Permit a CITY OF TIGARD MECHANICAL PERMIT
'1 a COMMUNITY DEVELOPMENT Permit #: MEC2009 -00275
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/10/2009
Parcel: 2S110DD04900
Jurisdiction: Tigard
•
Site address: 15640 SW OLD ORCHARD PL
Subdivision: Lot: 0
Project: Jones
Project Description: Replace gas furnace and a /c.
•
Owner: FEES
JONES, ALBERT E TRUSTEE Description Date Amount
15640 SW OLD ORCHARD PL
TIGARD, OR 97224 Air Conditioning or Heat Pump 06/10/2009 $14.00
Furnaces < 1001( BTU 06/10/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 06/10/2009 $8.70
• Minimum Fee Adjustment - Mechanical 06/10/2009 $44.50
Contractor:
A- ACTION HEATING
18245 SW TV HWY
ALOHA, OR 97006 •
PHONE: 503 -649 -3524 •
FAX: 503- 649 -6095
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
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: • 4) ,, 11,, Permittee Signature:
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.
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09/25/2014 07:54 FAX 1Z1001 /003
:.^ Wiechanical Permit Application FOR OFF 1(I1 1
City of Tigard RECEIVED R-etve Mid No.:
• INI 13125 S W Hall Blvd., Tigard, OR 97223 DatdBy. ` , I,! / e r, • a k. 4.
4 Phone: • 503.639.4171 Fax 503.598.1960 Pie° Review . Other Permit
JUN 0 8 2009 Date e
T 1 G A R p Date R
Inspection Line: 503 Ready/By. CM 1211 see Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
t e?Y?h 'r• =.;c. ;�•: _ CITY OF TIGARD _
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❑ 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:
r mechanical materials, equipment, labor, overhead, and profit.
Al ?; k R21111,�0$11Z:iil4'�,-- �,nrI `P t o n . , ;; 77T. - :rte = AIT., i^i�Pi`: �ta'2 >" Value: $
_. i..in :wu. f.,� .>`..',1.,j '�J_^,'1;x:i •t dia.",kt') ,, qq :LiJ r ` 4. rriPTl _ul ,7474 nC .D
.sm „iram t � � na,t_., <_� -: �y� L 13,.. csl ,., »�((..yw
' � r • -fl cdk'' i- 7P.."P 4 r Vi i - .c vr -. -d . " :.. �. :
/./ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building 55' ti' `X�� ��='• 6 r•» 'i' f 1_� �+Er ,:; =.. i :;, • .•
MI Multi- family ❑ Master builder ❑ Other; For special information use checklist.
Description
, ��� _ ption I Qty. I Ea
Ivallii f>tii n tiii ._.i T � . -A u. : k t , - 3 t , r h\�clQ+a s N. n ' fC ^ -I 01 it , --•._e I Total
F
r.,...F.r. - 9 imil?" , ihu. , .,a�..:.:� ut_ S :a,:..i /Mini ....as: ..•A;d•:di Si ! iF_ v�r nlr ?.;_ � !• ' - e ."'I Heating/cooling
Job site address: r]� / Air conditioning or heat pump W
�` - " �•�•�i��� -�)�� (requires site Plan showing placement) I 14.00
City /State/ZlP: $ • go dire Furnace 100,000 BTU (ducts/vents) 1 14.00 I L f
Suite/bldg./apt. no.: Project name: Furnace 100 BTU (ducts/vents) 17.90 •
Gas heat pump 14.00
Cross street/directions 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: Lot no.: Flue/vent for any of above • 6.80
Other: 20
Tax map /parcel no.: Other fuel appliances
t&3r .7'rr z'+' ercl4 ar; Fw L7semSh ' +• � - -
. f °U" } i k( t • -,n =, i: ` " m q fir .y! Ali Water heater 10.00
i�ttL,I r _ !. i'i. ctFn�`2i6. s � ,11, . LA- p S ; : ,: .- ' ' £`: : ran I ver s , J ,.. W
��. „�v:...:: �I ., i.. �i�r�. � ::,�t!.;w, =r.6�u,:;�:,�;i u.rnufwtt;,t v�` ���i�ii ,. +rti�a�.s�tt><;ri$SP't� °_• W aui �_ -s9�
..
