Permit CITY OF TIGARD MECHANICAL PERMIT
`''! 2 COMMUNITY DEVELOPMENT Permit #: MEC2009 -00254
:TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 2S102DD00801
Jurisdiction: Tigard
Site address: 13855 SW HALL BLVD
Subdivision: Lot: 0
Project: Russell
Project Description: Install a /c.
Owner: FEES
RUSSELL, SCOTT A & MADELYN L Description Date Amount
13855 SW HALL BLVD Air Conditioning or Heat Pump 06/04/2009 $14.00
TIGARD, OR 97223
12% State Surcharge - Mechanical 06/04/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 06/04/2009 $58.50
Contractor:
SERVICE NOW OF OREGON INC
621 SE 7TH AVE
PORTLAND, OR 97214
PHONE: 503 - 445 -2440
FAX: 503 - 445 -2443
Ty pe 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 dir questions . •UNC b / • 503.246.6699 or 1.800.332.2344.
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Iss ed By: ( Permittee Signatures
A
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 02:56p Service Now Inc, 503 - 445 -2443 p.1
Mechanical Permit Application [t OFFICE USE ONLY c i '
City of Tigard RECEI\IE[I ; ' . 1 permit No. / / ' _AI • G77�S 4
' ''''.1 13125 Sw Halt Blvd , Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DntSIBV. Other Permit.
T IG'ARD Inspection Line 503.639.4175 JUN 01 20 0 f Datc Ready /By: El lig See Page 2 for
Internet: www. tigard - or.gov Notified/Method: Supplemental Information
CITY OF TIG A ' 1
TYPE OF WORIBUILDING DIVISION 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
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
1- and 2- family dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
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❑ Commercial/industrial stria) ❑ Accessory building
For special information use checklist Multi family ❑Master builder ❑Other:
Description I Qty. Ea. Total
JOB ITE INFORMATION AND LOCATION Heating /cooling
Job site address: 1 Air conditioning or heat pump ��
� v J I � P g placement) 1 14.00 1''h=
J f f V t (requires site Ian showin lacement
City /State /ZIP: Furnace 100,000 BTU (ductsvants) 14.00
�) Furnace 100,0001 BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: t-'l C ?) -P,\, (, Gas heat pump 14.00
Cross streetidirections to job site: 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: Flue /vent for any of above 6.80
Lot no.:
Other: 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
AC (� n Gas fireplace 10.00
L fi (T n A Z__0, t l X t 1r> t1 -e-,---- 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
Ot ylliner /fluervent 10.00
} Other: 10.00
Name: ' - +-- Hl/_55 e.I1 Environmental exhaust and ventilation _ ^
Address: Range hood /other kitchen
_ equipment 10.00
City/State /ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ' ) toilet compartments, utility rooms) 6 SO
0 APPLICANT ❑ CONTACT PERSON _ Attic /crawlspace fans 10.00
Business non e: ` ` L � v Other: 10.00
_e_. isj 0,........- t Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc. I
Gas heat pump
City /State/ZIP: Wall /suspended /unit heater
Phone: ( ) Fax: : ( ) Water heater ,
E -mail: Fireplace
Range
CONTRACTOR Barbecue
Business name: l Clothes d er gas n Other:
Address: Co, .e_.-- 7 t)--' CA- t./ a_ MECHANICAL PERMIT FEES*
City /State /ZIP: p r-1-Ean z 1` 1 r 1 �f - Subtotal
1 \ `t Minimum ermit fee ($72.50)
Phone: (50 4-4-5 ')..2--4 Fax: (5,3,') 4-4-5 3_4+-5 p
Plan review (25% of permit fee)
CCB lie.: X St s urcharge (12% of permit fee)
CCJJ TOTAL PERMIT FEE Si, 0
`� - This ermit application expires if a permit is not obtained within 180
Authorized sig t e: / p days after it has been has as complete.
Fee methodology set by Tn -Count Building Print name: u{ 4 �{ ea Date: .0 Gl1�f * y 3' y � Service Board
I. \BuildingV'ormi \MEC.PcrmitApp_doc 01/19/07 440 -4617T (I 02 /CCMRW'EB)
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A1C- SEAT PUMP--UNIT SITE PLAN °
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FEET TO BACK OF PROPERTY LINE °
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FEET TO SIDE PROPERTY LINE
FEET TO FRONT PROPERTY LINE •
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