Permit a CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2009 -00639
T I G A A D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/01/2009
Parcel: 1S133DD14800
Jurisdiction: Tigard
Site address: 11787 SW 128TH AVE
Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 185
Project: Tell
Project Description: Replace furnace and install a /c.
Owner: FEES
TEEL, DAVID W & MARY C Description Date Amount
11787 SW 128TH AVE
TIGARD, OR 97223 Air Conditioning 12/01/2009 $46.75
Furnaces < 100K BTU 12/01/2009 $46.75
PHONE: 503 - 997 -7028 12% State Surcharge - Mechanical 12/01/2009 $11.22
Contractor:
SUNSET HEATING & COOLING
0607 SW IDAHO ST
PORTLAND, OR 97239
PHONE: 503 - 234 -0611
FAX: 503- 234 -0439
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $104.72
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 Notific. • 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 : estions t• OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued = 1 I � � Permittee Signa re: r
. r
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.
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Mechanical Permit Application t , '#v"....---..-' 4 14 ,._, t - - ..
������ � � Received �+ q
1 '' City of Tigard i Date/B y : II * Q If �¢y Permit No.: /(U Ape /.. 43/
k -'n .. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review . t Phone: 503.639.4171 Fax: 503.598.1960 N U V 2009 Pla Re Other Permit:
r!l TrEf, Inspection Line: 503.639.4175 Date Ready/By. r� s it B! ppl See ementa Page 2 l I for
'T Internet: www.tigard- or.gov CITY OF TIGARD Notified/Methed: 3/ /a unformation
BI 111 DING DIVISION
` . TYPE OF. WORK C OMMERCIAL ' FEE* SCHED -. USE CHECKLIST ,
Mechanical permit fees* are based on the value of the work
El New construction Addition /alteration/replacetnent performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION: Value: $
R EQUIPMENT / SYSTEMS FEES'
Ni 1- and 2- family dwelling ❑ Commerciallindustrial ❑ Accessory building
For specurl information use checklist.
❑ Multi - fam ily ❑ Master builder ❑ Other: Description 1 Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site address: 1 1 1 , j .- 1 S.,.,.i y 2c; I'‚t''' (requires site plan showing placement) 1 46.75 4(C l('
City/Slate /ZIP: '-p `' tit 1 '2 - 2 - 3 Furnace 100,000 BTU (ducts/vents) 1 46.75 ill 1c
Furnace 100,000.1 BTU (duets/ vents) 54.91
Suite/bldg. /apt. no.: Project name: `._ 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 (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.: Other fuel appliances
»ESCRIPTION OF .WORK.: Water heater 23.32
Gas fireplace 33.39
% 't _-L tvt4 l Uk i .( I Vti l Lt (L Flue vent for water heater or gas
t L fireplace 23.32
Log lighter (gas) 23.32_ _
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimne 23.32
PROPERTY' OWNER '.❑`TENANT . Other: 23.32
Name: r)i1\if '.--1-6D( Environmental exhaust and ventilation
Range hood/other kitchen
Address: I1- , cl r ( 2' !. equipment 33.39
- ) ) 3 Clothes dryer exhaust 33.39
City/State/ZIP: l l / i O Single -duct exhaust (bathrooms,
Phone: ( ) O CO _ 7 0 f 2_ Fax: ( ) toilet compartments, utility rooms) 23.32
Attic/crawlspace fans 23.32
[I APPLICANT ❑' CONTACT PERSON Other 3.32
r . I
Business name: _ Fuel piping
S14.15 for first four; $4.03 for each additional
Contact name:
Furnace, etc.
Address:
- Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Water heater
Phone: ( ) Fax: ' ( ) Fireplace
E -mail: Range
. - Barbecue
Clothes dryer (gas)
Business name: St,01 Se.,-t- 1-_L:' •y CZ'G 1t Other: •
Address: 010 C''1 5 0., 1 (401 C. Stree )fi . M ECHANICAL PERMIT FEES` .
Subtotal lj?��:
City/State/ZIP: PeY`3 t64 r1i` (� 6172 Minimum permit f ee ($90.00)
Phone: (ri U7) Z ` . - Giv l 1 Fax' (51)3 ) L 34 0 4y) Plan review (25% of permit fcc)
CCB lic.: ) L i C' FS • State surcharge (12% of permit fee) i k ,),,),
TOTAL PERMIT FEE [C 19_ ,
this permit application expires if a permit is not obtained within 180
Authorized signature: , days after it has been accepted as complete.
a iu :y
Ct, ,:, � � ?�Jr L I S l�ti Date: � � f 1 ` Lei i . Fee methodology set by Tri -County Building Industry Service Board
1 Print name: Jc-1
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SUJNEMIT e DIRECTION
Name & Address:
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