Permit CITY OF TIGARD MECHANICAL PERMIT
111 � COMMUNITY DEVELOPMENT Permit #: MEC2009 -00283
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/12/2009
Parcel: 2S104CC08200
Jurisdiction: Tigard
Site address: 13722 SW ASCENSION DR
Subdivision: HILLSHIRE WOODS Lot: 101
Project: Hawke
Project Description: Replace furnace.
Owner: FEES
HESS - HAWKE, MARY ANN Description Date Amount
5043 MOORPARK AVE
SAN JOSE, CA 95129 Furnaces < 100K BTU 06/12/2009 $14.00
12% State Surcharge - Mechanical 06/12/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 06/12/2009 $58.50
Contractor:
SUPREME COMFORT HEATING
9425 SW COMMERCE CIRCLE #16
WILSONVILLE, OR 97070
PHONE: 503 - 682 -1985
FAX: 503 -682 -1018
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
Util' otification C n Those - - are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
direct questions to OU calli u 5% .246.6699 or 1.800.332.2344.
Issued By: , �j / Permittee Sig ature: ski , /' /��%
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.
06/11/2009 13:50 503- 682 -1018 SUPREME COMFORT INC PAGE 01
Mechanical Permit A PPIicatia ���� � `� I c R OFFIC.� IISE ONl.v .
r ec¢ivctf
City of Tigard 9 ra gym,': i l l 6� Nee 9� �a ii .;
b P e rmit No
" 13125 SW Hall Blvd., Tigard, OR 07'22 JUN 200 P l an acv,ct
1
'= • 2 -, Phone: 503.639.4171 t=ax; 503,598, 1960 Untcll9v • Other Permit;
TIt,A`t. r., Inspection LinC', 503,639 4175 Date Rends /13v: 4n•ly, m Sec Page 2 for
..
Internet: o'ww. ligerd- nr, CITY OF TIGARD N.ntificd /Method'. Suppleme Information
..._ ,.,...., BUILDING DIVISION ....,...__
• T_ -,, W •_ _
T.Y•P"�, OF WORK, COMMERCIAL FEE* SC:1.1E»1JI,E - USE CHECKLIST
❑ New construction ® Addition /aIt.eration /replttcemenI Mechanical permit Ices"" are bused on the satire the worts
performed. fndicute the value (rounded to the nearest dollar) of iiiI
❑ Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit
__ •. CATEGORY OP - CONSTRUCTION - Value S
RI�ST'DENTTAL EQiUIPMENT / SYSTEMS PEES* "
M I- and 2- family dwelling � Commercial /industrial ❑ Accessory building — ._
f .. or SpeeIGI ilifOrmation use check/at,
0 Multi - family ❑ Master builder ❑ Other:
Description 1 . 'halal
JOB SfI''F r'NFQRMATION.AND 'LOCAtllQN -- L Q .. Ga. ........_ I
Job site address: 13722 SW Ascension Dr. Air conditioning.. heat pump
(requites site plan Sh io OR'lll }; placement) 14,00
City /Stale /ZIP: Tigard, OR 97223 Furnace 100,000 BTU (duct, /vents) I 14.00 14.00
Furnace 1 00,000+ RTI-J (ducts /vents) 17,90
Suite /bldg. /apt. no • Project name: Don Hawk -- —
-- - „,.......- ...__ -_- __ Gas bent pump I ri 0(1
Cross street /directions to job site: -
. I -,,_._ _ Duct work ,•..._- ,- •.._
- -- ,. O.On _ -
I lydrunic hot water system 14,00
Residential boiler (radiator or
hydrnnic) 14.0(1
le ....,.........._
--..- Unit healers (fuel -type, n ot cJCCtrie).
in -wall, in -duel, suspended. etc. 14,00
Subdivision: FIueivcnl for any of above 6.fi(J
Lot no,; —
--
Tax nip /pterccl no,: 10.00
Other furl appliances ._
t let':
DESCRIPt Or. WOR'IC u ale,' heater -- _ 10,00 --
_— _._.,,- ,..•..- ,•,,,,,.y.�.. .. a,:",- ..:...� T•..,.,,..,....._... Gas Tire 7lacc 10.00
Replace furnace ....._..._. -_-
.._ Flue vent Ihr water heater or gas
fireplace 10.00
m. -m. log lighter ( g as 2_ ... ,...,.. 10.0()
Wood /pellet stove 10.00 , ___
Wood fireplace /insert 10.00
:E .PROPERTY OWNER Q: TENANT t _,_ 10.00 , .__..._
Chimney /lincratc /vent
Other: _ __ If),00
Name. Don Hawke - - Environmental exhaust and ventilation
Address; Range hood/other kitchen
--- _ e quirtntcnt 10.1111
C i l /S tote /7 -.• I P; —...
Y Clothes dryer exhaust 10.00
, Single-duet exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet cam artntcnts. utilit roams) 0.30
El . APPLIC'AN'T - - -
CONTACT PERSON Al.ti� /crawls ucc Inns In_
._•,.w_,. -,..— . - Other. f (1.0(1
Business panic; Same as contractor „_ -- _ - --
Fuel piping -
Contact name; 55.40 for first four; $l.(14 yor each additional
_...W_____
Address: _...W_____
etc. --- -�,,.. ..._ . --
....
— Gas . -_
. ray teat pinup
try /, care lIP;
Wall /sus cndcc
P I /unit heater ...
Phone: ( ) P ax: ; ( ) Water heater ,
E-mail: _ Fireplace __
—
_... Rant/
•
. CONTRACTOR . Barbecue
Business name: Supreme Comfort Inc. Clothes dryer (gas)
.., Other:
Address: 9425 SW Commerce C ruhlf ^ _ MECHANICAL PERMIT FEES*
City /State /ZIP: Wilsonville, Or 97070 Subtotal 14 00
Phone: (503) 682 -1985 Fax: (543) 682 -1018 - -,_ Minimum permit tae ($7250) 72 tO
Plan review (25% of permit tae)
urrhm•re (1 2 o --
C'C'13 lie.: 21592
state c f permit fee) H 7
TOTAL PERMIT FEE R i,20
Authnri•ied .,s ' intt re' / This permit annlicntiea expire? if n permit iv nor n bt,i; I An
...,. __.._ e — . _. e” , • __ - „_ , day, utter it hoc born nccepecd n.s corn plric.
Print name: Randal I..app Dale; 6111/09 ' fee mcihcdnlnpy set 1iy Tri- Co I-t 1 n huma t rv Ron,
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