Permit °:..: q CITY OF TIGARD MECHANICAL PERMIT
s >: COMMUNITY DEVELOPMENT Permit #: MEC2009 -00655
13125 SW H all Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/08/2009
T f GARI? Parcel: 2S114BB20500
Jurisdiction: Tigard
Site address: 16431 SW 103RD AVE
Subdivision: RIVERVIEW ESTATES NO. 2 Lot: 49
Project: Anderson
Project Description: Replace furnace.
Owner: FEES
ANDERSON, STEVE Description Date Amount
16431 SW 103RD AVE
TIGARD, OR 97224 Furnaces < 100K BTU 12/08/2009 $46.75
12% State Surcharge - Mechanical 12/08/2009 $10.80
PHONE: 503 - 620 -2614 Minimum Fee Adjustment - Mechanical 12/08/2009 $43.25
Contractor:
TRI COUNTY TEMP CONTROL INC
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 557 -2220
FAX: 503- 557 -0919
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �� �1, k L Permittee Signature:
A �}^
`(` `(� \�/� CaII 503.639.4175 by 7:00 a.m. for an inspection that business day. PP
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.
;, ;' DEr -3 -2009 01:29P FROM: TO: 5035981960 P.1
Mechanical Permit Auplicat' , .. EC x , � '. � . .
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City of Tigard Received DalelBy. (p Permit No.. /i�/
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review l
R Phone: 503.639.4171 Fax: 503.598.I96 DEC 0.8 2009 Pia Rev
Other Permit:
Inspection Line: 503.639.4175
f Ise :1 \It•I) 1� Date RenAy/By tuns 6t1 See Page 2 for
c..' - Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: 11q Supplemental Information
BUILDING DIVISION 1
TYPE OF WORK COMMERCIAL FEE* SCHEDULE USECHJ;CK[.IST
❑ New construction ® Addition /alteration/replacement Mechanical permit fees* are based on the value of the work
performed..Indicate the value (rounded to the nearest dollar).of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY 01? CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
0 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
12 Multi-family ❑ Master builder For special igformatioa use checklist.
❑ Other: Description p I Qty.. I Ea. I Total
JOB SITE INFORMATIO AND LOCATION Heating/cooling
Job site address: 1 X746 ` 0 W tin' u Air conditioning
(requires site plan showing placement) 46.75
City/State/ZIP: Te Furnace 100,000 BTU (ducts/vents) I 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: � ,, N�`� (t ,/QOf 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 (fllel•type, not electric),
in-wall, in -duct, suspended, etc. _ 46.75
Flue /vent for any of above 1 23.32
Subdivision: Lot no.:
Other: _ 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 33.39
Flue vent for water heater or gas
D fireplace 2332
``^�'� Log lighter (Bas) 23.32
Wood /pellet stove 33.39
Wood fireplace/insert 23:32
PROPERTY OWNER 1 El TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: 8401f tarty) Environmental exhaust and ventilation
Address: `D�+" Rage hood/other kitchen
equipment 33.39
City /State /ZIP: Clothes dryer exhaust 33.39
`� Single -duct exhaust (bathrooms,
Phone: ) Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Other: 23.32 _
Business name: Same as contractor Fuel tin
Pp P
Contact name: Diane Mason $14.15 for first four; 54.03 for each additional
Furnace, etc. •
Address: Gas heat pump ,
City/State /ZIP: Wall /suspended/unit heater
—
Water heater
Fax: Phone. ( ) ( ) Fireplace _
E -mail: Range
•
CONTRACTOR Barbecue
Business name: Tri County Temp Control Clothes dryer (gas)
Other.
Address: 13150 S Clackamas River Drive MECHANICAL PERMIT FEES*
City/State /Z1P: Oregon City, OR 97045 Subtotal
Minimum permit fee ($90.00)
Phone: (503) 557.2220 Fax: (503) 557.0919 Plan review (25% of permit fee)
CCB tic.: 72623 State surcharge (12% of permit fee )„k i h
— TOTAL PERMIT FEE tOCt ()
Tbls permit application expires if a permit is not obtained within 180
Authorized signature: _ days after It has been accepted as complete.
Print name: T n/r1OY' Date: L m {
n r ' Fee methodology set by Tri-County Building Industry Service Board
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