Permit ` CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00428
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2009
"TIGARD. W2 Parcel: 2S111CD01400
Jurisdiction: Tigard
Site address: 15606 SW SUMMERFIELD LN
Subdivision: Lot: 0
Project: Malone
Project Description: Mount tankless water heater
Owner: FEES
MALONE, CARMEN Description Date Amount
15606 SW SUMMERFIELD LN Water Heater 08/18/2009 $10.00
TIGARD, OR 97224 12% State Surcharge - Mechanical 08/18/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 08/18/2009 $62.50
Contractor:
ROBBEN & SONS HEATING INC
2214 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 233 -5841
FAX: 503- 238 -8849
Type 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 direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ' Permittee Signature: t yk e D J j t -
CaII 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.
i,A. ,
• 5 --59, -ici&d
Mechanical Permit Applicat t C ? Full OFflCF USE ONLY
City of Tigard Received
Date/Sy; Permit No,: �( e[ L�U�
1 f • 13125 SW HMI Blvd.. Tigard, OR 97223 I t 4 't 009 plan Ro�iew
Phone: 503.639.4171 Fax: 503.598,194 3 1 Date/By, Oiher Pennir.
T I C n R f) Inspection Line; 503.639 Date head fB )uric:
Internet: www.tigard.or.gov ardor, ov CI •tt� Y 'r 'TIC) MO AT Ready /By: Id SeePa
�� \rISION NotiGed/meuiod: Supplemental Information
, TYPE OR :.` ORIt KA ... l,NA sfi, , t}. , QMM>fyii.CIA0 ft " - SCHEDULE USE CHECKI.iST'
❑ New construction +'ion/alteration/replaeement Mechanical permit foes* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demol ition p Other: mechanical materials, equipment, labor, overhead and profit
CATEGORY. OF COIYSTRIJCTION , . ; µ 'r! r4 ti q,' Value $
• 1■ 1- • • - amity dwelling [] Commercial /industrial El Aoeessory building R31D EQ YIIPM EIVT /SYSTEMS FEES"
• Multi - family El Master builder ❑ Other: For special Informar;on use checklist.
Description . Qty. Ea. J Tota1
2; IOIa. SITE INFORMATION Al 1) LOCATIOly 4$ Yi ,.4,01 1 Reatin
Job Site address: Air conditioning or heat pump
1 I a. 1 . .‘ i l ..... M '. (requires site plan showing placement) 14.00
City /State /ZIP: f' ri, G Furnac 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt" no.: ` Project name: ` Furnace 100,000+ BTU (ducts/vents) 17.90
t �� 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
jydronic) 14.00
Unit heaters (fuel -type, not electric).
in -wall. in -duct, suspended, etc. 14,00
Flue /vent for any of above 6.80
Subdivision: • Lot no.: -
Other: 10.00
Tax map /parcel no.: Other fuel appliances
. DESCRIPTION _OR i wORK ; U j �;"`'„ i ', fl ,eitb Water hoator 1 10.00 I 0 ? —
Gas fireplace 10.00
�►� ..,•.■� d 4.-�� S k t ►`:�/s t; Flue vent for water heater or gas
0 i'A. 1 fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
� " i � , �., Chimney/liner/flue/wet 10.00
RTY. Q �!1 \i+IZ 6, 1 5..) f � LGt . M.At : .t J. y i AFi \!i _ 10.00
Other.
Name: 4: L t + k . i. I Environmental exhaust and ventilation
l 0 (D , ` A i kA ^ e , �. e e ,/
Address: It VlJ �\ t Y N C J� Range hood/other kitchen
t.� _equipment . 10.00
City /State /ZIP: A • ~ Clothes diver exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ' * � Fax; ( ) toilet compartments, utility rooms) 6.80 _
;,.r■ ' PLICANT, s a ve lr " CONTACT ?ERSON .,. ! ",s,, , , Attic /crawlspace tans 10.00
Business name: •
1 Other: 10.00
\ , OA 1, r ., :d Fuel piping
Contact name: n&`• $5.40 far first four; 51.00 for each additional
•
Address: cis a *) Furnace, etc.
at ' `' Gas heat pump
Wall /suspcndcd/unit heater
Phone: Fax: ; Gt ■ A , Water heater
Fireplace
E-mail; tivi ♦ (M ! 6 _ /L ♦/1! Range
'? , l RACTOIi u l °t trf4VI
�* J CO141'
.n... �. 6C;A: WAT ,I " .t cRl ` . 1 gaih CCUC -
Business name:��� ` i Clothes dryer (gas)
O ther
MIS Anil . t
Address: A �_. 1 y R r
_ ,�7•., . n cH
City /State /ZIP: 01--- fa 2-I Subtotal
�1
"� Minimum permit fee ($72.50) W
Phone: tart , Fax A fi r Plan review (25% of permit fee) MEM
CCB lie.: _ State surcharge (12% of permit fee) c (
r, � TOTAL PERMIT FEE •
Authorized sigoatur ' � Ak�i V "�� Thin permit application expires If a permit 19 hot obtained wl bin 180
��--- .--vvv ��• days after it has been accepted as complete,
Print name: . ‘ , rl`L ; '1. 12 Date: ! 11. • Fee methodology set by Tri•Couniy Building Industry Service Board
o6„i}dinaTvmi . d ' °N .Dui Au i ;paH suoS '8 a °qq°d WdOl :5 6002 'tit Any