Permit ph CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00441
1 3125 S H all Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/21/2009
TIGARD 13125 Parcel: 2S 109DA06600
Jurisdiction: Tigard
Site address: 15027 SW GREENFIELD DR
Subdivision: Lot: 0
Project: Blaettler
Project Description: Installation of A/C. Unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
BLAETTLER, DAVID I Description Date Amount
15027 SW GREENFIELD DR
TIGARD, OR 97224 Air Conditioning or Heat Pump 08/21/2009 $14.00
12% State Surcharge - Mechanical 08/21/2009 $8.70
PHONE: 503-372-9606 Minimum Fee Adjustment - Mechanical 08/21/2009 $58.50
Contractor:
COLUMBIA NW HEATING
PO BOX 622
SCAPPOOSE, OR 97056
PHONE: 503 - 543 -3624
FAX: (503) 543 -6285
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
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: e____ Permittee Signature: eirA/ /7 69
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.
, Mechanical Permit Applicatia� EC FOR c - - I USE ONLY' '
1 111 q City of Tigard Received 1 Permit No./�
13125 SW Flail Blvd., Tigard, OR 97223 AUG 2 0 2C109 Date/By: „?/ Q „�� I // ��`# j10
' Phone: 503.639.4171 Fax: 503.598.1960 Date Review
on e: ax: Plan
/By: Other Pcrmit
T I GA RD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: NM 6d See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ' Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead and profit.
• CATEGORY OF CONSTRUCTION Value: $
JO 1- and 2-family dwelling RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
y g ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description Qty. I Ea. Total
• JOB SITE INFORMATION AND LOCATION Heating/cooling
7 ? Q J /r . ,� Air conditioning or heat pump
Job site address: l� � J(JC/ �3 � � (�/J (q plan showing placement) / ,�y6�
(requires site Ian showin lacement 14.00 W
City/ State/ZIP: T.Z619g6 tG , 7 I L7 Fumace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name:
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
DESCRIPTION OF WORK Water heater 10.00
2_ 7 Gas fireplace 10.00
7 -/Q S ,�Z CO ,G�Uf "C /\ 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
['PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 10.00
Other: 10.00
Name: , 69 J� � � ' TVA' Environmental exhaust and ventilation
Address: ' 5(12-7 sai) r_rzczo Range hood/other kitchen
equipment 10.00
City/State /ZIP: T q- 9 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( 53) 377 . G1AO,6 Fax: ( ) toilet compartments, utility rooms) 6.80
(r APPLICANT : ❑ CONTACT PERSON Attic /crawlspace fans 10.00
^„ , N /' I g_6-4 � Other: 10.00
Business name: (� t!/
Fuel piping
Contact name: SA F c3797€' $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/State /ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: CQ ri) A- /\/&) f! -i9 / .Z/Z-) Clothes dryer (gas)
Other:
Address: /OD 801( 6 .) MECHANICAL PERMIT FEES* -
City/State/ZIP: 5 ppOOSE az .9719 S‘ Subtotal !l. OZ)
Phone: (a)3) 5y3_, 3 6th 6,2,5 ci Fax: ( 53) 593 - t Minimum permit fee ($72.50), S()
/ Plan review (25% of permit fee)
CCB lic.: 61 qy 7 Y State surcharge (12% of permit fee) 3.161
i/ TOTAL PERMIT FEE 8" /, ,JU
Authorized signature: / / Al 4&(--264a1 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 7 V7') Qt `) Date: s -_ /r - * Fee methodology set by Tri -County Building Industry Service Board
1. \Building\Permits\MEC- PermitApp doc 01 /19/07 440 -4617T (1 t /02/COM/WEB)
I♦ .
•
JOB #09B256H
BLAETTLER, DAVID
15027 SW GREENFIELD DR
TIGARD, OR 97224
50 3 - 372 -9606
Installation Property Information
DIRECTION:
Property Line
z5 FT.
f l‘
Gr je
C
SIG r�
Z- FT:
Property Line
(F =FURNACE)
(X= OUTSIDE UNIT) STREET
Columbia NW Heating, Inc.