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Permit n CITY OF TIGARD MECHANICAL PERMIT .. _ ' sI COMMUNITY DEVELOPMENT Permit #: MEC2009 -00638 13125 SW Hall BIvd., Tigard OR• 97223 503'639.4171 Date Issued. 12/01/2009 TIGARD: :Parcel: 1S133DA03700 Jurisdiction: Tigard Site address: 12545 . 2545 SW GLACIER LILY CIR Subdivision: Lot: 0 • Project: McClure Project Description: Replace gas furnace. Owner: FEES 'MCCLURE, KEITH E AND Description Date Amount PATRICIA E, 12545 SW GLACIER LILY, CIRCLE TIGARD, OR 97223 Furnaces < 100K BTU 12/01/2009 $46.75 12% State Surcharge - ;Mechanical 12/01/2009 . •$10:80 PHONE. Minimum Fee Adjustment :. Mechanical 12/01/2009 $43:25 Contractor: BEN'S HEATING & AIR CONDITIONING LLC P0 BOX 80607 PORTLAND, OR 97280 PHONE: 503- 233 -1779 FAX: 503 - 651 -3345 Type of Use: SF Class of Work: ALT Type of Const: . Occupancy Grp: Stories: • Fuel Fuel Types: Natural Gas • Gas Pressue: • Total $100.80 Required'Items and Reports (Conditions) • This permit is issued subject to the regulations contained in'the Tigard Municipal?- Code, Statelof OR.- Specialty Codes: and all other applicable law: At work will be done in accordance with approved plans. This permit will'expire'if work is not started within 180'days of issuance, orif work is suspended'formore the.180 days. ATTENTION:- Oregon law requires ybu to ;follow the rules adopted by the Oregon Utility Notification,Center.. Those rules are:set forth in`OAR „952= 001`0010 through OAR 952.'001 You may obtain•a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: ( U . Permittee Signature: (i .� \_ 0 jUJ\--) • Call 503.639.4175 °by 7:00a.m. for an inspection that business day. Thispermit'card; shall bekept in a conspicuous place on the'job site untilrcompletion of the project. Approved plans are required on the job site.attthe time of-each inspection. 1VIXZical Permit Application R"' C R = City of Tigard Date/ay; Permit Nn.! " 13125 SW Hall Blvd., Tigard, OR 97223 N 0 V i n I Review Phone: 503,639,4171 Fax; 503.598,1960 a ell3 (J'j Inspection Line' 503.639.4175 Y: Other Permit. s 3 e R4dyiDy; Juriy ® See Page 1 for Internee www,tigard-orgov lid i T!ql Method: ` Supplemental Information ~ Y I 1V 17, TaTF'•OFI~f!O~ICi ,':?;~fil~ ,(w~ 3rs C0mMERCIAL FEE" SCHEDULE - UM-CHECKLIST Mechanical permit tees' are based oil the value oft is Work ❑ New construction Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) ol';dl ❑ Demolition ❑ Other: mechanical materials, equipment, labor, n rI d. and profit. 'lp .;rl •;ia;t:,.;~~,... Value: 5 v . Of CU)VIR N' CATEGdRX ~fCl RE$IDENTIAL PQUIPMENT I• and 2-family dwelling ❑ COtt1111erclAl/industrial Accessory building /SYSTEMS FEES* For special h1fornrarion use checklist. ❑ Multi-family ❑ Master builder © Other: Description Qty, [a, total JOB SITE, INF0 RMAT[(1t~,11)+I `Y~ft~j°I<' N'15,.,`it / ar, Htatin Cuolin lob site address: S~ - f Air conditioning or heal pump re uires silo plan allowing placement) 14, 00 City/state/ZIp: Furnace IK000 BTU (duets/vents) 14.00 Furnace 100.000+ STU (ducts/venti r17.90 Suite/bldg./opt. no.: Project name: 1005 heat um 14.00 Cross street/dircction5 to job site: Duct work 14 00 H dronic hot waters stem 14.00 Residential boiler (radiator or h dronic) 14.00 Unit heaters (fuel-type, not electric), in-wall in-duel sus cndcd ctc, 10.00 Flue/vent for any of above 10.00 Subdivision: Lot no.: Other. 7 O.UU 'fax map/parcel no.' Other fuel appliances Water heater IQUU Gas fireplace 10,00 Flue vent for water heater or gas fireplace 10.00 Lo lighter (gas) 10.00 Wood/ pellet stove I0.00 Wood fire lace/inscn 10.00 Chimnc /liner/flue/vent I000 PROPERTY OWNER Other: I U.uu Name' ► Environmental exhaust and ventilation Range hood/othcr kitchen Address: c ui mellt 10.00 City/Slate/"LIP: T a Clothes d cr exhuust Ion Single-duct exhaust (bathrooms. l')lot1C: ) ;)4 --SAW _Cz Fax: ( ) toilet con artmcnts, utilily rooms) 13 APPLICANT CONTA('~;;y"R5fI1V Altic/crawlspace fans 10.00 Business nalne: 11 . ~T'rt' L L C Other I u Fuel piping COMM name: $5.40 for nrst four: $1.00 for each additlonnl Address: Furnace, etc. Gas heat um C'itylState/Z.IP: Wall/sus ended/unit heater Phone: CS-1i 3) 313 - 3 g Lo Fax:: (h3) 6 S/ - 33 Y J_ Water heater Fire lace Range CONTRACTOR.... ! Barbecue liusiness name: t Clothes dryer (gas) _4gr1 NPI t~ fr r b>.r G Othcr: Address: MECHANICAL PERMITFEES° ('it)/SlulelZlP: 9 Subtotal nc: (S ~3) 3 3 7 9 Fax: 603) Minimum permit I'ee ($72,i0) - Plan rcvieu (25%ofperrntl lee) C'03lic.: Lr/S-C~ Slanesurcharge (I2%PI'pcrmittee) TOTAL PERMIT FEr. AMI10FiLed signattlre: 'Phis permit application esplrea if a penult is not ubtnined %%hfiin IAu days after It has been accepted as complete. C Prinl (lame: g e: A-( 114 1A ' 1'ee methodology set by 'I ri•C'ounty Building Intillsll\ Ser%ice I9u;lyd I'•.I tuddiaylPCnuilYMlf:C•PennitApp doc a4/lminti 440-461&7T(I l/ com/W12a) TOO in T HIVV9KI1VHH-SMH9 SMTMOS XHd 8C: TT 6002/OC/TT