Permit CITY OF TIGARD MECHANICAL PERMIT
• ! > `'' COMMUNITY DEVELOPMENT Permit #: MEC2009 -00164
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 639.4171 Date Issued: 04/17/2009
Parcel: 2S110BB01000
Jurisdiction: Tigard
Site address: 12405 SW DUCHILLY CT
Subdivision: Lot: 0
Project: Shaw
Project Description: Replace gas furnace
Owner: FEES
SHAW, DONALD J & SYLVIA 0 TRS Description Date Amount
12405 SW DUCHILLY CT Furnaces >= 100K BTU 04/17/2009 $17 90
TIGARD, OR 97224 12% State Surcharge - Mechanical 04/17/2009 $8.70
PHONE Minimum Fee Adjustment - Mechanical 04/17/2009 $54 60
Contractor:
CARSON OIL COMPANY INC
3125 NW 35TH
PORTLAND, OR 97210
PHONE. 503 - 471 -4365
FAX. 503 - 222 -0186
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types Natural Gas
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
Issued By:` 6111141
Permittee Signature:
' A
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.
i
04 -14-09 - 10:42AM FROM- Carson Oil Co 5032220186 T -218 P.001 /002 F -574
Mechanical Permit A I .• eat' a m.� COVED ! t ! lORR OF� ICS. USE 2 . Permit No, i
n 13125 SvTigard, OR 97223 iew
Oiler Permit.
' : Phone 503.639 4171 Fax: 503 598- 1960APR 14 4.1, 2009 Date /By
Inspection Line: 503.639.4175 /i Date Ready/By tuns 21 See Page 2 for
;a'GAR'L� Internet: www ngard or.gov Notified /Method 15+� J Supplemental Infot oration -
CITY O�F TIGARD
Dia�l r ' . lei\ COMMERCIAL FEE* SCH - USE CHECKLIST
; •i ,TYPE OF I �
Mechanical permit fees* are based on the value of the work
❑ New construction ZAddition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
Value $
''''';a' , , ' : CATEGORY OF'CONSTRUCTION.:'.i , ,
61' RESIDENTIAL. EQUIPMENT / SYSTEMS I'EES * i ; : .
l�J i and 2- family dwelling [] Commercial /industrial 0 Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea Total
- ;, ; - ', . ; , ;;'; "; `t, '. i ,.TOB: M1E, INF,O10IATIQN, SAND ,LO6ATI011';,-,'. ' - . (, •, ,• Heating/cooling
Air conditioning or heat pump
Job site address: 4 G' , (requires site plan showing placement) 14 00
City/State /ZIP: Rp / - V / / Li
Furnace 100,000 BTU (ductstvents) 14.00 r �
Furnace 100,000+ BTU (ducts/vents) j 17.90 /1. . �I9
Suite/bldg. /apt. no,: r Project name: Do, Sj,i o Gas heat pump 14 00
Cross street/dtrections to job site: Duct work 10•('0 -
Hydronic hot water system 14.110
4� 1. 1 14 A z& L ■ I _ V) R. Residential boiler (radiator or
+1 1 hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14 00
Flue/vent for any of above 6 80
Subdivision: Lot no.: Other: 10 00
Tax map /parcel no.: i Other fuel appliances
� Water heater 10 00
•i .•, i , ,; >/,:i, , [t-. '', 'i'4'Itk}31 . ; PO,N`OF W,0, r . ;, , •; 10.00
;' ; y� _5:(� , �.; Gas fireplace
/?� q e ? R'jz 16 t2E p C M1 , Flue vent for water heater or gas
�L77 C7 7 �' fireplace 10.00
� Log lighter (gas) 10 00
Wood /pellet stove 10 00
Wood fireplace /insert 10 00
.. - Chimney/)iner /flue/vent l0 00
.. �.:. ;.; TEN.!.". .
(PIiQPE1t Y OV4 ••'' ; �:, s " •; ' 10 00
Name: Dow 31-kAV -I Environmental exhaust and ventilation
Range hood /other kitchen
Address: J») „so D' c ,,, f, t� Cr, equipment 1000
7T AA Clothes dryer exhaust 10 00
City /State /ZIP: /tea a,O r n ' Single -duct exhaust (bathrooms, 6.80
Phone: (503 ) 6 39 . J r Fax: ( T- — toilet compartments, utility rooms)
1 , ' r� ( � Attic /crawls ace Fans l0 00
. ne T a ;,:1,:'' ' ;`. Ci At r�;';P RSO t : :-,,,,-, P
1 a ;c `i`i'I1�>"HT;ICANT? ;i}$''r i,',:',1,::.1'
..t ` ' N,T G Ps N - .;;, .00
.� i _ :T )': '• �' Other: _ _ l 0 -
Business name: ,e5/ 0 ,,/ eOH 1 y _ Fuel piping
Contact name: L �., / $5.40 for first four; $1.00 for each additiona r , ^' �; /} Furnace, etc.
Address: ,5/075 1 Ann/ . - Av I • - Gas heat pump -
City/State /ZIP: Po2" n11n O9 9721 Q Wall/suspended /umtheater
— r' — Water !tearer
Phone: (5Q3) 7 L 3 5 Fax: : (503)22;2_, Q / 84 — Fireplace
E -mail: j4/A ��ird � /'tLTOA.iO; I.. D M . ,_ Range _
;(i , ' 7 , ,�� �_•- ,.,. :, ;t. " ,,. „' ";'- Barbecue -
Clothes dryer (gas)
r , ' ., �,Pr.. �CONTRACTQB� '= ih�;.i, •.1...,,
/`�
Business name: efusON CJ; ( CD # -/DA / Other:
• Address:2 / �J5 / At,.._
, � '. --- :"•• ,.., : 'MECIIAN CA PERMITFEE ; " y •
Subtotal /7 90
City/StatelZIP: OR rt q e 72 ?Zia Minimum permit fee ($72.50) 7 , SO
Phone: (5t 2 /, 4.3 6,s Fax: (SO3 )Z2?,- o 1 g It, Plan review (25% of permit feel
CCB lie,: 85ab State surcharge (12% of permit fee) 8 ,70
TOTAL PERMIT FEI'; A/. 2Q
7014..dZILI Tbls permit application expires If a permit Is not obtained within 180
Authorized signature: days after it has been accepted as compretc.
Print name: � //AI Dater- /0 -
C1 7 1 • Fee methodology set by Tri -County Building Industry Service Board