua]on use checklist.
0 Multi- family 0 Master builder D O _ Description Qty. Ea. _. Total
pay {744 V 1 i ..� P! p k ]= r.,e u,c..r , C ,. G „w ,l7 � y I . } 1 I f ^. �t i + io.le !r I !I �f rg ptrp9� ' , , . -
I ii, �1f Ili; o �; ? q d r' 1 F i 71TT i 4v . h f t i r: s ; 4�1 ift14 , ueati i „,u., 7 r. , r r i; r!< r +;r Ir.r t x�,t', .'a I1 i V( r7 4
Air
Job site address: l -3 Li sv.� o� r � z) r fires t plan h o heat pump
e.urea site plan showing .lacetrrexrt) 14.00 or a r QQ` Furnace 100,000 BTU ducts /veats) 1'5,00 .1'
-
City /State/ZIP: ��`n � Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg /apt. no.: Project name: Gas heat .um, 14.00
Cross street/directions to job site; Duct work 10.00
Residential hot wale stern 14.00
• Residential boiler (radiator or
h drone) 14.00
— Unit beaters (fuel-type, not electric),
in-wall, in -duot, suspended, etc. 14.00
•
„ Flue/vent for any of above 6.80
Subdivision: Lot no.;
— - Other: 10.00
Tax map /parcel no.: Other fuel appliances
1 `I r { 1 1 } r t ,A� 4 i1L t +33ft t b . ar t ^ f 1��� 1 1 H11 Water heater 10.00
Gas .lace IIM 10.00
In 541.\ -eorro C<7 T Flue vent for water heater or gas
fireplace 10.00
m - Lo li.btu raSSJ MIE 10,00 Ell
Wood/pellet stove 10.00
Wood fireplace/insert , 10.00
• if arl3 , �� ��1 3, , 11:. Cl}iaut' /liner /flue /vent .... V 1 0 .00
i r i , nn� �dt 1„ rt ''. iuta d t.. t m r Other 10.00
Name: tAn r f b C . Environmental exhaust ana venrllattou
• 7
Range hhood/other kitchen
1 ,a\k C\ 15e
Address: e•ui meat 10.00 w
City/State/ZIP! ∎ ,. i r,
. . Clothes • ex- exhaust 10.00
k Single duct exhaust (bathmotns,
IIL Phone: a .6 q9 {' Pax ( • ) toilet corn •rttneuts utili rooms) 6.80
} ! 4 �F 4 , , a main } 9 • q � E rl , i. mr� p I rl , s } � #a t $ k Attic /crnwls. ace fans 10.00 go, I ¢ 1 i , 1�II' I I €r. �f = @ l , i
Other° 10.
business name: ea r icak ' A1., a:r = NC__
Fuel piping
Contact name: y �„ �� $5.40 for first four $1.00 for each additional
py�� Fumace, I.C. e
Address: t \ 1 �7� x I L\ I Gas heat pump __
City /State /ZIP: t l , o f' on ` \ 5 Wall/suspended/unit heater III
Phone: (�) i ` Fax:: ( W3) l ,, Fireplace ter
E-mail: Range _
f r i I ^ r �4l I Gra , i;, rh l''! (e1 r I r;rV ff {t.- n 1, y 1 1 !r'! ! I ,� r i' 1S d } �'
t I TO ((,j )� 1 a( 11 i ` i' y pt li !l l 11 I i ' - , } 11 f'' • B arbecue
A.IhI ., ir�' fUilr4��- 11�aI�171��11������ltl,�r„ j {� l}di4� , ' rtlr r �1411r�ar. �. ) r �� �IkP!1�.�,� 1,1 r.� yf:�
Clothes d er (:as)
suslness name I ` ` �... Other I_
QA_t t,rr . 4 , r ,
Addres a!ITiR, ! i P7! t 1,,,: •., } li 4 ! ` i 7
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1�:1194�, It t � : � ti , a1 lda`n � it , b,� a ,:: �,1 �� ii . �
City /State /ZIP: �fi 1 pP 911 15 � V y Subtotal C1.00
( (5 6 \" 5 an rev ie w (2 (25% of fee) none: �� �. Qi � ♦ Faze: • ('tan revie (25 °a of permit fee)
CCB lie.: vi,
I. . State surcharge (12 %, of permit fee) �.
v TOTAL PERMIT FEE 4 251 till °' , QC )
Authorized si ature:. P i M This permit application expires if a permit is sot obtained within 180
€n ► —_� _ lt
[Print mime: ^ �. � Date: bi' (/ q 1 * Fee methodology set by Th- County Building Industry Service Board