Permit CITY OF TIGARD MECHANICAL PERMIT
I I D COMMUNITY DEVELOPMENT Permit #: MEC2009 -00152
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/13/2009
Parcel: 1S133DD05500
Jurisdiction: Tigard
Site address: 12769 SW WINTER LAKE DR
Subdivision: Lot: 0
Project: Greenwood
Project Description: Replace gas furnace.
Owner: FEES
GREENWOOD, ROBERT & SHIRLEY REVO Description Date Amount
LIVING TRUST, BY GREENWOOD, ROBERT Furnaces < 100K BTU 04/13/2009 $14.00
A/SHIRLEY J, 12769 SW WINTERLAKE DR 12% State Surcharge - Mechanical 04/13/2009 $8 70
PHONE: Minimum Fee Adjustment - Mechanical 04/13/2009 $58.50
Contractor:
A -TEMP HEATING & COOLING
16000 SE EVELYN ST
CLACKAMAS, OR 97015 -9519
PHONE' 503 -650 -5014
FAX 503- 557 -2990
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, work is s .ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility tification Center T e rul::. re set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
I r
Issu d By: ( KAA) Permittee Si ature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business da .
This permit card shall be kept in a conspicuous place on the job site un 'I c. • etion of the project.
Approved plans are required on the job site at the time of each inspection.
t
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Mechanical Permit Application FOR OFFICE IISF ONLY
City Of Tigard t � � C_, Rc -w d
1 -
• ( Pcrmiu Nn.. * • • 10 t 11 n 13125 SW Hall Bled., Tigard, OR 972 3 / D R IC (B } - lima •
IN
i ,
5 ' Phone: 503,639.4171 Fox: 303,598.1960 PM. Basic
Other Permit
inapectionLine: 503.639.4175 APR - 7 2009
Date/By;
Internet www,ti}Inrd•or,gov Pate Ready/D}, ISM E1 Sec Pnge 2 mr
Notified/Method. a Supplr matt nI !Mtn
CITY OF TIGARD
•TYPE OE' ,.II` V ISIOK,' - ' COMMERCIAL FEE' SCHEDULE - UST CHECKUS t'
❑New construction dition /niterntiot �r . Ni
oehnniod pannit fees" are based un the value of Ilte work
❑ Demolition perfilrmed. Indicate 11tc value (rounded to the nearest dollar) of all
❑ Other: - mechanical materials. equipment, labor. overhead. and profit.
- ,• ' ,•• .• C CATEOPR \r: Or COIYSTRUCTTQN. Value: S — 1 -and 2- family dwelling ❑Commercial /industrial 12 Accessory building '1tESIDENTtr1L EQttiP�1EivTa_S\ rErvIS FEW. •
❑ Multi - family ❑ Master builder 0 Other
For tprctal rntorn+nitOn Ilse checkli,et,
Description I • QTY. 1 En. I Total
JOfl.S1T31,'1NPORMATkt1V'. how.;LOCAI',40, . - Hcntln /cn nlitt�g
Job aitc addre 1 �� � Air coudittom or bent pump
( require : :its plan i howinulnccmcnt) 14.00
City/Statc/ZIP: l La g jr 4' 3 Furnace 100.000 BTU(duet :hens) 1 14.00 1 if
Suite/bldg. /apt no.: ` Project name: ��y 79--,..3 �� Fu+tince 100 BTU (ductsivcnta) 17.90 -
--" -���� �� Goa heat pump 14.00
Cross street /dirccrions to job site: - Duct work 14.00
Hydronie hot wntcr aystcnt 14.00
Residential boiler (radiator or
-- hydronic) 14.00
�—"- Unit hcatera (fitcl -typo. not electric),'
in -wall, in -duct, u,uapended, etc. 10,00
Subdivision:
Lot act : Flue /vent for any of above 10.00
Tax map /parcel no.:
~-- Other: 10.00
Other Mel a ll nncea
. • ; . ` :')TSC: trrTiC0 .OF NORKi'. Water heater 0.00 —
1
U S k r . /1� , e �/ Gas fireplace 10.00
_______p �.13C vF- Flue vent for water healer or gas
r �; : ...L. . +I / i fireplace 10 00
- Log ligh (go 10.00
Wood/pellet stove 10,00
\Vood tircplacc /inacr( 10.00
fd ` • Chimneyllincr /llucwem 10.00
Q ) 0 `0 r 1.IW -6 Envir IO.UO
Name:
` EmiMntncntal exhaust and vcntllntlnrt
Address: Range hood /other kitchen
City/State/ZIP: iP; equipment 10.00 .
� �' / Clothes dryer exhaust 1 0.00
(�� / O`� �>� I P ax: ( ) toilet rap
Phone: IL Single-duct exhaust (bathrooms.
•,.. . compartments t rooms) ,
t 'Ict cot ttitdy 6
ilP, . , ' fI; fi : Attic /craw nee fans
Business name: 10.00 RO Cllltcr: 10.00
Foal plQInp
Contact name' ATEMP HEATING AND COOLING, I N' $5.40 for first tsar; $1.00 for each nddlttn a
Address: (bailing (DR 411114 Furnace. etc.
_Gas hem pump
City /State/ZIP: 503-650 -501 Walllauspcndcd/unitseater
Phone. ( ) Isar::( D j Ci 9 o Wntcr heater
E-mail: Firinec ,�
I2anso
!CY3N!TTCACTCy1i. 13anc�c
Business name: n, TEl i2 R .... Clothes dryer (gas) -
Address: 16090 SE Evelyn St. -
Cit,aanu ,OI NrECrc�,�lr. m, PERMIT PEES* .
City/Stec/ZIP. -
S.(11Q —, Subtotnt
Phone: ( ) Fax: ( ) Minimum permit fee (572 50)
CCB he.: fi 1 C> f _ -- Plan rcNicwO,3 °'ool'permitfee)
r • Suite aurchnrge (12% of permit fee) ;
1 i TOT,1J e PERMIT rr E t _114 _____
' Authorized signature: I• , 4'!. r This permit application expires if a permit la not nbtnlnwithin 150
- _
_ days after It has been accepted ON complete.
Print name: Da te:
• A � t �t C • Fee meuhmdoioey seh by Tri- County Building Industry Service Barad
1 : 1 BulldingWennits \MF.C- PermitAppcoo 04106/(16 44 0. 4 61'/T111/0 COM/WEn)