Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00168
Date Issued: 04/21/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171
Parcel: 2S104DC08800
Jurisdiction: Tigard
Site address: 13293 SW WOODSHIRE LN
Subdivision: Lot: 0
Project: Khavari
Project Description: Replace gas furnace and install a /c.
Owner: FEES
KHAVARI, ALI A & IRENE M Description Date Amount
13293 SW WOODSHIRE LN Air Conditioning or Heat Pump 04/21/2009 $14 00
TIGARD, OR 97223 Furnaces < 100K BTU 04/21/2009 $14.00
PHONE: 12% State Surcharge - Mechanical 04/21/2009 $8.70
Minimum Fee Adjustment - Mechanical 04/21/2009 $44 50
Contractor:
SERVICE NOW OF OREGON INC
621 SE 7TH AVE
PORTLAND, OR 97214
PHONE: 503 - 445 -2440
FAX: 503- 445 -2443
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 i spended for more the 180 days. ATTENTION: Oregon law requires you to follow 1- rules adopted by the Oregon
Utility Notification Center. ' A • - = ules are set forth in OAR 952 - 001 -0010 through OAR 952 -• r I You may obtain a copy of the rules
Issued By: - AO/ - Per ittee Signature: ." AprAr // E /
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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Mechanical Permit Applicatio I - •' , ''' - VE FOR OFFICE USE ONLY
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li - City of Tigard APR 16 2009 Receive Date/By: i 1�' { Permit No H ►2/y9F. /r
v 13125 SW Hall Blvd.. Tigard, OR 97223 1 r/ �
Phone: 503 639.4171 Fax. 503 598.196 ar _ Plan Review
y � y . Other Permit•
Inspection Line: 503.639.4175 t9 ' 1�1 iU� Date/
By.
GARD �p 0 ry � � � Dale Readv /By mri, II Sec Page 2 for
Internet: wmv.tigard- or.gov AMMO Di VISION Notified/Method: 1 � L Supplemental information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
Mechanical permit fees* are based on the value of the work
1=1 New construction ® Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit,
CATEGORY OF CONSTRUCTION Value: S
RESIDENTIAL EQUIPMENT !SYSTEMS FEES''
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist
❑ Multi- family ❑Master builder
❑ O ther:
Description p Qty I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating /cooling
lob site address: 13293 sw Woodshire Ln Air conditioning or heat pump
(requires sne plan showinu placemer) 1 14.00
City/State /ZIP: Tigard, OR 97223 Furnace 100,000 BTU (duets/vents) 1 14.00
Furnace 100.000+ BTU (ducts/vents) 17 90
Suite %bldg. /apt. no.: Project name: Kharari 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
Flue /vent for any of above 1 6 80
Subdivision: Lot no.:
Other: 10 00
Tax mapiparcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10 00
Gas fireplace 10.00
Gas furnace replacement, and airconditioner fnsrallation. Flue vent for water heater or gas
fireplace 10 00
Log lighter (eas) 10.00
Wood /pellet stove 10.00
Wood fireplace/insert 10.00
El PROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 10.00
Other I 10.00
Name Irene Kharari Environmental exhaust and ventilation
Range hood /other kitchen
Address: equipment 10 00
City/State /ZIP: Clothes dryer exhaust 10 00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6 80
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 1000
Business name: Service Now Inc.
Other 10,00
Fuel piping
Contact name: Kurt Wakefield 55.40 for first four; $1.00 for each additional
Address. 621 se 7 ave Furnace, etc.
Gas heat pump
City /State/ZIP: Portland, OR 97214 Wall /suspended. /unit heater
Phone: (503) 445 -2440 Fax:: (503) 445 -2443 Water heater
Fireplace
E -mail:
Range
CONTRACTOR Barbecue
Business name: Service Now Inc. Clothes dryer (gas)
Other,
Address: 621 se 7th ave MECHANICAL PERMIT FEES*
City /State/Z1P: Portland, OR 97214 Subtotal
Minimum permit fee (S72.50)
Phone: (503) 445 -2440 I Fax: (503) 445 -2443 Plan review (25% of permit fee)
CCB lie : 161582 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within t80
days after at has been accepted as complete.
Print name: Kurt Wak field Date: 4/16/2009 ' Fee methodology set by Tri- Count• Building Industry Service Board
t - 1Suilding1Permcs\MEC•PcrmitApp dcc Nil WO? 440-46171 (I ! /02 /COMIWEB)
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