Permit ' 4 s �' CITY OF TIGARD MECHANICAL PERMIT
' ' :: COMMUNITY DEVELOPMENT Permit #: MEC2010 -00351
,LC Date Issued: 07/21/2010
,TA G ARE) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S109DB05000
Jurisdiction: Tigard
Site address: 13277 SW SUMMIT RIDGE ST
Subdivision: SUMMIT RIDGE NO. 3 Lot: 129
Project: NICHELSON
Project Description: Add A/C. Unit must meet 3' minimum rear and side yard setbacks.
Owner: FEES
NICHELSON, ALISON Description Date Amount
13277 SW SUMMIT RIDGE ST
TIGARD, OR 97224 Air Conditioning 07/21/2010 $46.75
12% State Surcharge - Mechanical 07/21/2010 $10.80
PHONE: 503 - 522 -7173 Minimum Fee Adjustment - Mechanical 07/21/2010 $43.25
Contractor:
RUMBOLD HEATING & AIR COND INC
14214 FIR ST SUITE D
OREGON CITY, OR 97045
PHONE: 503 - 656 -0475
FAX: 503 -656 -4572
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $100.80
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: ZIZCf��, Permittee Signature: _. �G� — =—.—___
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.
Mechanical Permit Applic on, - i) - - FOR OFFICE USE ONLY
City of Tigard d ' Received - / - Permit ... _d iS/
Date/By: Other Permit:
;. • • 13125 SW Hall Blvd., Tigard, OR 97223 0
Plan Review ter ermt:
Phone: 503.639.4171 Fax: 503.598.19 21 2010 Date/By:
Inspection Line: 503.639.4175 B See Page 2 for
T I G A K D Date Ready/By: Juris:
Internet: www.tigard or.gov '0;';'11 i ` ' . r Notified/Method: Supplemental Information
• ' TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLLST
❑ 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: mechanical materials, equipment, labor, overhead, and profit.
• CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
Si and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family 0 Master builder
❑ Other: Description 1 Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION • Heating/cooling
�J�J / /f Air conditioning erheat-pmnp
Job site address
/32 / / f 4V f i del /�•/4 (s s� (requires site plan showing placement) / 14.00
• City/State/ZIP: l 1� / /(7,Z 97 z z c iT p i 1 Furnace 100,000 BTU (ducts/vents) 14.00
-Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. 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
Flue /vent for any of above 6.80
Subdivision: I Lot no.: Other: 10.00
Tax map /parcel no.: Other fuel appliances
• • • DESCRIPTION OF WORK • Water heater 10.00
�/
��pp // Gas fireplace 10.00
frDP 1-' 4-i Z, (rrt d ��C/L- 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 I . ❑ TENANT — Chimney /liner /flue/vent 10.00
Other: 10.00
Name: /T Vl 3i5y7 S lsc9.// Environmental exhaust and ventilation
yq Range hood/other kitchen
Address: 730 7 7 Sit, SLc .4./ ,t E/4 t 5 - equipment 10.00
City/State/ZIP: % v , Q/L y 7 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (57)3 ) 5Zz_ 7/ 73 Fax: ( ) toilet compartments, utility rooms) 6.80
' ' " Q APPLICANT • . • ❑ CONTACT PERSON Attic/crawlspace fans 10.00
Business name: Other: 10.00
Fuel piping
Contact name: $5.40 for first four; $1.00 for each additional
Address: Furnace, etc.
Gas heat pump
City/ State/Z1P: Wall/suspended/unit heater
Phone: ( ) I Fax: : ( ) Water heater
Fireplace
E -mail:
Range
• • CONTRACTOR . Barbecue
Business name: / /.L ,/,, id t �� /G 1 Lp Clothes dryer (gas)
Other:
Address: P. 0, ear 31 7 MECHANICAL PERMIT FEES *.
City/ State/ZIP: 4,tex_Ciex� 1e 9700 ef- Subtotal • Minimum permit fee ($72.50) 9,e) , G v
V Phone: 603 ) 4. 51,- 04-75 Fax: (52/3) - Fro 3) 63Z. 6 Plan review (25% of permit fee)
CCB lic.: / 7 Z.r 7 t / /he/ea' 9/q a State surcharge (12% of permit fee) le , ere
1 TOTAL PERMIT FEE Lee „f,)
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
I Print name: ■ I Date: • Fee methodology set by Tri-County Building Industry Service Board
1 :1Building)Permus)MEC- Permit 01/19/01 440.4617T(11/02/COM/WEB)
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