Permit •
CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 00553
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2011
Parcel: 1 S 125DA01100
Jurisdiction: Tigard
Site address: 9035 SW 66TH AVE
Project: Courtnier Subdivision: JACKSON WOODS Lot: 6
Project Description: Install gas furnace, gas fireplace, venting for gas water heater and gas piping for (3) outlets.
Contractor: FIRST CALL INSTALLATION COMPANY Owner: COURTNIER, FRANK E AND KATHLEEN C
13150 S CLACKAMAS RIVER DR 9035 SW 66TH AVE
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -0230 PHONE: 503 - 246 -6313
FAX: 503 - 557 -0919
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/01/2011 $46.75
Type of Use: SF Gas Fireplace 12/01/2011 $33.39
Class of Work: ALT Type of Const: Flue Vent for Water Heater or Gas 12/01/2011 $23.32
Occupancy Grp: Fireplace
Stories: Fuel Piping 12/01/2011 $14.15
12% State Surcharge - Mechanical 12/01/2011 $14.11
Fuel
Fuel Types:
Gas Pressure:
Total $131.72
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �/ ` ✓�
Perm ittee Signature: — or , ',` �� •
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Mechanical Permit ApplicfCfd
1011 01. I It t.1!ti . ON II
City of Tigard (� C 1 2011 Da Received /5���
Permit No.: " ev - 53
13125 SW Hall Blvd., Tigard, OR 97 Plan Review rr' ((([ t�
Phone: 503.639.4171 Fax: 503. t Y °OF TIGARD Date/By: Other Permit:
1 1 (3,.‘ it I) Inspection Line: 503.639.4175 Date Ready /By: turfs. RI See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction ® 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
0 Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1- 2 dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES"
® y g ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: _ Description Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Destine/cooling
Job site address: cyczo VV (" -W. v Air conditioning
(requires site plan showing placement) 46.75 /
City /State/ZIP: � t 4•{ rt W l N d 112. Q �, Furnace 100,000 BTU (ducts/vents) I 46.75 t • 7(
t l 1 1.l• ✓
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06 .
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
- Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. / 46.75
Subdivision: l Lot no.: Flue /vent for any of above W J . „,..1- ---- "23.32
Other 23.32 f
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
�
C Gas fireplace I 33.39 r�• �!
•
Oa) .p i � L?) 10 CCal u
O 1 Flue for water heater or gas
• . , , 1` ,: L A/ �p, fireplace I 23.32 0
. t � I 1 art) Log lighter (gas) 1 23.32
• In . AI Wood/pellet stove 33.39
. WY* OP. - fi Wood ftreplace/insert 23.32
'PROPERTY OWNER t lA1V ❑ TENANT Chimney/liner/flue/vent N /A -4- 23.32
�/ \����,,� Other: 23.32
►,7.,
Name: J � i'i I Cr �. Environmental exhaust and ventilation
Address: �� ,,� n Range hood/other kitchen
�a r w equipment 33.39
City/State/ZIP:-Clothes dryer exhaust 33.39
5 3 Single -duct exhaust (bathrooms,
Phone: (50 2 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Tri County Temp Control Other: 23.32
Fuel pipi
Contact name: Diane Mason $14.15 for first fo r; $4.03 for each additional
Address: 13150 S Clackamas River Drive Furnac ,
Gas heat pump
City /State/ZIP: Oregon City, OR 97045 Wall /suspended/unit heater
Phone: (503) 557.2220 Fax: : (503) 557.0919 Water heater I
Fireplace 1
E -mail: Range
CONTRACTOR Barbecue
Business name; First Call Installation
Clothes dryer (gas)
Other:
Address: 13150 S Clackamas River Drive - MECHANICALPERMIT-FEES* qq
City /State/ZIP: Oregon City, OR 97045 Subtotal (if .t'
Phone: (503) 557.0230 Fax: (503) 557.0919 Minimum permit fee ($90.00) ^
Plan review (25% of permit fee) --='.. /t
CCB lie.: 182714 State surcharge (12`'o ofpermit fee) ! � �
ckAa; 1 TOTAL PERMIT FEE �
Authorized signature: / /Y✓" This perm appl ication expires if a permit is not obtained within 181, 7
days after it has been accepted as complete. I z
Print name: Diane Mason l Date: � � j (I " Fee methodology set by Tri - County' Building Industry Service Board ( J
t\w.ndinn\Pe.mi,,MPC.v...nit Ann dne in /ni me ddn.4F1Tr n 1/n7 /mum/FMI
I'd 096186S20S :01 :40d- dL2 :2T TT02-I -030