Permit CITY OF TIGARD MECHANICAL PERMIT
`1 2 : COMMUNITY DEVELOPMENT Permit #: MEC2009 -00468
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/04/2009
Parcel: 2S104BA11700
Jurisdiction: Tigard
Site address: 13529 SW LIDEN DR
Subdivision: Lot: 0
Project: Nguyen
Project Description: Install aa/c unit.
Owner: FEES
NGUYEN, TONY DUNG & Description Date Amount
VUONG, TIFFANY TUYEN, 13529 SW LIDEN DR Air Conditioning or Heat Pump 09/04/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 09/04/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 09/04/2009 $58.50
Contractor:
FIVE STAR HEATING
10542 SE MARKET ST
PORTLAND, OR 97216
PHONE: 503 - 544 -9567
FAX: 503- 251 -4781
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 que •• • e NC by c• ' g 503.246.6699 or 1.800.332.2344.
Issued y:
v s
= Permittee Signature: -� _
Call 503.639.4175 by 7:00 a.m. for an inspection that bu iness 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 Application , OFFICE USE ONLY
1 ,1� � � j r- �� Received
11 City of Tigard cltI[ . !; , / :I__.:L.i Date/B y D' Permit No.: 2Le 1 0 f 44,q
• 13125 SW Hall Blvd., Tigard, OR 9722 w
Phone: 503.639.4171 Fax: 503.598.1960 S E P (D 4 2009 D D a e Review
ate /By. Other Permit:
T I C; A R D
Inspection Line: 503.639 Date Ready /By: la See Page 2 for
Internet: www.tigard - or.gov Notified /Method: Supplemental Information
CITY OF T,dGAPD EN
TYPE OF 4 $1 • D 1 ` 7 Dt Ui 5 3 J COMMERCIAL FEE* SCHEDULE - 'USE CHECKLIST
❑ New construction 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
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
VI- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: e 1 DC Air conditioning or heat pump
1 S �� s >J (requires site plan showing placement) \ 14.00
City/State /ZIP: ckcl rcl c" L qv-NI-D-3 Furnace 100,000 BTU (ducts /vents) 14.00
Fumace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg. /apt. no.: Project name: A C 44 pn 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
Gas fireplace 10.00
1c• °- +t'Ck \ "AT- +10 nIc•ri 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 I ❑ TENANT Chimney /liner /flue/vent 10.00
Other: 10.00
Name: Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
Fuel piping
Contact name: $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
r Clothes dryer (gas)
} �-
Business name: 1 ■ 09... S j 9- �j.. i I L.IA- Other:
Address: \ 10 Sy ' P1 _ j c.,,"7— MECHANICAL PERMIT FEES*
City/State /ZIP: 7 tr.> � `camel OIL o\"\a \ le Subtotal 7 , ,v
Minimum permit fee ($72.50)
Phone: ( \ ) S,{yqc6`1 Fax: ( So" 9 XI ' 9 I Plan review (25% of permit fee) __
CCB lic.: (l $ 3 g a 49./10 State surcharge (12% of permit fee) % ,
I TOTAL PERMIT FEE g'l
. I This permit application expires if a permit is not obtained within 180
Authorized si gn ature: .4111M , ` 1 days after it has been accepted as complete.
Print name: f&4 Cr — ‘ ' - Date°tt -py -0C' • Fee methodology set by Tri -County Building Industry Service Board
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