Permit •
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CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009-00171
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/21/2009
Parcel: 1 S133DD04300
Jurisdiction: Tigard
Site address: 11581 SW SHOREVIEW PL
Subdivision: Lot: 0
Project: Kerfer
Project Description: Install gas furnace.
Owner: FEES
KERLER, THEOLA E Description Date Amount
11581 SW SHOREVIEW PL Furnaces < 100K BTU 04/21/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 04/21/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 04/21/2009 $58.50
Contractor:
COLUMBIA NW HEATING
PO BOX 622
SCAPPOOSE, OR 97056
PHONE: 503 - 543 -3624
FAX: (503) 543 -6285
Type of Use:
Class of Work: 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
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Issued By: Ce\ f 1 1X �j Permittee Signature: SD Q 0 kea Q r\
�vv
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.
Ieci nical Permit Application FOR orFlcl t ONLY
City of Tigard Received
Ft Date/By: - 0.Oq / r .4 Permit No. MI , V v t
II
q 13125 SW Hall Blvd., Tigard, OR 97223 1 Plan Review
Phone: 503.639.4171 Fax: 503.598. l9 �c� Date/By: Other Permit:
T I G A 1t D Inspection Line: 503.639 9 Date ReadyBy: ® See Page 2 for
Internet: www.tigard- or.gov A PR 0 20 Notified/M Supplemental Information
TYPE OF WORK 0 i . OF lI \0 N COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
� ❑ New construction KAddition/alterationV �� v` St 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: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
gs 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
❑ Multi- family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. I Fa I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: /ggI � ��+,' r /y ,]t r/ �� ! Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: 7Z,6 9 ejg q 24.23 Furnace 100,000 BTU ( ducts/vents) / 14.00 / y. tt)
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldgiapt. no.: Project name: 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: 10.00
Tax map /parcel no.: Other fuel appliances
—�q '�7+ '/ /� � + DESCRIPPTIION OF 10.00
� WORK Water heater
2 S/Y5 //! /V�C Gas fireplace vent or 1 U.00
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 Chimney/liner/flue/vent 10.00
Other. _ 10.00
Name: 7f 7 , 9 � � cic :' � Environmental exhaust and ventilation
Address: (/ Sv / c i ,, , SIDE/ &') fL Range hood/other kitchen
equipment 10.00
City/State/ZIP: 7zg.A GYM Q ,2:?3 Clothes dryer exhaust 10.00 _
�) Sq 616 Fax
Single-duct exhaust s (bathrooms,
Phone:
( �— ( ) toilet compartments, utility rooms) 6.80
[7 APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: �i)41 AS C .)7R -C / )( Other 10.00
f 4/ Fuel piping
Contact name: $5.40 for first four, $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: C'J Uilifi � N// f g�o � Clothes dryer (gas)
1 RD vC.- A'•, (/4/v Other:
Address: / MECHANICAL PERMIT FEES*
City/ State/ZIP: e a_ q ?D,56 Subtotal ly,043
Phone: (53 ) go - 3, f Fax: (/j3 554/3_ 65 Minimum permit fee ($72.50) "V. 5
Plan review (25% of permit fee)
CCB lic.: 6 (pi 7 State surcharge (12% of permit fee) g - )
0 TOTAL PERMIT FEE S /. as
Authorized signature: I
i This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 66417 .RC i '6 /J I Date: [/_,, j i • Fee methodology set by Tri-County Building Industry Service Board
1:\ Building \Permits\MEC- PermitApp.doc 01 /19/07 440- 4617T(I1 /02/COM/WEB)
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CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009-00171
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/21/2009
Parcel: 1 S133DD04300
Jurisdiction: Tigard
Site address: 11581 SW SHOREVIEW PL
Subdivision: Lot: 0
Project: Kerfer
Project Description: Install gas furnace.
Owner: FEES
KERLER, THEOLA E Description Date Amount
11581 SW SHOREVIEW PL Furnaces < 100K BTU 04/21/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 04/21/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 04/21/2009 $58.50
Contractor:
COLUMBIA NW HEATING
PO BOX 622
SCAPPOOSE, OR 97056
PHONE: 503 - 543 -3624
FAX: (503) 543 -6285
Type of Use:
Class of Work: 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
•
Issued By: Ce\ f 1 1X �j Permittee Signature: SD Q 0 kea Q r\
�vv
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.