11111 Gas fireplace 10.00
`� ' � L� I _' TT �� Flue vent for water heater or gas
• c is • • fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
"j sl iIiig: ,�d1M -0I Iw 7 1' P Fl y }!<pa;
, • t 6- h, .t'uk , 'r rh;Vi'• .'I PT? kw a i r'6 o Chimney/liner/flue/vent
t r' "s 1Var -11 s `_'_, .Q 12 r1 n: l.i u.;.: ii Gi t l �., .. r , i rye .Hit' i14, 4: .� � t/fl/ 1
1 c,ai., :,��v.:. a��!- ` �?.....�.,e�Js��r,n. �,�m4at Other 10.00
Name: rl rJ �. _ Environmental exhaust and ventilation
Address: I ^MI • , EC Range hood /other kitchen
equipment 10,00
City /State/ZIP: 1 . t J C) ■ �� Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: 55 ) , • Fax: ( ) toilet compartments, utility rooms) 6.80
itia ' f- - �.,rF F; i- - i Q i tka ATr. ] ,^ . L NIZ-WE FH PITI t : ;i:"'-'; ,'rrs"•:i ' r;,. •r
crot M y 1 �- i f:• : �1 Attic%rawls ace fans t„�•, � - -, , *,i/� I ��. K�? t:Ii i � -� •� P ans 10.00
tllzd('�i7t� .ii`si H�„xaif.:�;tt cTxi;c i,o`L d:�+!'sou3A �!i,+. ?1x16L'!�s1A.rai •w0�ivat i�i.i�rs•..�r s.h II': n
Business name: Other: 10.00
_ i 1 i if Fuel piping
Contact name: $5.40 for first four; $1.00 for opch additional
Address: , Furnace, etc.
! 1 . ; I: al ' 1 1 . Gas heat pump
City/State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
E -mail:
Fireplace
r ya g�s•:;.�:., psi," sl? + r ,� b 4�t Range
. i:Fri: r "i,a ili! t ii. aF�.' r . - r' T07 P :' AICf'h 7'::... ew+r:'�Ri: 9F;ii in4 �i i `;=4; ;1Ef _
I10',.:I,..a.[d =44 L'.:.,v.. L1 . < &i i , iF J>t�i;•�I : 6. i t r it 9N'.ti :: t _ i � k1:S'• Y
� . -� i� -aria r i F{�'r.� !4±• B arbecue
B u s i n e s s name: 1 " . H E A T I N G H E A T I N G Clothes dryer (gas) ,
Other. .
Address: i _ i 1 • ' • •i r . � i .P .- lti .444k r _ i"! x!1 t r ,..,.. - F� a6.'•c.
r - 1 i ;. re _._iti R. r at...,..,4. _= .m.1eTt ;;;ML•'I•:
City/State/ZIP: Subtotal
Phontr�( tr. 9 - -1 jEdejl Fax: E . 9 ..,(,,0 Minimum permit fee ($72.50)
Plan review (25% of permit fee)
CCB lie.: '� ° permit fee) Qr '7....0 i �
State surcharge (12/6 of o
i TOTAL PERMIT FEE
Authorized signs a ,l- / This permit application expires if a permit is not obtained within 180
`.'� • ti rr days after it Luis been accepted as complete.
I Print name: - S-1 ra____ K l j R f Date: Lp $ I o' I • Fee methodology set by Tri -County Building Industry Service Board
1:1Buiw u�,aitafeC-- Pm®egpp,d°° 01/19/07 44046 17r (I 1/02/COM/WEB)