Permit y 4 CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: MEC2009 -00259
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 2S111BCO2800
Jurisdiction: Tigard
Site address: 10445 SW CANTERBURY LN
Subdivision: Lot: 0
Project: Calvin Presbyterian Church
Project Description: Replace (2) existing gas furnaces. No plan review required per Dan.
Owner: FEES
PRESBYTERY OF PORTLAND THE Description Date Amount
CALVIN PRESBYTERIAN CHURCH, 10445 SW
CANTERBURY LN Permit Fee 06/04/2009 $72.50
12% State Surcharge - Mechanical 06/04/2009 $8.70
PHONE:
Contractor:
SYSTEM AIRE INC
14444 SW FERN ST
TIGARD, OR 97223
PHONE: 503 - 524 -5927
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp: Occupancy Load:
Stories: .
Fuel Air Handlers
Fuel Types: Natural Gas Units < 10000 cfm:
Gas Pressue: Units > 10000 cfm:
Furnaces Boilers & Compressors
Furnaces < 100K BTU: 0 - HP:
Furnaces >= 100K BTU: 3 -15 HP:
Floor Furnaces: 15 -30 HP:
Unit Heaters: 30 -50 HP:
Vents w/o Appliances: 50 or Greater HP:
Air Conditioning:
Heat Pump:
Appliances
Vent Fans: Vent Systems: Total $81.20
Hoods: Comm Incinerators:
Required Items and Reports (Conditions)
Woodstoves: Gas Fireplaces:
Clothes Dryers: Other Mech Units:
Gas Outlets: Other Desc:
Duct Work:
Fire /Smoke Dampers:
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 by calling 503.246.6699 or 1.800.332.2344.
C Jr
Issued By: r h71 ^ 11 n Permittee Signature: a 2 C Acpk e ms, -U an
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.
- Jun.,01 09 03:43p Systemaire 503 - 590 -8357 p.2
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Mechanical Permit Application . : Foil 0FFleE l a '. ,.
CI of Tigard C� D Received ( l 0 • e P rnnitNo.:. ,0 —�� •• •
H " Date/By: r'�
1 3125 SW Hall Blvd Tigard, OR 97223 Plan Review
: C . Phone: 503.639 4171 Fax: 503.598.19 1 t1 Bate gy. Other Permit:
Tic .v r, D Inspection Line: 503.639.4175 I N 0 1 2009 pate Ready/By: Mil la See Page 2 for
Internet: www.figard-or.gov Notified/MeUwd: Supplemental information
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CITY OF TIGARD
TYPE . . l ig NG DIVISION COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
ID New construction ® Addition/alteration/replacement Mechanical permit fees` arc based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other. mechanical materials, equip nt, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION ue. $ i!S/7, he
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
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❑ 1 - and 2 family dwelling ® Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Church Description I Qty. I Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
(requires site address: 10445 SW Canterbury Lane q quires sne plan showing placement) 14.00
City/State/ZIP: Tigard OR 97224 Furnace 100,000 BTU (ductc/vents) 14.00
Furnace 100.000-F BTU (ducts/vents) 17.90 3 c.
Suite/bldg. /apt. no.: Project name: Calvin Presbyterian Churc Gas heat pump 14.00
Cross street /directions to job site: Top of Canterbury Lane off 99W Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
. -.- Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Lot no.: Flue/vent for any of above 6.80
Other. 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Replacing existing gas furnice 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
❑ PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 10.00
Other: 10.00
Name: Calvin Presbyterian Church Environmental exhaust and ventilation
Address: 10445 SW Canterbury Lane Range hood other kitchen
equipment 10.00
City /State/ZIP: Tigard OR 97224 Clothes dryer exhaust 10.00
- Single -duct exhaust (bathrooms,
Phone: (503)703 - 8766 Fax: ( ) toilet compartments, utility rooms) 6.80
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fins 10.00
Business name: System -Aire, Inc. Other. I0-00
Friel piping
Contact name: Bill Bright $5.40 for first four: $1.00 for each additional
Address: 14444 SW Fern St Furnace. etc.
Gas heat pump
City / State/ZIP: Tigard OR 97223 Walt/suspended/unit heater
Phone: (503) 524 - 5927 I Fax: : (503) 590 - 8357 Water heater
Fireplace
E - mail: bill@ systemaire.net Range
CONTRACTOR Barbecue
Business name: System - Aire, Inc. Clothes dryer (gas)
Other:
Address: 14444 SW Fern St _
MECHANICAL PERMIT FEES*
City /State /ZIP: Tigard OR 97223 Subtotal "3s
Minimum permit fee ($72.50) - 12,:SO "
Phone: (503) 524 - 5927 Fax: (503) 590 - 8357
Plan review (25% of permit fee)
CCB lie.: 38062 State surcharge (12% of permit fee)
/ ' / �-+ TOTAL PERMIT FEE a w v
Authorized signature: t' f L l This permit application expires if a permit is not obtain thin 180
[� days after it has been accepted as complete.
- Jun .,01 09 03:43p Sstemaire 503 - 590 -8357 p.1
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14444 SW Fern St
Tigard, Oregon 97223 s Stem - Ai re Inc.
503 - 5245927 - Office Y
503 -590- 8357 - Fax
Fax
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To From: fl I 6_,L8..(
Fa3c Pages; >
Phone: Date: 6-12- / —D7
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