Permit CITY OF TIGARD MECHANICAL PERMIT
11111 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00143
Date Issued: 04/02/2009
.TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S103CD02000
Jurisdiction: Tigard
Site address: 13770 SW FAIRVIEW CT
Subdivision: Lot: 0
Project: Powell
Project Description: Replace gas furnace.
Owner: FEES
POWELL, FLORENCE A TRUSTEE Description Date Amount
13770 SW FAIRVIEW CT Furnaces < 100K BTU 04/02/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 04/02/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 04/02/2009 $58.50
Contractor:
BEN'S HEATING & A/C
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: 41----0A Q �� Permittee Signature: 0 tQcCtic)v\
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.
tw•
eN�mica! Permit Appli ; S. F +: ; E D fOR OI'I Ii a USE c � N � ,Y ��pp- y � �
Ci of Ti and R eve,vY 1'�Q I Permit No: IV`QG •001
ty 1);41e/By: l'
N 13125 SW !kill Blvd.. Tigard, OR 9 plan Review
�� Phone: 503.639,4171 Fax: 503.599 0 - 1 2009 Date /By: Other Per E(e2009 , co I 43
&' Aitl1 Inspection Line: 503.639,4)75 T Date Ready /By. Jeri+ ® Sec Pngr 2 rnr
I nternet: www tigard- or.gov CITY OFTIGARD Notified /Method: Supplemental Information
BUILDING DIv1SIP L . .. ' • —
TYPE OF WORK .. .. .
. COMMERCIAL FEE* SCHEDULE - USE CIIE:CKLisI
Mechanical permit fees' are based
❑ Neu construction {� Addition /alteration /replacement C the cable ar est work
performed. Indicate the valor (rounded to the nearest dollar) ml'sll
❑ I)en olition ❑ Other: mechanical materials, equipment, labor. overhead. and pro
-
CATEGORY OF CONSTRUCTION Value, $ 17
RESIDENTIAL EQUIPMENT / SYSTEMS FEES'
c1 1. and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special n(/or(nn /inn tore chtleklr.er.
❑ Multi-family ❑Master builder ❑Other: Description M Qtr. Fa. 'frul
JOB SITE INFORMATION-AND .LOCATION IIeaOng/cooling
- -- ' Air conditioning or heat pump
lob site address: " 77 o . t,s1 ;er1t t/ t Gt✓ Of. (requires site phi showing pineenwm) 1.1,00
City /Stale /ZlP: •T141°t"ti oL /` c' ).a'? �— Furnace 100.000 [trill Iductsivem5) / 14.00 — —
Furnace 100,000+ BTU (duets/veins) 17.9(1
Sui(c/hldg./upt. no.: Project name: Gas heat tun 14.00
Cross street /directions to job site: Duct work i•t 00 -
Hydrunic hot water system 14.00
Residential boiler (radiator or
h drank) 14.00
Unit heaters lfttcl -type. not electric).
in -wall, in -duct, suspended. etc. 10.00 _
Flue /vent for any of above / 10.00
Subdivision, Lot no.: Other: 10((0
T ax map /parcel uo.: Other fuel appliances -_._.—
--- DESCRIPTION OF WORK Water heater 10 U)) -
�• Gas fireplace _ ....., 1(1.1)1) ._...,..
laA[ G ti
4$ /'t A4t � /V✓ Flue vent for water healer or gas
fireplace 111.00
-- .. .. .- 1.4)2 ii_hter(• as) -- 10.00
Wood /pellet stove 10 .00 _
Wood fireplace /insert 10,00
Chi y
ne /liner /fkte /v ant 10.00 __
PROPERTY' OWNER ❑ TENANT
O ther 10.00
N ame: / °r Po IA) i Environmental esheusl and ventilation
/ Range hood /other kitchen
Address: i ' <W - tr J c.
_ . equipllent_ 10,00
Clothes dryer exhaust _ 1 0.00
C'ity(Stale(L.IP: . Q. •7 Single - duct exhaust(bathrooms. - -- --- --
Phone ( ) 6 ' Fax: ( ) toilet coin ianments. utility rooms) • 6,80 __- ______-_
0 APPLICANT • ® CONTACT' PERSON • Auic /crawlspace fans 10,00 ._, ______
Other: 10.00
Ilusinesti nano: 13¢2i1 {><r tt . , y I_L G Fuel piping -- -
Contact name; C n r SSA) for first four; .51.01) fur each OWlir nal
C. 1.! r� r .L?IA. ( - r - D /� )'urntiee etc.
Address: tt Gas heat pump
City /State /ZI Wall /suspended /unit heater _
.. Water heater
Phone; (S713 ) 31 =` 3gG0 r - ax: , (57 , 3) G S�/ ~ 33 %
S-0 Fireplace
(::.mail: _ R_t a -
CONTRACTOR Barbecue
— Clothes dryer (gas) _ _ , _._
Business name: r� fr „ �. Z
I3kn t 14P�# ^�. d Other: _
Address: e o g 2-0 6 6 17 MECHANICAL PERMIT FEES' -...
CiI /Sta(a /Z1P: 10 f. { -1f1 ,)d ox 9 _. __ Subtotal
/ Minimum permit fee (572.511)
'nc:( 2 3 3 -127 (So3 ,,,r,'_ - Plan rev iCN'(_5'gillpel'Illllh')
'13 lic.: 6 4 / S 4 , A _ State surcharge ( I 2% of permit fee)
+ TOTAL PERMIT FEE
/ ,.ter' This p application expires If a permit ix nut ohlained +Blinn ISO
Authorized signature: .;' i n' days after it 155 been accepted P ra III plele•
Print name: r /vd e a-I t__7 , ' ld e ' Fee methodology set he'I'ri.County Balkh al: Industry Sot iur littmd
t IlmldmC \I I iu\\it C'.PcnnitApp dnc 51/00(05 130 40111' III //1?/CUM /WI:IJ)
Z00E 2IIY'80NI.LV3H - SN3fl 9 fiCCT90CO5 It'd CZ :g0 000Z /T0 /170