Permit CITY OF TIGARD MECHANICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit #: MEC2009-00227
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/28/2009
Parcel: 1 S135DB08200
Jurisdiction: Tigard
Site address: 9155 SW NORTH DAKOTA ST
Subdivision: Lot: 0
Project: Wrbanek
Project Description: Replace a/c unit.
Owner: FEES
KLM INVESTMENTS LLC Description Date Amount
1280 HOLMGROVE DR Air Conditioning or Heat Pump 05/28/2009 $14.00
SAN MARCOS, CA 92078 12% State Surcharge - Mechanical 05/28/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 05/28/2009 $58.50
Contractor:
ANDERSON HEATING, INC.
6463 DAWN AVE.
LAKE OSWEGO, OR 97035
PHONE: 503 - 841 -0742
FAX: 503- 536 -6615
Type of Use:
Class of Work: 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: 5 n, �� � Permittee Signature:
LC— Qli e
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.
* May- 18 -09 04:59P MINUTEMAN PRESS LO P_02
Mechanical Permit Applic 'p —1
n psi �� i f (IId llI I I1, I I �I. C►.1 1 -, „.:
City of Tigard Received
r 13125 SW !fall Blvd., Tigard, OR 9722, i)s Permit NO 1'�AY 1 2009 y 2CQ• �p3a7
I N
0 Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Inspection Line: 503,639.4175 I�trelBy. Other Permit:
I { i.) Id 11`
CITY OF I�• t +': 1 8 See Page 2 for
Internet; www. tigardlir.gnv Date Read s •/n r kriY
Notified/Method: T (C 1 Supplemental information
BUILDIN�� r DiV:t,_�,
TYPE OF WORK _ COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction 21 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 _ ❑ Other: mech materials. equipment, labor- overhead, and profit. _
CATEGORY OF CONSTRUCTION Value: $
1 - dwelling Commercial/industrial RESIDENTIAL EQUIPMENT'ISYSTEMSFEES*
® Y g ❑ ❑ Accessory building
For special iufornati on use checklist.
❑ Multi - family ❑ Master builder ❑ Other: -
Description Qty. Ea. 'total
JOB SITE INFORMATION AND LOCATION Heating/c0oling _
Job site address: 9155 SW North Dakota St. Air conditioning or heat pump
tiequires silt phut showingplaccumin) 1 14,00
City /State /ZIP: Tigard, OR 97223 Furnace 100,000 BTU ( ':/veld) 14.00
Furnace 100,000+ H11.1 (duets/vents) 17.90
Suite/bldg./apt. no Project name: Leilani Wrbanek - - -
- .... teas heat pump 14.00
Cross street/directions to job site: _Duct work _ 10.00
Ilydronic hat 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
l Lot no : Flue/vent far any of ab ove
Subdivision: II __ 6.80
- - • Other: 10.0(1
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater _ _ 10.00 _
REPLACE AC UNITS Gas fireplace 1
Flue vent for water heater or gas
- fireplace
10.00 _ •—
Log lighter (gas) 10.00
Wood/pellct stove 10.00
Wood fireplace/insert 10.00
❑PROPERTY OWNER Chimney /liner /flue /vent _ (0.00
—
❑ TENANT Other: 10.00_
Name: Leilani Wrbanek Environmental exhaust and ventilation
Range hood /other kitchen
Address: 1280 Hnlmgrove Dr equipment 10.00
City/State /T.IP; San Marcos, CA 92078 Clothes dryer exhaust I OA0
- , ..- Single -duct exhaust (bathrooms,
Phone: (760)798-0501 Fax: ( ) toilet compartments, utility rooms) 6.80
0 APPLICANT 0 CONTACT PERSON Anicicrawlspace fans _ IU,W -
- Other: 10.00
Business name: Andersen Heating, Inc Fuel piping -
Contact name; Art Andersen S5A0 for first four; 51.00 for each additional
Furnace, etc.
Address: 6463 Dawn Ave
-
Gas heat pump
City/State/ZIP: Lake Oswego, OR 97035 WaWsuspendedlunit heater
Phone; (503) 841 -0742 Fax: : (503) 5366615
Water heater
Fireplace
E -mail: gogreen(a)anderaenheating.com Range
CONTRACTOR - Barbecue
Clothes dryer (gas)
Business name: Andersen Heating, Inc _ Other
Address: 6463 Dawn Ave MEC PERMIT FEES*
City /State /ZIP: Lake Oswego, OR 97035 _ - Subtotal v
•
Minimum permit tee ($72.50) • 7 a , s - Q
Phone: (503) 841 -0742 Fax: (503) 536 -6615 _ Plan review (25 % ofpe-nit fee)
CCD lea: 168214 State surcharge (12 %ofpermit fcc)
- TO I'AL PERMIT FEE o
Thii permit application eapimi if • permit Is not obtained within t
Authorized signature' an
day, after it has been accepted as ...mete,
May -18 -09 04 :59P MINUTEMAN PRESS LO P_03
BACK
•
Not to Scale
39'
AC Unit
3'
lir Door
21' +
1W Garage
FRONT