Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00207
Date Issued: 05/13/2009
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503 639.4171 Parcel: 1S125DD06600
Jurisdiction: Tigard
Site address: ,9580 SW VENTURA CT
Subdivision: Lot: 0
Project: Lindsey
Project Description: Install gas line and venting for tankless water heater
Owner: FEES
SATALICH, ANDREW L & VERONICA L Description Date Amount
9580 SW VENTURA CT Water Heater 05/13/2009 $10.00
PORTLAND, OR 97223 Flue Vent for Water Heater or Gas 05/13/2009 $10.00
PHONE:
Fireplace
12% State Surcharge - Mechanical 05/13/2009 $8 70
Contractor: Minimum Fee Adjustment - Mechanical 05/13/2009 $47.10
SHAMBURG HEATING LLC Fuel Piping 05/13/2009 $5 40
PO BOX 829
TUALATIN, OR 97062
PHONE: 503- 692 -5563
FAX: 503 - 691 -6855
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types. Natural Gas
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
Issued By: th ol i s i k.(4 , 164 , 1 _ Permittee Signature: 1
v
Call 503.639.4175 by 7:00 a.m. for an inspection that business 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.
i -•' ,05/11/2009 11:33 5036916855 SHAMBURG HEATING LLC PAGE 01/02
Mechanical Permit Application 3 "(At orrl(E USE. ()NI N'.. , .; _iv
City of Tigard 4/ ReceB Peer at No ` 13125 SW Hall Blvd , Tig- j. Y - ' 1 • •� 'v ±� •' Plan Review •
Other Permit:
: N Phone: 503.639 4171: ` 1 1 3. :. 0 Elk/
' "bef 5 D
T r C, A 1 t) Inspectio Line: 503 1 ' ; / Date Ready/By rte= ® See Page 2 for
Internet. wrvw.tigard - . 1 7O in s Nottfied/Method: 1 Supplemental information
t , i!, 1 tr •r�l'�7r, ,v+nujml 71 1 ., 1 1 1? A i e tn i7lrrn W A _ . 4 , 07 �t s .T,
' 7t 1. " 5: I![ T'1! .. s l !° � ,,,� � li: I1 �' lfa lf, lt9' " "1b, y .1.9�t l a:i ; +h t .�
1 t 1 . iI . . '. I(l 13 i �I. 1 l ,�,1.1 it i a .1i4iti.�th iniii., i1 iii ti r14 .... fi �I- , I�!► ! i, :: :1 = F ' 74 t titr - 't , i ,
l tt f, 1 i 1 l � .t.,.l 1. , , �. PIT t� _;fie rrpn1+ r.L..IlI tit n, Cr t - . .:f14`:3 ,,. 'C i{ u t t o _ ,
t Mechanical permit fees* arc based on the value of the work
I=1 New construction I! ' dam..,. 10, plr
Vv t a performed. Indicate the value (rounded to the nearest dollar) of all
III Demolition III O t ' ' mechanical materials, equipment, labor, overhead. and profit,
! F ;g 1 1jt i r, ye r. O tt g} ui r:
ail i : ,r ftijlif t! ii r - 1 Value: $
i 1 11 r11!lfll'-il i6tnmeiit ra+'�+Aiui r tilkCi� t rgitli tt;rllii me.. •...„ , i #, �i }i� r 14 jI •
it ,itrt I It4oal ti � iu},++t t rgtri7me 1 . iii p,,,
�� °Sl I�il art t Ltr4! 1 i't lnrlii 4 c:hl{ ir)nM.tr�al li e �t'r'ihih li n t f IK;' : r, 1411,
1- and 2- family dwelling III Commercial/industrial D Accessory building For special information use checklist
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea I Total
1 i ' r 11,tir,� IQi t I�fr70iNt al t.in 'f ti � n rn4t r. u t x1 _ �cr 1 i(t T i' t
�f{tyi. it i+It rE t1 x t t..� + ny f f t yre', r�y{r,'t^ o a 1 il ITFI'i'Il fl Beating/ cooling
