Permit CITY OF TIGARD MECHANICAL PERMIT
°- COMMUNITY DEVELOPMENT Permit #: MEC2009-00136
Date Issued: 03/31/2009
T I CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S136AD02800
Jurisdiction: Tigard
Site address: 6913 SW PINE ST
Subdivision: Lot: 0
Project: Cardwell
Project Description: Replace gas furnace.
Owner: FEES
CARDWELL, FRANK D Description Date Amount
6913 SW PINE Furnaces < 100K BTU 03/31/2009 $14.00
PORTLAND, OR 97223 FlueNent For Any of Above 03/31/2009 $6.80
PHONE: 12% State Surcharge - Mechanical 03/31/2009 $8.70
Minimum Fee Adjustment - Mechanical 03/31/2009 $51.70
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: Permittee Signature: 76 Q
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.
N ec >lanical Permit A,uulicat CEIVED Received
!Olt 01 list: O l.Y
City of Tigard Date/By: • 7, •. _1 Permit Nu.. e
• t , • 13125 SW (tall Blvd., Tigard, OR 97223 LI 7 2009 200 Plan Review `Y • O � '
• Phone: 503.639.4171 Fax: 503.598.196 Dele/By• Other Permit: el rli - COS t
Inspection Line 503.639.4175
(; n u I) Data Ready/By; Sec Pace :fur
Internet: www,tigard- or.gav CITY OF TIGARD Nutified/Me,hud: 1 �! Supplemental Information
BUILD/ICU ..
- . TYPE OF WORK COMMERCIAL FEE* SCHEDULE: - USE CHECKLIST
Mechanical permit ices' are based on the value or the ,,,,ork
❑ Nov construction Addition /alteration/replacement performed. Indicate the value (rounded in the nC;vesl dollar ) of all
❑ Demolition ❑ Other: mechanical materials. equipment. labor, overhead. and profit.
CATEGORY OF CONSTRUCTION . - Value $ /
RESIDENTIAL EQUIPMENT / SYSTENIS FEES*
K 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special mformnNn" use ebeckh.u.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I ha. Total
JOB SITE INFORMATION "AND LOCATION' . •: . .. • ' • • ' . • Heating /cooling
I .Itch site address; 6,7 /3 Pi t Air conditioning or heat pump
.5 GPI ive _ (requires site plan showing placement) 14.00 t - --
City /State/ZIP: P C O Gj7 � Furnace 100,000 BTU (duets/vents) / 1.,00
l� ( Furnace 100.000+ BTU (ducts/veins) 17.90
Suite/bldg. /apt, no.: Project name: Gas heat pump 1 4,00
Cross street/directions to job site: Duct work 14.00
-- _ydronie hot water system 14.(1(1 .....
Residential boiler (radiator or
hydronic) 14.01) --
Unit heaters (titel•typc. not electric).
in -wall, in -duct, suspended, etc. 10.1)1)
Subdivision: Lot no.: Flue/vent for any of above 10.00 -
- Other: 10.0 ----I
Tux map /parcel no.: _Other fuel appliances
DESCRIPTION OF WORK Water heater 10.0(1
Gas fireplace 10.00
eQ erf!.. 6/4 [ U /(, Flue vent for water heater nr gas
fireplace 1(1.01)
Log lighter (gas) 10.00
Wood/pcllet stove Iu.01
Wood fireplace/insen 10.0)
hP' PROPERTY' OWNER CI TENANT Chimney /liner /I)uc/vcnt Ih.Ult
Other: 10.00
Name: rrAnf k e AI d ) I I 1 Environmental exhaust and ventilation
Address: 9 / t /ve S J - e q u ip ment 10
Range hood /other kitchen
h I _
City /Slute /ZI Porlt A DJ S w ; a3 Clothes dryer exhaust xhuu 10.00
• ^•� Single•duet cst (bathrooms.
Phone: (6113 ) ,Wit (1900 lax: ( ) toilet compartments. utility moms) '6.K0
❑ APPLICANT ® CONTACT PERSON Attic/cruwls2ncc rims __ — _ - __10
Business name: _ � L Other: � 11).00 —
j , }iti , l I A
Contact Hume: C w a �� SSA for first four: SI.00 for each additlnnn
Address: d Furnace, etc.
-. -..-,_ Gas heal pump
City /State /LIP: Wall/suspended/mil heater
3) 7 I Eu. :: (S ) / Water heater
Phone:
3i �y v 3 6r�- J
- -- Fireplace
E-mail: � Rangd _ ....__.
CONTRACTOR • • Barbecue
Business name: I J 140 ,�Q d- ilfr 4 4 �' Clothes dyer I as)
O t t a I �r. r j Other;
Address: PJ v Qtr/ y-() 4 b 7 !J MECHANICAL PERMIT FEES*
('it)/statcr /_IP: 2, Subtotal
eO(� �1+1a/a f op_ Minimum permit fee ($72.111) •
ne: ( Sv3) G.9. 3 3 -1) 9 9 Fax: (Sp 1-1 -33 Y-r Plan review (25 %ofpermit fee) _ --
:13 lie,: /O [r/.S q 7 Stale surcharge (12% of permit fee)
l I
C._ 'I'()TAI. PERMIT Fn.: Fn.: i
lulhari e d signature: : "ter Thls permit application expires if a permit is nnl ubmtinell nithin 15" A' . • days after It has been acrvptvd ii). eumpiele,
Print name: i .64 _ J • Fee methodology Sul by rti•l•uPnhv handing Indiolry Service 110:hit
1 11Wit , uMI'ertu;tt \NIh(-PMpuil App doe 04"int, 44 (.1 1 (I ro✓oitoryEIIt
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