Permit CITY OF TIGARD MECHANICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: MEC2009 -00409
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/07/2009
Parcel: 2S 1038603900
Jurisdiction: Tigard
Site address: 12111 SW 125TH AVE
Subdivision: BROOKWAY Lot: 39
Project: Pete Anderson Realty
Project Description: Install gas furnance
Owner: FEES
PETE ANDERSON REALTY Description Date Amount
10610 SE WASHINGTON ST Furnaces < 100K BTU 08/07/2009 $14.00
PORTLAND, OR 97223 • 12% State Surcharge - Mechanical 08/07/2009 $8.70
PHONE: 503 - 256 - 9723 Minimum Fee Adjustment - Mechanical 08/07/2009 $58.50
Contractor:
THERMAL FLO INC
7236 SW DURHAM RD 100
PORTLAND, OR 97224
PHONE: 503 - 670 -8343
FAX: 503 - 598 -6746
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct questions to OUNC .fling 503.246.6699 or 1.800. 332.2344.
Issued By: I p - Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
t 0,9/4G/ 2009 13:59 5035986746 THERMALFLO #0936 P.002/002
. Mechanical Permit Anplicati
1.01.1 OFFICE l 51: ONL1
City f Ti :1,, �«� / Ty and g AUG 06 20 Pu mitNo.: i 13125 SW) tell Blvd„ Tiga OR 97223 atc/By: �� C—C L Oc��_ Q., C a n Revi
P hone: 503.639.417! Pax: 503.598. Other Puluic
Inspection Li 503 OF TIGARD Date/H
Tl G A R D (Ate RGrdy/By: Amis. la See Page 2 for
Internet: w'ww-tigard- or.gov BUILDING DIVISION NotinedNethod: Supplemental information
y 751.$ "" 3 w
f .. R4 .".' 7 , T d � �F S:.w od W�A } `�.� n VS ° � q. �r �+ "'�z p�X �'� � , nY�F1G ' r "'�r lT rk� iy� d�
p 8 dire l.:,ti." o .. 4 7' " . F '�'clr ` SY • ...... ` rl.. .1.: , �. '� .�'N :mm�
0 New construction '4: 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
17 Demolition ID Other:
mec
,�., ha nical materials equip tabor overhead, and profit.
*?txr X �,. "'• �, iM14 :•:r..r �v 9 '� fn ' r r r 4
Value: $
'
..w.,.vn y 0 ., Commercial/industrial ' .... e r.. � .!v
r� 1- and 2 -famtl dwelling Comme s 1 d ' ❑ Accessory °. � P „,,.:—.::4,- ;a '
spry building •�..._ . y,..,, e . ^,r,M . ,�r
El Multifamily 0 Master builder El Other:
For specs! information use checklist. Qty. l .
r i ormation
Description + Qty. I Fa. ! Total
∎
Sri%, �`E1IFiy l -� ..: ..,v - av 44'o , i l,'!"M�r{,
'1n•.'(" i ' ' - � '.,' 7' '; rc .• ,, , ? fr,aK 6 • • n r�V,6 °-+, " ,ii w ?k ': ; He cooll • Air conditions or heat um
Job site address: i Ut s / 25 1 ro • uires site , in showin _ laccment 14.00
City/State/ZIP: 77 / W p e Furnace 100 000 BTU (duets/vents 14.00
` Suitc/bldgfapt. no.: Project name: R /1/00
Furnace 100,0004- BTU (ducts/veins) 17.90
Gas heat pump 14,00
Cross sn'eeUdirectious to job site: Duct work 10.00
Hydronic hot water system 14.00
/�%�j
``, / Residential boiler (radiator or
tOin i e We5 r r✓ ` hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct. suspended, etc, 14,00
Subdivision: Flue/vent for any of above 6.80
Lot no.:
. . Other: 10.00
—
Tax map/parcel no.: Other fuel appliances
.g,',747, . � .i ” °'1 '.' ;,. r ` y.'v<",41 4ae <.. t',., , '^e,, f 0
W;—:deh' ; y 7,,° , `�" ra, A : :: :" ... :i water heater 10.00
Gas fireplace 10.00
ktQ i 6 _ ��/_�( S�
"�L �`
Flue vent for water heater or gas
"-* Sr5:rlrira 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
- .
Wood fireplace/x eit _ 10,00
""Y �'1'�r a Jww ) n YY n !'iS
Chimney/liner/flue/vent 10,()0
Ye, .e i 6 bd 6 ,, ° r 1 d a Aa ;r r w. Y 4 �. 74 enn
ah ' �, - W ; Other: 10.00 _
n
Name: r / / Environmental exhaust and ventilation
ry ` t mach j '! A rO Range hood/other kitchen
Address: / equipment 10.00
City/SL�t V erzrp ` Q h Y 11 h Clothes dryer exhaust 10,00 ..�
/y /�, �y Singlo-duct exhaust (bathrooms,
Phone:
OQ 2062 ! q +l g p ms) 6.80 ,
1 a r9 J °e "'' er Fax ( ) toilet compartments, utility rooms)
o r ' y r r Y'ix^ Attic/crawlspace fans 10.00 '
K? , 1 [1 .4 . 04 ., rr "' "CF 'k'° 7itv it ? t 04 ,,, a , a l name: Other, - 10.00
Business
"� er nf / 7) zdC� Fuel piping
Contact name: ` / er're . £'oo� 1e / 55A0 for first four; $1.00 for each additional
Address:
* �4 J �+ �i /lji (d FiDO Fuma etc.
Gas heat pump
City /Statcl 77 gr f 9122+, + . w Q Wall /suspendcd/unit heater
Phone6". 4 f - Q 4 Fax: :6 &TS- 44.40 Water healer ..
E-mail: � may' �r ef l filer na T iOm G.i oin2... _.... _
mail_
V �. �r � J l y � � yp (.� y Ran c
,:w32 '.i A i . �. r4 ,6d - �r�l'.t1 MYN )4 .
kY�p 4' 60 ° gttl 1) �• , �', J21 9 ?fi iG �, J Y B �.rl�
.. . ..F .., `,°4 °e�.:!'�, , .... .. ...... rw,GV.^....__ •_ ...nwDe a -� , -r � rfn h err h� ;
Business name: ' �/j /�]ee,, jJ r,. Clothes dryer (gas)
� `�'J0� 1 y�. _
Address: Other: 1 4.: ' 1r •r ;f Y "l ; 3 �� ,"— 7: w
City /State/ZIP: Subtotal
Minimum permit fcc (572.50) 12.000
Phone: ( ) Fax: ( ) (12% Plan review (25% of permit fee)
CCD lie.: tai i3 — d1I4' 11) ry -- State surcharge (12/o of permit fee) .10
TOTAL PERMIT FEE 1. Grp
/ This permit application expires if a permit is not obtained within 180
of prized Si / days after it has been accepted as completer •
Print name:gp l? Ca+ob/.S f . i
r., n.. J Date: $ ' I • Fee methodology set by Tri- County Building Industry Service Board
:,. n ......,,,,aauur_p...i.i.,,.,,a„• ninam7 ✓ 4:en.aF;rrr„rrr.-r.A men