Permit •
CITY OF TIGARD MECHANICAL PERMIT
•
II
COMMUNITY DEVELOPMENT Permit #: MEC2012 -00176
T1GAD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2012
R
Parcel: 2S 111 CA11400
Jurisdiction: Tigard
Site address: 9553 SW LAKESIDE DR
Project: Thiemann Subdivision: LAKESIDE PLACE Lot: 5
Project Description: Replace gas furnace.
Contractor: ARROW MECHANICAL Owner: THIEMANN, HAROLD
10330 SW TUALATIN RD 9553 SW LAKESIDE DR
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -1565 • PHONE: 503 - 670 -7470
FAX: 503 - 691 -1879
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/06/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/06/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/06/2012 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / �e� Permlttee Signature: QA./ /I /..64L-77 1,
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
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.
04/05/2012 08:19 5036911879 ARROW MECHANICAL PAGE 02/02
Mechanical Permit Application �� FOR orFICC USE ONL1'
City of Tigard 7 __./ . O..
' . ��i
13125 SW Hall Blvd., Tigard, OR 9�
=
P hone: 503.9182439 Fax: 503:598.1960 c. 20 DatdBy: Mar Permit!
Inspection Line: 503.639 ) pa 6! See pace 2 Am
r 1 c n ti Internet: www.tigard er.gov N11) Notifed/Method: ∎ Sapptnmmta! lafbrurathm
TYPE O Il 1 W) ;3 ' . . . COMMERCIAL. FEE" SCHEDVUt —. USE cgt..MUPT
Mechanical permit fcos are based on the value of the work
❑ Ncw construction IA Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollsr)nfall
❑ Demolition ❑ Other. _ mechanica materials, equ iomcnt, labor, overhead, and profit
Value: $
CATEGORY OF CONSTilltICIIION. RESIDEN17AL •SQVIPMENT"/ MS 'PEES*
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special /nforurefon use checklist
❑ Multi - family 0 Master builder ❑ Other. Description I Qty.- j Ea. I Total
JOR :SITE INFORMATION: kip ,LOCATION. Reating/cooling: _
• Air canditiootng
Job site address: ' g L • i / r. (reaeire4 site plan showily( t �
d cat) 46.75
Furnace 100.000 BTU�a/vrnts) I 46.75 Igo•7b
City/StatelZiP: -
►vex 17� `C3224 Furnace 100.000+ BTU (du�/vcrtl 54.91.
Suite/bldg./apt. no.: V I Project narnc —Fr 1G AM Loh LO (rvv • `G Heat site p l a n placement) 61.06 ,
Cross street/directions to job site: Duct work 23.32
- —' Hydronic hot water system 23.32
Residential boiler (radiator or
jydranic) 23.32
Unit heaters (fuel - type, not electric),
in -wall, itrduct, suspended, etc. 46.75
Subdivision: I Lot no.: , Flue/vent Remy y of above 2332
Other: _ _ 23.32
Tax map/pareel no.: Other Biel appliances:
• . .Ot @SC6lWAIt)N':'O1I"WOftt"(.' •
. .. Water heater 23.32
Gas fireplace 33.39
_g L A 1. a &A Fie /LMA L. a Flue vent for water heater or gas
fireplace 2332
Log lighter (gas) 23.32
Wood/pellet stove _ 33.39
Wood fineplaa/msert 23.32
ChinuteyflinedHue/vcnt 23.32
al : DPERi Ot . , D :' '? 23.32
Name: fA i2.014 74 1 (Fn.-A # .4.4 Environmental esbe st and ventilation -
Range hood /other kitchen
Address: R Ty- 3 6 L� 3339
Keyi Or. _ equipment
City/State/ZiP: ' ,4 v ., 4l Clothes dryer exhaust 33.39
(503) I7 7470 ( ) toilet (bathrooms,
Phone: Farr: toilet aom�meots, trtil iM tetras) 2332
W Yru s . •:. , : ,CON' 'Vt.40: :flRSON .Attic/crawl , . Ems 2332
asiness name: Other.. • 23 .32
B
A YCtE;ow M �frM/s�is ya 1 Fact pipi5:
Contact name: ,Z FF let 4" /Ad>, 514.15 for first four, $4.03 for each a&Nona!
Address: 11:9:.;•30 6t0I___ At n,;,4 kJ Furnace, etc.
Gas heat puma_
City /State/ZTh Tp A /Ali,/ . OA b WaWUsus�ended/unit beater
Phone: (CO3) 6RZ —I 5' 66- Fax:: (663) &ci 1- `'a 7 q► Water flier
Fireelace
E -mail: Range
-
Od"f;tiC'. Barbecue • •
.. ' � `. ��ry.;.• ^: , :Rd�i ea �. ... ...trams : -: e • , ., b
Business name: A rtizot.1./ w L_HrW iC / O dryer (pars)
Other:
Address: 10 3P &%„ • 'T►'Alw77.v M , A e441, *11„t +It. ,1:
City/State/ZIP: Tb tAT/#„1 �19i 7o 6 z - . Sabtotat ►x(,
Minimum permit fee ($90.00) ci 0
one: (6 )
/3- icv(�+>`' ' ( '' 6h -s Fax: ( �`3) 611 --/E3 7 7 • • flan review f�25`%of permit fee) -9--
CCB lie -: , clef 3 _ State surcharge (12"x6 of permit fcc) k . DO .% _
TOTAL PERMIT FEE
'11Sb permit appal lion expires l a permit a not obtetned vathin 180
Authorized signature�� after
l /2.0,1. days ar it bas been l+ red as complete.
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