Permit J... ,
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CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT COMMUNITY MEC2009-00543
TIGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
14
Date Issued: 10/15/2009
? Parcel: 1 S 134CC00500
Jurisdiction: Tigard
Site address: 12165 SW MERESTONE CT
Subdivision: Lot: 0
Project: Chavez
Project Description: Remove and replace gas furnace.
Owner: FEES
CHAVEZ, GREG Description Date Amount
12165 SW MERESTONE CT Furnaces < 100K BTU 10/15/2009 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 10/15/2009 $10.80
PHONE: 503 - 317 -3398 Minimum Fee Adjustment - Mechanical 10/15/2009 $43.25
Contractor:
WESTERN HEATING & COOLING INC
50618 COLUMBIA RIVER HWY
SCAPPOOSE, OR 97056
PHONE: 503 - 543 -5599
FAX: 503- 543 -3693
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No • - . on - - -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir: questions to OU ' by - ' g 503.246.6699 or 1.800.332.2344.
Is ued By: . // 4 Permittee Sign. ure: �,�� , • :la ��
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Call 503.639.4175 by 7:00 a.m. for an inspection that bu$i -ss 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.
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ect� �13 09 01:22p Western Heating 503 - 543 -3693 p.1
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Mechanical Permit Appli ; O
� ��1 FOR OFFICE l'. t °Se•: ONLY
. I V ED Received
City of Tigard r CE Date,By: /, /3 of Ar Pcrmit No.: te'4,4,9 405
• 13125 SW Hall Blvd.. Tigard, O 97223 Plan Review
11 Phone: 503.639.4171 Fax: 503 598.1960C 1 1 3 2009 9 Datersy: Other Permit:
T 1GA ft D Inspection Line: 503.639 Date Ready /Sy: �/'^ See Page 2 for
Internet: www.tigard- or.gov
TIGARD N S a
CITY OF pplemearsl Information
TYPE , ING DIVISION
COMMERCIAL FF,E't SCHEDULE — USE CHECKLIST
hlteration/replacement Mechanical permit fees" are based on the value of the work
❑ New constructionAddifio performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Other: mechanical materials, equipment, labor, overhead, and profit.
X CATEGORY O CONSTRUCTION Value:5
1 -and 2-family dwelling Comme lal /industrial RESIDENTIAL. EQUIPMENT I SYSTEMS FEES*
y g ❑ C ❑ Accessory building
For special information use checklist.
Multi- family C..] Master i ilder 1171 Other: Description I Qty. I Ea. I Total
JOB SITE INFORM TION AND LOCATION : Heating/cooling
j : Air conditioning .
Job site address: l/J I iiv .S -, c (requires site plan showirte placcmcng 46.75
City/State/ZIP: ` ^ a nR .I 9-,,,93- 3 j & K Furnace 100,000 BTU (duets/vents) r 46.75 1-i6i, L5
1a i. no. I Project nitric: /� Furnace 100,000} BTU (ductslvcnts) 54.91
Suite /bld
g' p l 3 t 1 v1 Z Heat pump 61.06
Cross street/directions to job site: { Duct work . 23.32
I Hydmnic hot water system 23.32
Residential bailer (radiator or
hydronic) , 23.32
Unit heaters (fuel -type, not electric).
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no: Flue /vent for any of above 23.32
Other: _ 23.32
Tax rnap /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
f) Gas fireplace 33.39 • .,y\r u' , �- ( pl QI cp. I �� (, rtA t` Yl e C Flue vent for water heater or gas
V fireplace 23.32
Log lighter (gas) 23.32
Woodlpellet stove 33.39
Wood fireplace/insert 23.32
y i
Chimney/liner /flue/vent 23.32
PROPERTY OWNER I I ❑TENANT Other: 23.32
Name:
Coq k1P z
in Y c'' Environmental exhaust and ventilation
Address: Su ) �P s 4-one. L `�— Range hood/other kitchen
I
1.1 t. equipment 33.39
City/State/ZIP: U r� r � 9-7.9,3 I 3 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (->" ) 3 - 3 J 9 g I Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT I ❑ CONTACT PERSON Attic /crawlspace fans 23.32 i
Business name: !I Other: 23.32
Fuel piping
Contact name: . Q II 514.15 for first four; 54.03 for each additional
Address: / ��
1 Furnace, etc.
� (� Gas heat ptunp
CityiStaterZIP: j ` uy I Wall/suspended/unit heater
t
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: \ I I ` I y Clothes dryer (gas)
'1... P. n �" , ` r, no a G� t I +� Sn Other:
Address: S.J is ) L (/ I u I19 Cat a- I t , ; VAC 0 ( MECHANICAL PERMIT FEES*
City /State /ZIP: � /�.,) �� I CI 05=9 / Subtotal 75
�_� i � i7 Minimum permit fee (590.00)
Phone: � J p1 ) _ 5 �1q I Fax: (3) 5L13_30') Plan review (25% of permit fee) ..-e -
CCB lie.: ' 9 ' I State surcharge (12% of permit fee) /(J, by
TOTAL PERMIT FEE /a) ,20
/t..Z 1 //ft> /� This permit application expires if a permit is not obtained within LBO
Authorized signature: I lY't days after it has been accepted as complete.
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
l /Building.rannitstMEC•P .doc LOOM 44a-4617T (I 1:02r tNWEB)
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