Permit . CITY OF TIGARD MECHANICAL PERMIT
•
• :` - : 2 ' COMMUNITY DEVELOPMENT Permit #: MEC2010 00405
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/12/2010
Parcel: 1 S133CC01000
Jurisdiction: Tigard
Site address: 14054 SW SPRINGBROOK LN
Subdivision: PEBBLECREEK Lot: 4
Project: Bogumil
Project Description: Replace existing furnace and existing a /c.
Owner: FEES
BOGUMIL, RICHARD W & Description Date Amount
14054 SW SPRINGBROOK LN
TIGARD, OR 97223 Air Conditioning 08/12/2010 $46.75
Furnaces < 100K BTU 08/12/2010 $46.75
PHONE: 503 - 590 -5150 12% State Surcharge - Mechanical 08/12/2010 $11.22
Contractor:
ABLE HEATING & COOLING
8900 SW BURNHAM F -5
TIGARD, OR 97223
PHONE: 503 - 579 -2250
FAX: 503 - 620 -3980
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue:
Total $104.72
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 • is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit otification CentBr Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or irect questions to OU y ca in 03.246.6699 or 1.800.332.2344.
A
I sued By: _ Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business
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 Application ' foR.oll is ErtS1.ON) r
- ' City of Tigard Received g Permit No.:
711
® 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C ` Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date /By:
11: iG A R D Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for
I - Internet: www.tigard or.gov Notified/Method: � Supplemental Information
• • ' TYPE OF WORK ' - ' COMMERCIAL FEE* SCHEDULE -- USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction tAddition/alteration/Leplacemetlt 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*
„I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty. Ea. Total
. . JOB SITE INFORMATION "AND LOCATION Heating/cooling
Job site address: SW FR conditioning or heat pump
(�6S y SV �F' iI gRc. L-Afi (
(requires site plan showing placement) 1 14.00 /y
City /State /ZIP: / I / w D G+ R , 7 z z 33 Furnace 100,000 BTU (ducts/vents) ( 14.00 �y
U'T1 / Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg. /apt. no.: Project name: gab v „ ..4> ' L Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
� Hydronic hot water system 14.00
WilI ,.i U T ' 4 g4) RR 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
DESCRIPTION OF WORK . - - - Water heater 10.00
Gas fireplace 10.00
_R &C X / s 7'N ( A f c u m/7- / /1,/ S/Qil/E Flue vent for water heater or gas
fireplace 10.00
$ dak / 6 n) / R4 Pcit C.E-- • / _ 4 . 4- Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue /vent 10.00
{`_PROPERTY; OWNER " ` ' . . ' - ❑ :TENANT`
Other: 10.00
Name: R 10-1A 0 go (si MA / L Environmental exhaust and ventilation
Address: pi Q ¶ L� s W 5 R / n1C� g Rn!°< /
Range hood/other kitchen
�- equipment ment 10.00
City/State/ZIP: 1.--, GAgo GO, 7 Zz. Clothes dryer exhaust 10.00
�T / Single -duct exhaust (bathrooms,
Phone: ($Q -) S5'a -s f S a Fax: ( ) toilet compartments, utility rooms) 6.80
❑ - APPLICANT - ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Other: 10.00
Business name:
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
Clo
Business name: ABA M , ,/' _ 6:0 /1/gq 0..c., e es dryer (gas)
Address: 87 00 . 514/ gv2i.Jf'A�•t 57 STE �, S -MECHANICAL PERMIT FEES* t —
City/State /ZIP: f G 5121.3 Subtotal calt. .5
Fax: Minimum permit fee ($72.50)
Phone:
( 3) s? _ L � Z ( ) Plan review (25% of permit fee) e� r
� —, ��' ham`
O
CCB lic.: ' ` 7 Z State surcharge (12% of permit fee)
�+ TOTAL PERMIT FEE
Authorized signature: / This permit application expires if a permit is not obtained within ISO
days after it has been accepted as comp
Print name: � LL w( � Date: �. 1 ' Fee methodology set by Tri County ui ing Ind / S / e � r C vi / c � e • 1
B,�rd ,
I:1 Building V'ermits\MEC- PermitApp.doc 01/19/07 440-4617T (1 t /02/COM/WEB) a , t ` V " g
L 8900 SW Burnham St Suite F5 Air Conditioning Site Plan
- n
TIGARD, OR 97223
(503) 443-2058 Fax (503) 620-3980
Heating & Cooling, LLC Email: ablehvac2@aol.com
CCB #184392
Customer RI ctiARD So 60A1-/ 4.
Address /L/O 3V' 5PR ir)GigRook LAO E City ryGgKo Zip 77z7-3
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