Permit CITY OF TIGARD MECHANICAL PERMIT
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'Ill COMMUNITY DEVELOPMENT Permit #: MEC2009 -00644
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/02/2009
Parcel: 1S134DA06300
Jurisdiction: Tigard
Site address: 10747 SW NORTH DAKOTA ST
Subdivision: Lot: 0
Project: Whitney
Project Description: Replace gas furnace.
Owner: FEES
WHITNEY, JACK C & HEATHER A Description Date Amount
10747 SW NORTH DAKOTA ST Furnaces < 100K BTU 12/02/2009 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 12/02/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 12/02/2009 $43.25
Contractor:
ROTH HEATING & COOLING
PO BOX 1265
CANBY, OR 97013
PHONE: 503 - 266 -1249
FAX: 503- 266 -3478
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 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 question to UNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: t1 ��I rn l x (I Permittee Signature: .... 4.1 / ` �
[ 1 Call 503.639.4175 by 7:00 a.m. for an inspection that business day. �
Thls 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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Mechanical Permit Application vol( oriicl tist: ()NIA
City of Tigard , i ij ' - LEMIMIIMEIMMEMPASZI
1 11 II 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503:639.4171 Fax: 503.598.1960 Date/BY, Other Permit: l _ �, l - Inspection Line: 503.639.417 DEC 0 2 200 p Date Ready/By: ;,: 13 See Page 2 for
Internet: www.tigard.or.gov otified/Method: Supplemental Information
CITY OF TIG . ° ,!
TYPE OF WORK B UILDING DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
ID New construction IN 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
jzi I- 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 1 Heating/cooling
Air Job site address: , 01 t.. V.1 SW N ocac� �tx�0k L S T • (requites site plan showing placement) 46.75
City/State/ZIP: Furnace 100,000 BTU (ducts/vents) I 46.75 1 -4 - (t , -7
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldgJapt. no.: I Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
r Gas fireplace 33.39
VI 0.S v (\tvi.c e._ Lkn nor q e_ Q t_7'� . Flue vent for water heater or gas
U fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
17ik PROPERTY OWNER I ❑ TENANT Chimney/liner /flue/vent 23.32
Other: 23.32
Name: --Scoxy_ \0 v\Q (' Environmental exhaust and ventilation
Address: .5 Range hood /other kitchen
equipment 33.39
City/State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503) ( - W;, Z, \ Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT ❑ CONTACT PERSON • Attic/crawlspace fans 23.32
Other: 23.32
Business name:
Fuel piping
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) I Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: 1-1, lit (1. 1,- ' )OLUl� Other:
Address: p 0. box 2tp 5 MECHANICAL PERMIT FEES*
City/State/ZIP: 0_61.4/ b 3 , D✓L criois Subtotal Z- 75
Minimum permit fee ($90.00) Q • OC
Phone: (503) `a (0 (Q , i a y Fax: (603 )c2 (p _�-�`7 ��! 7 Plan review (25% of permit fee)
CCB lic.: j/-1 p G P State surcharge (12% of permit fee) / 0.80
1 TOTAL PERMIT FEE 1 .250
Authorized signatu d ri &"(-1--11-'-r\----------- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
I Print name: aGLt • , f `��1 I Date: l Z - l o I • Fee methodology set by Tri -County Building Industry Service Board
I:1 Building�Permits \MEC- Per>(tApp.d 10/01/09 440- 0617T(I1/02/COM/w®)