Permit „ CITY OF TIGARD MECHANICAL PERMIT
Il i ' 11. COMMUNITY DEVELOPMENT Permit #: MEC2009 -00213
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 639 4171 Date Issued: 05/18/2009
Parcel: 2S110BB00700
Jurisdiction: Tigard
Site address: 12255 SW DUCHILLY CT
Subdivision: Lot: 0
Project: Hansen
Project Description: Replace furnace.
Owner: FEES
HANSEN, R KENT AND RENITA J Description Date Amount
12255 SW DUCHILLY CT Furnaces < 100K BTU 05/18/2009 $14.00
TIGARD, OR 97224 12% State Surcharge - Mechanical 05/18/2009 $8.70
PHONE Minimum Fee Adjustment - Mechanical 05/18/2009 $58 50
Contractor:
ARROW MECHANICAL
10330 SW TUALATIN RD
TUALATIN, OR 97062
PHONE: 503 - 692 -1565
FAX. 503 - 691 -1879
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 drys of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules - dopted by t : Oregon -
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100 You .. ..ta ! a cop +f he- rules
Issued By: • , , , Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that busine- day.
This permit card shall be kept in a conspicuous place on the job site until co .f the project.
Approved plans are required on the job site at the time of each inspection.
r
Mechanical b V chanical Permit Elpplicatia .•, _.. „ ., 4 R eceived "1”, - .: 1111 City of Tigard Date/By 1 l Permit N. ,. aa t V oe�13
13125 SW Hall Blvd., Tigard, OR 97223 M 1 2 009 v
Plan R eview
Phone: 503.639 4171 Fax: 503.598.1960
Date/By- Other Permit 1 Inspection Line. 503 639.4175 I �/ r yf @ �y �g Date Ready/By El See Page 2 for
TiItGARD Internet. www.tigard-or.gov CITY I V 11GltfiL! Notified/Method Supplemental Information
BUILDING DIVISION En
=_t, cs. - TYPE OF:WORh ,, _ ;?; ' ?CO1VI114E FEE.•4 - U SE "CHECKLIST
❑ New construction ® 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
El Demolition El Other: mechanical materials, equipment, labor, overhead, and profit.
Value: $
' .:,,; CATEGORY -OF C
rtONSTRUCION
T<2 ,`,: `,
'i';� . - .,_. .. -- - .. , - -, : : - ., - - _ - - -- = _ - -- --
1,,,,. R ESIDEIVTIALEQUIPMENT ,/:SYSTEMSFE *' '
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ,. " . ` -,
For special information use checklist.
❑ Multi family El Master builder ❑ Other.
Description I Qty. Ea I Total
` "' - _ "' °° Y JOB :SITE ''INFORMATION` , ANI) i LOC "_ATION: '
,:,.,4- a- Heating /cooling
Job site address: 12255 sw Duchilly Ct Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: Tigard, OR 9797224 Furnace 100,000 BTU (ducts/vents) 1 14.00
Furnace 100,000+ BTU (ducts/vents) 17 90
Suite /bldg. /apt. no : Project name: Hansen
Gas heat pump 14 00
Cross street/directions to job site: Duct work 10.00
Hydronic hot 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
Subdivision: Lot no.: Flue /vent for any of above 6.80
Other: 10.00
Tax map /parcel no . Other fuel appliances
' °' DESCRIP_TION'-OF'-'WORIK - -- Water heater 10.00
Replace furnace Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood /pellet stove 10 00
Wood fireplace /insert 10.00
-- Chimney /liner /flue/vent 10.00
- T ' : I le ROPERTY`O t__ ' 7 `0 , TE N ANT' ''= °.
. Other: 10 00
Name: Renita Hansen Environmental exhaust and ventilation
Range hood/other kitchen
Address: 12255 sw Duchilly Ct equipment 10 00
City/State/ZIP: Tigard, OR 97224 Clothes dryer exhaust 10 00
Single -duct exhaust (bathrooms,
Phone: (503)639 -8727 Fax ( ) toilet compartments, utility rooms) 6.80
= 11 - f, 1,APPLICANTt` - ' '.t' l _ ®t CONTACF.P vkil Attic /crawlspace fans 10.00
Other: 10.00
Business name Arrow Mechanical
Fuel piping
Contact name Zachary Ped $5.40 for first four; $1.00 for each additional
Address: 10330 sw Tualatin Rd Furnace, etc.
Gas heat pump
City /State/ZIP: Tualatin, OR 97062 Wall/suspended/unit heater
Phone: (503) 692 -1565 Fax: : (503) 691 -1879 Water heater
Fireplace
E -mail: arrowmech@verizon.net Range
_ " CONTRACTOR. _ Barbecue
Business name: Arrow Mechanical Clothes dryer (gas)
Other.
Address ALL SAME AS ABOVE "
-„ - MECH , - - e
City/State/ZIP. Subtotal
Minimum permit fee ($72.50)
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lie.. 5193 • State surcharge (12% of permit fee)
� TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: g days afte it has been accepted as complete.