Permit q CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT
Pe
COMMUNITY MEC2009 -00184
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/29/2009
Parcel: 1 S134BD10300
Jurisdiction: Tigard
Site address: 10846 SW 118TH CT
Subdivision: PENN LAWN ESTATES NO.2 Lot: 31
Project: White
Project Description: Replace gas furnace.
Owner: FEES
WHITE, PHILIP S SR & CAROL J Description Date Amount
32391 SW LAKE DR Furnaces < 100K BTU 04/29/2009 $14.00
WILSONVILLE, OR 97070 FlueNent For Any of Above 04/29/2009 $6.80
PHONE: 12% State Surcharge - Mechanical 04/29/2009 $8.70
Minimum Fee Adjustment - Mechanical 04/29/2009 $51.70
Contractor:
BEN'S HEATING & NC
PO 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 $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, 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
•
Issued By: () ; /� Permittee Signature: i ` ii \ c (
U` Apt) 111��` N \
• 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.
, ca9 i?:,sc
Mechanical Permit Application,
City of Tigard Received 4 - .pct Permit Nn.: t 0_2009 '00«l-k
• 13135 SW H Blvd,. Tigard, OR 97223 ,
- Man Review
r 1 . Phone: 503.639.4171 Fax: 503.598,1960 p P
t{ R D ato/By
2 7 2009 inter Pei ucil.c_ ( CZ� ' - is % l • q
is AHD Inspection Line 503.639.4175 Data Ready /Ry. Juris El See Page I for
Internet www.ligard- or.guv Notified /Method: Supplemental
CITY OF TIGARD
`t upplemen Information
._.,�. -- r�..._.,- - - --
f .i 1.1 ._
• TYPE OF WORK: l' COMMERCIAL FEE* SCHEDULE -- USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction X Addition /alteration /replacement
performed, Indicate the value (rounded to the nearest dollar) of all
At ❑ Demolition ❑ Other: mechanical materials, equipment, labor. overhead. and erolit. -. --
CATEGORY OF CONSTRUCTION value: $ a.020
RESIDENTIAL EQUIPMENT !SYSTEMS FEES*
"44 I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special irlforrnalion use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty P.a. ` loin)
JOB SITE INFORMATION `•AND LOCATION Heating/cooling
Job site address: /� �) ' r Air conditioning or heat pump
_ __ _ 1( �l Ski I ( �j 11 (requites site plan shod in> nlncemcn l _ I t 00 _ _ - .—w.
City /State /ZIP: * f ' I , y v '2 9'7 2 -a' Furnace 100,000 BTU (ductsrvemsi / 14.1)(1
Suite/bldglapt, no,: Project name: Furnace 100,000+ RTU ldacwr,crvr) 1 7.9t1
Gas heat pump 14.00
Cross street /directions to job site: Duct work _- 14.00
""""""""'"""' ""' -" I lydronie hot water system 14,00
Residential boiler (radiator or
jydronic) 14.00 -- _
— LIM( heaters (fuel -type, not electric).
in-wall, in -duct, suspended, etc, , _ IU;00.,.. _____.___
Subdivision: Lot no.: Flue /vent for any of above 1 10.00
Other; 10.00 __
"l "as map /parcel no.: Other fuel appliances � -
DESCRIPTION OF WORK Water heater 11100
/����� /�� Uas fireplace 10.00
Pep
164e t a tsl z, Flue vent for water heater or gas
fireplace 1 0.00
-__,_,... .,.. - Log lighter (Ras) lam
Wood /pellet stove 10.00
Wood fireplace /insert 10.00
- -- si PROPERTY OWNER ❑ TENANT Chimney /li /flue /vent 10,00
_ - Other: . _ _ 10,00 Y _ __ _ __
Name: em Gt ■ r- Environmental exhaust and vanilla Inn Y
Address: 1 a3QJ .s `eke I Range kitchen r
J equipment . 10,110
C'ili /Stale /ZIP: W x1404 al At - 0/ LI 7 v Clothes dryer exhaust 1000
J 6147.5, :0 Single-cluct
comp rt en (bathrooms,
1'h 6 ) F'ax, ( ) toilet wtnpartmcn(s, utility rooms) e.;tq
❑ APPLICANT ® CONTACT PERSON Attic /crawls ace funs 1 (1.00
-�/ Other: 10.00
Business name: QaMI r .aTr'l t Ac L L-C Fuel piping
Contact name: L'( ,, n IV
• Furnacc. $ 40 for fir ,. r each ndd • - -- __......
first Four: SI.(IU far Ah)nul
• Address;
-,.,,, _, Gan heat pump —
C'ity /State /Z,1P: Wall /suspended /unit heater
..
Phone, (5V3) 313 '3 yip Fax:: (373 ) 6 ]"l - 73 %I
,— Water healer __,
l
1-1-mail: _ Range
cON ritAcrolt 13ankcue - - --
Clothes dryer (gas)
Business name: t Apr e,,,, Other,
f N��+ �y 0 , ( ' (fib.,; f !_
Adairess: L) Ls 1f t1 6 G MECHANICAL PERMIT FEES*
(pit)/State/ZIP: PA t7 +1,1,9 1 op
9 7 . Snbtorel
Tic: ( S�r3) 3 — Fax (rD � I - � 3 f ` r- Minimum permii lee ($72.501 7 ,,�"�
,e7 Plan review (25% of permit (eel
'l3 lie.: 4 (r/5 4? J tj 1 State surcharge (12% of permit lee) ) g. 7() -
I I TOTAL PERNI IT FEE Efate_
Aulhurizeai signature: r T his permit application expires if permit Is not ubtaine,Tntthin ISO
k
Frit is days after it has been accepted ats complete.
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