Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00101
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/12/2009
Parcel: 25111 AA04800
Jurisdiction: Tigard
Site address: 8640 SW INEZ ST
Subdivision: Lot: 0
Project: Seivers
Project Description: Install furnace.
Owner: FEES
SIEVERS, WILHELM V Description Date Amount
MONICA, 8640 SW INEZ STREET
TIGARD, OR 97224 Furnaces < 100K BTU 03/11/2009 $14.00
12% State Surcharge - Mechanical 03/11/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 03/11/2009 $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
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
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.
• 03/10/2009 12:43 503 - 691 -8556 OREGON HEATING PAGE 01/02
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4 13125 SW Hall Blvd., Tigard, OR 97223 LA 10 2009 Review' n vv
Plan
P1tOtle: 503.6398171 Fax: 503.598.1960 Date/Byy; : tither Permit:
tti ' L. inspeCtiot'1 503.639.4175 �F TIG AR Date Kcady/ y: Jugs' g See Page 2for
Internet: wv w.tigard or.gov CI'I'� DIVI ; No tifiedlhlethod: `[ I C Supplemental Information
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mechanical permit fees'" are based on the value of the woke
❑ New construction gu Addition /alterat
performed. Indicate the value (rounded to the neatest dollar) of all
0 Demolition ❑ Other: mechanical materials, equttnent. labor, overhead, and profit.
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[.1- and 2- family dwelling ❑ CoxnrnerciaUindustri.al ❑ Accessory building "'” °
F specia/ infor tnatinrt ua,- checklist.
❑ Multi - family ❑ Master builder 0 Other. Description Qty. j Ea. Total
.,d �:. � •, w dr�;t; � ram, ,,,�. ^r; e;r;, �'�isS P31I't'6' y�r ,
i,fll ii�rli6A; i. Eji l ; r i,INi ii' gi' a i , i I(3ty'1" '4'X , , '.I,js r r i`�!` Heating/cooling w—
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Job site address; ' 1 S . :"f \ c''
Aix (requires or hag ac
emt
re a rras site fan showing placement 14.00
City /State /ZIP: ` \,_ • t-c\ or1 a 0 Furnace 100,000 BTU' U (ducts /vents) 1 14.00 11
Furnace 100 0 00± BTU (duets/vents) 17,90
Suite/bldg. /apt. no,; Project name: ��''> exie_C-'� Gas heat rum 14.00
Cross street/directions to job site: Duct work 10.00 _
” - . H 'd onic hot water system 14_00
Residential boiler (radiator or
-- bydronic 14.00
Unit heaters (fuel -type, not electric),
'in -wall, in -duct, sus carded, etc. _ 14,00 M_
. Flue /vent for any of above 6 80
Subdivision_ Lot no.: Other. 10.00
• Tax map /parcel no.; Other fuel Yrr y + IF -- appliances
C 1 ! , 9 �d c ;MAW to nt e�:, . r (, { { 1 Water heater 10.00
Gas :fi • lace 1
\r\S \ tS)% I "t Urn(liCe . Y „ • _ Flue vent for water heater or gas
fireplace 10.00
Lou li :titer 'as) — 10.00
. . Wood/pellet stove , 10.00
— Wood freplace/insett 10.00
t: } Chimney/liner/flue/vent 10.00
s?Srih1- 3 l ' ' . �,` €i ;I� l :10•ie i . r � , � i,i,.4 10.00
t, r1+ t - t Vt11er:
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen � C1t? Z equipment 10 -00
City /State/ZIP: c(..n '� Clothes dryer exhaust 10.00
Ey Single-duct exhaust (bathrooms
Phone: ( li • * C\ `1 Fax; ( ) toilet compartments. utility rooms) 6.80
.LP i{ , } n , �+. r , , r a , e r ti `,fir o , ` { e,t, t t i +' s� + ce Ib ris 10.00
n�)'` t iii +/ l ) )' d p I 'i tU �,F iAf t�Mp +{ {, c1� , � ] I y p r!Q ;11 yi pry { �yi a:(/pr (_�{( r Ill l 3�jf} Attic /erzwis a
I}1il��!!d;�s�if' ��f11a „ �, r��S1��1��Wl�, �M4�$, I�, tlll�. O! �P( 9����„ tjdCll��. �P{ ���1�3a��i�����` �1���. Y11R��191/ R�`� p
Other: 10.00
Business name; cxe 0 . .t-' I ,0. *\ % \ – Fuel piping
t
p p
Contact name; t t okk a $5.40 for first four; $I_UO for each additiona
Address: ' VO (i as Furnace, etc.
Gas heat pump
City /State/ZIP: 't xy,‘,e ? 0\ , \5 WaWsuspended/unit heater ____
Phone: ( ) i om ) p ._ ! ,) j- Fa x:: ( ) Weter heater
Fireplace
E -mall: ,
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e li . i . ! } �, �:1 ,a1 t +� - 0,1, 1, Barbecue •
��i;)�P� � t �tJ� p t��r = iii .:,� b;1� �,..,, { ; .v �;�� � , � , �a,�} �, � � ft, �1 t PI p, • d ii', 004 .. .
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Business name: a �� } ` r` , Clothes dryer (gas) _
., - Other:
� °� � I�FdI !>,.�!, ij ria x•�b t'7<. r. °..., r�,..,,.'. v . F,b �,viu + O 'i,a ,U S.,'r
*� r� II r,, I i i ai I,sYti P t . r, r � a ' i , t�i;,:, .t
Address: i ���, i i i ' . .d� r aZO A) 4I ' F , . rgij :!2 I r, f�i:A
City /State/ZIP; e , 2 - 'V `1 r h Subtotal 1`1.t',JC'
Phone: ((:): _a ` i 53
Fax: JV to qI V Minimum permit fee ($72.50) '7',Q,.) 0 L4 I • Plan review (25% of permit•fee)
CCB lie.: yl a \'Z (' State surcharge (12% of permit fee) 5 , ,10
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•
TOTAL PERMIT FEE `61 ,'O( )
This permit application expires If a permit is not obtained within 180
Authorized signature' 1 • s days after it has bash accepted as complete_
Print name; ,17c- t 1 V e-, a. te: / 0 CI • Fee methodology set by Tri -County Building Industry Service ,Board