Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00398
• 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/09/2010
T, [ G;AR. L? g Parcel: 2S110DD09300
Jurisdiction: Tigard
Site address: 15845 SW HIGHLAND CT
Subdivision: Lot: 0
Project: Baldwin
Project Description: Gas piping to barbecue and fireplace.
Owner: FEES
BALDWIN, JERRY & SHERYL Description Date Amount
15845 SW HIGHLAND CT
TIGARD, OR 97224 Fuel Piping 08/09/2010 $14.15
12% State Surcharge - Mechanical 08/09/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 08/09/2010 $75.85
Contractor:
SHAMBURG HEATING LLC
PO BOX 829
TUALATIN, OR 97062
PHONE: 503 - 692 -5563
FAX: 503 - 691 -6855
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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: �/ _Permittee Signature:
03.639.4175 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.
08/05/2010 12:01 503691685 SHAMBURG HEATING LLC PAGE 01/02
Mecha nical Permit Application CP Mr •° ! ,. UOR'01 IIC 1 1 Si: OM
City Tigard AUG 5 Received
h' g 2010 Date/By: �® C1r Permit No.:
13125 SW }call Blvd., Tigard, OR 97223 Plan Review
,a
., r
Phone: 503.639.4171 Fax; 503.598.11�U�{�} +/� 9604 t Y OF i 1 n p i,
ii lr.' Date/By: Other Fermi
' - Inspection Line: SU3.639.4175 �U1 r ' ' Date Ready /13y: La See Page 2 for
. BUILDING J!k C r
-. Internet www.tigard- or.gov l `;�' � ,� Notified/Method: lini Supplemental Information
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Mechanicsl permit fees* are based on the value of the work
❑ 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,
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® I and 2- family dwelling ❑Commercial /industrial ❑Accessory building
For special information use checklist.
❑ Multi family ❑ Master builder ❑ Other; 1.3escription 1 Qt I Ea_ 1 total
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Job site address: 15845 SW Highland Ct. Air conditioning
(requires site plan showing placement') 46.75 .,
City /State /ZIP: Tigard, OR 97224 Furnace 100,000 BTU ( ducts/vents) 46.75
n Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bidg. /apt. no.: I P r o j e c t name: !tea L j J jJ Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydrontc - ___.......... _...... 23.32
, Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: i Lot no -
Other: 23.32
Tax map /parcel no.: Other fuel aypliancet
t !fir •'ll i# fi 1 :lt rf!? t 1 p! d t ,tfrir +tl77sr+.•t rl tirrizNi i7r- r x i7 " •� t mil ; r I 4 ,11, i 1irn i r;l Irj 'f f' r ifs t I I Water heater 23.32
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l l .; l.x unl4 4 r li r «, {i,i t it r,. { L q r l 111 1.,� L �l�1{0 f kii d ilt !Il. •,,, Gas fireplace 33.39
•
Installation of gas line to BBQ and gas line to dual listed log set Flue vent for water heater or gas
fireplace 23.32
.
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace /insert 23.32
I I l i ri 1fgr14i17rHtam� i °f t o {ua l rci(8i X111` < a t 9 :, rm +n�hk �p1g11 77 7:7.777,777,7 ( Chimney/liner/flue/vent 23.32
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Name: Sheryl and .Terry Baldwin Environmental exhaust and ventilation
•
Address: 15845 SW Highland Ct. Range hood /other kitchen
eduipmetlt 33.39
City /State /ZIP: Tigard, OR 97224 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)968 -1853 Fax: ( ) toilet compartments, utility rooms) 23.32
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r{ 7 1 p 23.32
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nr.,t.. 9 _ t+ , I xat,i fi a. 7 l !
Other: 23.32
Business name:
Furl piping
Contact name: S14.15 for first four; 54.03 for each additional
Address: Fumace, etc.
Gas beat pumjp
City /State/ZIP: Waft /suspended/unit heater
Phone: ( ) I Fax:: ( ) Water heater
. . Fireplace _ 1 14.15
E -mail: R ange
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suis..4+
Business name: Shamburg Heating LLC Clothes dryer (gas)
Other:
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Address: PO Box 829 p i { � i It ,l , t "i r it ,i . i 1 il ` #iIiii Il 1 ► i { r ' 1
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City /State/ZIP: Tualatin. OR 97062 Subtotal 28.30
Phone: (503) 692 -5563 Fax: (503) 691 -6855 Minimum permit fee ($90,00) 90.00
Plan review (25% of permit fee)
CCB lie.: 126881 e _ . State surcharge (12% of permit fee) 10.80
_ TOTAL PERMIT FEE 100.80
S "" 'r Thla permit application expire, if a permit v not obtained within 180
Authorized signature: . • days after it has been accepted as complete.
Print name: Scott Shamburg Date: 8/5/10 4' Fee methodology set by in-County Building Industry Service Board