Permit II CITY OF TIGARD MECHANICAL PERMIT
" . COMMUNITY DEVELOPMENT Permit #: MEC2009 -00500
TJG 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 09/23/2009
Parcel: 1 S133DD05300
Jurisdiction: Tigard
Site address: 11546 SW LAKEVIEW TER
Subdivision: Lot: 0
Project: Jackson
Project Description: Replace furnace and a /c.
Owner: FEES
JACKSON, DOUGLAS Description Date Amount
11546 SW LAKEVIEW TERRACE Air Conditioning or Heat Pump 09/23/2009 $14.00
TIGARD, OR 97223
Furnaces < 100K BTU 09/23/2009 $14.00
PHONE: 503 - 524 -4249 FlueNent For Any of Above 09/23/2009 $6.80
12% State Surcharge - Mechanical 09/23/2009 $8.70
Contractor: Minimum Fee Adjustment - Mechanical 09/23/2009 $37.70
TRI- COUNTY TEMP CONTROL
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 557 -2220
FAX: 503- 557 -0919
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 dire es ions . •UNC • calling 503.246.6699 or 1.800.332.2344.
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Iss edBy: _ , LIA..4 Permitte�Signature: ,- _ ��. �
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Call 503.639.4175 by 7:00 a.m. for an inspection that bu ' ess day.
- - — ` This permit shall be kept in a conspicuous - on the job sit• until completion of the project. -- - --
Approved plans are required on the job site at the time of each inspection.
SEP -22-2009 10 : 20R FROM: TO : 5035981960 P 1
Mechanical Permit Application' ECEIVE 1014 01.1.1( I I `,1 0\1 1
City of Tigard L-. eceived
Datc/13y: 5' " el s b Permit No.: tti / . it r . 0 0 500
II - il 13125 SW Hall Blvd., Tigard, OR 97223 SEP 2 2 2009 Plan Date/By: Review
: 1 Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
1 I , , •\ i , i , Inspection Line: 503.639.4175
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Internet: www.tigard-or.gov CITY OF 1-If' Date Ready/By!
Noufied/Method: See Page 2 for
Supplemental Information
BUILDING DIVISIO
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0 New construction 23 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
0 Demolition 0 Other: - materials, equipment, labor, overhead, and profit.
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66,ggif :. : :,.. ., .:, , ,,, - ,,,,: ,,,,:..,,, ,. : : , T „ . _ _ , . y f,i„ $
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0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist.
D Multi-family 0 Master builder 0 Other: Description I Qty En. I Total
gte,-1,4colik:1,,4;,fit*...;vi:iiii4;66 -: '. .- .. ' ,:' Heating/cooling
Job site address: I i ek(V 6 IN LaKeV te,vv -re,ril Air conditioning or heat pump
(requires site plan showing placement) I 14.00
City/State/ZIP: Tigard, OR 1 Z.22,) Furnace 100,000 BTU (ducts/vents) I 14.00
Furnace 100,000+ BTIISducts/vents) 17.90
Suite/bldg./apt. no.: 1 Project name: Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Rydronic 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
Flue/vent for any of above I 6,80 ,
Subdivision: { Lot no.:
Other 10.00
Tax map/parcel no.: Other fuel appliances
, a1v.t:&701wi.':!.•,' ',"',,•:::"' ' 11 “:- ' ' 7 ()
liggFAVIglr,P,;6;..,i.0-?A.Yk-----T.::Y114,I.Orgift9,TC,,Y41.V.O.,„„„•,,,,:,....... Water heater 10.00
1.4.. ..
t 10.00
• ' q latti fWalfite-A cur Ce 1 tu 1 n v ner ;rue r 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
0 (c . ;:14'.'-Ok.','A,:li:F.:d4.10Z01,1:fii,;03(,7;;'::;;1,;;;:,;.'„;,:,.q,c, other: 10.00
Name: II l DI 1 ,, Environmental exhaust and ventilation
.1. Range hood/other kitchen
Address: a 0 I _ equipment 10.00 _
City/State/ZIP: Clothes dryer exhaust 10.00 .
Single-duct exhaust (bathrooms,
Phone: (5rib ) S2,4-..-47A Fax: ( ) toilet compartments, utility rooms) 6.80
5; ...:-:',•.';' .... Attic/crawlspace fans 10.00
. .. 11 ),',VM1M1',..1 ).....n:..3:.:44"::1.c... r..I.N14.4,.;:..i:fit*,m570 - ,,:-• ..
Other: 10.00
Business name: Same its contractor Fuel ipin
Contact name: Diane Mason $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: .
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E-mail: Range
'),,,...L-... . 4.9,-KOREPA,', :, :.'. ..; .,: .: ,, ; ....-, -..., ': -'„i. ,:.: . . -: Barbecue
Clothes dryer (gas)
Business name: Tri County Temp Control
Other:
Address: 13150 S. Clackamas River Drive
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City/State/ZIP: Oregon City, 97045 Subtotal
Minimum permit fee ($72.50)
Phone: (503) 557.2220 Fax: (503) 557.0919 - Plan review (25% of permit fee)
- CCB-lic.: 72623 - -- — -- — _ __ . _State_surchgrge112% of permit fee) 401 4 A
011.41
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized signature: ,iite ka4e-73 days after it has been accepted as complete.
Print name: Diane Mason Date: C1129,40C1 • Fee methodology set by Id-Comity Building Industry Service Board
i krb.or1innw,rnits\MEC-PennitApo.c1co 01/19/07 440-4617T (11/02/COMAVEB)
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CUSTOMER INFORMATION
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NAME A,1•4
ADDRESS
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i O PLEASE ! FAX APPLICATION WITI I SITE PLAN
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