Permit CITY OF TIGARD
MECHANICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: MEC2007 - 00676
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/20/2007
PARCEL: 2S 114AB - 10100
SITE ADDRESS: 09217 SW MARTHA ST ZONING: R - 4.5
SUBDIVISION: KNEELAND ESTATES NO.2 LOT: 083 JURISDICTION: TIG
PROJECT: PENN
Project Description: Replace furnace.
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
•
TYPE OF USE: SF UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS /COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP:
FIRE DAMPERS ?: 30 - 50 HP: REPAIR UNITS:
GAS PRESSURE: 50 + HP: WOODSTOVES:
FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm:
GAS OUTLETS:
Owner: FEES
KYLIE PENN Description Date Amount
9217 SW MARTHA ST
TIGARD, OR 97224 [MECH] Permit Fee 11/20/20C $72.50
[TAX] 8% State Surcha 11/20/20C $5.80
Total $78.30
Phone: 503- 819 -9934
Contractor:
ANCTIL HEATING & COOLING
4320 N WILLIAMS AVE
PORTLAND, OR 97217 REQUIRED ITEMS AND REPORTS
Contact #: PRI 503 -281 -0752
FAX 503- 282 -5722
Reg #: LIC 8897
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: g /� �,� Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for inspections 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 XI t • Ti 1 .., 4t. :: -, - - . .1. i c)1 �I � 1( ctrrl Mti`�Yc). F . - , ' ax +t > y •
City of Tigard Received %�,/ � `
' 7 Date/By: �� 9 0 V� Pe No 7 i e 21 -ee e, 7i;
n 13125 SW Hall Blvd., Tigard, OR 20Q 1 Plan Review /
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
1 1( \' I nspection Line: 503 .639 7 V r j iu ARD Date Ready/By: mng. ® See Page 2 for
-ss Internet: www.ti and -or.
g g Notified /Method: Supplemental Information
BIJrLDING DTVISION
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Mechanical permit fees* are based on the value of the work
❑ New construction 1A Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
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A 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total
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, Air conditioning or heat pump
Job site address: t �' � ft)
� . 11/14, 5jY.foe ;- (requires site plan showing placement) 14.00
City /State /ZIP: 11 rd 4 1 Li Furnace 100,000 BTU ( ducts/vents) i 14.00 )4, se
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: 4PAtel 1 Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 1400
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: Lot no.: Flue/vent for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
:. E -F ea y l x c . tk f"t ::-$ 1 Y,. ,86trq 1M1 k gr t .. ;a
- 0z . . Kw t ., .:,• 4 ;t �# •ta(' o ! t #r Water heater 10.00 _
n ,t Irizsasrurwarnn�.rar.?�t . .r._ .= sal}•(. mukk` �I t r _,w...r Gas fireplace 10.00
? 1-1 J pun I r e_ Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
• Wood fireplace/insert 10.00
5 2 t ft.t iti`fslt. F a 1 t 0 `tt t F !irt .'r "fig ` .,;+ t;p' at,4 Chimney/liner /flue /vent 10.00
idiom 3'_i. 'tee_.. °"- "k:I1&litini?:Ag !t qallq• tx,:tINiha_.,i.a - t•r :•4 _^. s':. WN7F'i5O other: 10.00
Name: • , Fi "pP rt Environmental exhaust and ventilation
Address: /1�� Range hood/other kitchen
4
r}� �W / ✓-]Gtr c, ��e r equipment 10.00
City/State/ZIP: ! 1 ( 1 fe - � ) _ )14 Clothes dryer exhaust 10.00
`'sue t Single -duct exhaust (bathrooms,
Phone: Ib ) • - ' Fax: ( ) toilet compartments, utility rooms) 6.80
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k: �'y� ``'','li i F i -. 'c ,. r Is t aSro �t 3 �''y. ' w $! �' ' �t,�t t ; « rF'..t:;L' , T4 Attic /crawlspace fans 1 .00
yytki�u�Cq{�[N!P!Cfidar, , .94 kv ;:!d . ���T::.:m.�caes�t§a r ��d� :.rt1r�sSr, &rt}�87�.,dA� n..�,....tw;ev Lnt(k47k��
/f ' Other: 10.00
usiness name: i/1 1 ) � i 11n�i l -o S Fuel piping
Contact name: ! J
✓1S (7v� L} S5.40 for first four; $1.00 for each additional
�,f , � /� lab Furnace, etc.
Address:
�!J l ' ' 1 N��� F�j�15 j��.��.{ Gas heat pump
City /State/ZIPT41 A D � . Wall/suspended /unit heater
Phone: �` I
) �1 ' • Ii, Fax:: Water heater
% ) - "
/ -
Fireplace
Range
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ig ii i r r t • u L n3 r '' i ttli 1}NA. .t t iizi mi. c�uo . K"i :� pr Barbecue
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Business name: �n y., l n 4 �� i7 � Clothes dryer (gas)
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Address: : 'L$g i� +zm . 7� . C . �``di y g ` : a PI ,>.' a''0
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City/State/ZIP: •
_. t 1 / Subtotal ) N , a •
Phone: ( )
- y • - / . r Fax: ( ) Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lic.: 6- 8-.013, 5 /o /0 ir State surcharge (8% of permit fee) t., t 0
TOTAL PERMIT FEE !mi 30
Authorized signature: (/�� This permit application expires it a permit is not obtain within 180
j l/ n days after it has been accepted as complete.
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Print name: t/Kj 1 p. 2 Date: 1 )) 1 ,4, 9. • Fee methodology set by Tri-County Building Industry Service Board
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