l��l} i��tQ�llffFPN�1 :;'tf169�'.���- F.l:trltfl '� ��m�li�ualunik „�rlatltrh_hafr3e1��,4. ; rHIHiYh.. .L7� 1 ., +� .�,11t... t 1 ,>. .I`,
0 Air conditioning or heat pump
Job site address:
:./ 0 Veil C( (requires ntr plan yllowiuic plw,euieul) 14 00
City/State /ZIP: Po 4 ote ' 7 Z 0-3 Furnace 100 BTU (dints /vents) 14 00
Furnace 100.000+ BTU (ducts/vents) 17 90
Suite/bldg. /apt. no.: Project name: Gas heat pump — 14 00
Cross strcet/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 (10
Flue /vent for any of above 6 80
Subdivision: Lot no _
Other: r 10.00
Tax map /parcel no.: Other fuel appliances
01
�i � i �, }� t mrt a! , n "7/"A!,410.., t ,�('` � nry � l Ir1 ft �p •f Water heater ! SS / 10 DO • , t9�/
121 a i f1l 111 1 ;' , .111 f II l�� � hter i i ii lE 1 Agr a �Irit • ll�• •: ' r. 4- if 1P 4)I1 r - t lfll l l � ll l l Gas fireplace 10.00
a - 5 L ' 'I J -f - ; L'c Flue vent for water heater or gas /a
fireplace I 10.00
1 ` Log lighter (gas) 10 00
Wood/pellet stove 10 00
Wood fireplace /insert 10 00
1 IY . mr t aru ^7� t' 714 I ar, It l it ! tl [ r ate, , { r r t I * p [ Ch imney/liner /flue/vent 10.00
u � 1119 4�r t r 7 uj t. t 5 ' i � l�! lllf IA i I �1 `' ! l l i - fi t! i }1
ft _'(♦ e,.t i m llfti_ n. i ,1.imld�r'1}r t itt�ct. i f.,:,l.r_,,, lliva .,, Irtt Other' 10.00
Name: / d Environmental exhaust and ventilation
Address: Range hood/other kitchen
�' �� j /9f.4 (moo r�� J equipment 10 00
City /State /ZIP: / d 04 i� Q t° z / V Clothes dryer exhaust 10 00
Single - duct exhaust (bathrooms,
Phone: ( 5P.A 7/9 5Z1/62 Fax: ( ) toilet compa, orients, utility rooms) 6.80
E11111151 ��p��r +.nmtfl nit �I,u�l � � t(t €,i �J 1 i f! �d :l'I r lnnn 4i 1 '15 Attic /crawls ace fans 10.00
1 iEt ,Ilrlafi4lfl}41G ,1�t1 1tdk N41! i k u }.rm tti i t.. ' rq;ti111 ''.1i# i f r ui d $ i ; lill Ent Other: 10.00
10.00
Business name: Fuel piping
Contact name: 55.40 for first four; $1.00 for each additional
Furnace. etc
Address: . -
Gas heat pump
City/State /ZIP: Wall /suspended /unit heater
Phone: ( ) F ax:: ( ) Water heater I 5 Yo
Fireplace
E -mail: Range
t lj y { I i'I r li {t'1r •1 � N #I1 ;�y{- r �L1 17y ❑ i i 14 I { 1 t 1 t ' 7� 1 ! '
11isIiI l lit r�ill�lr,r�l l:�litIlli i t 1 1, 1,,miti+Ul� i k' l(li ltttlli'I_1ifl K-1 If., it ,l i c.�. W fi :i , :11,L i i, i t NdP Barbecue
F
Business name. Clothes dryer (gas)
.L/ ), !� C ice `—' Other:
11 ! , ) 11 „i rlu,,
,,„„ „„ : , i , u�l r,,,, t , i i
m
Address: k {!u , r u, , r< 7, S 11 t r , iNIM r ,1'
O O U � f��7 Ill �� ��lt�r �tll{�Lt:ri �il� litrtF! �+'tifu2 lla , ,a 1,
City/State /7,IP: ��, O/Z `T 06 z, _ Subtotal 7.4 io
Phone: ( 0 ) o 537".3 Fax: Imo ) 60y /-- Z Sr Minimum (25% of permit ) ��•
9
P l an review (25% of pwtnit feee)
CCB lie_: .... fer/ State surcharge (12% of permit fee) $, 7Q
��a� TOTAL PERMIT FEE ,
W '�. 10 This permit application expires if a permit is not obtained within ian
Authorized signature: days after it bas been accepted as complete.
Print name: 5G r Date : --// y — I * Fee methodology set by Tn -County Building Industry Service Board
8\.