Permit CITY OF TIGARD MECHANICAL PERMIT
11 COMMUNITY DEVELOPMENT Permit #: MEC2010 00502
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/15/2010
Parcel: 2S 111 AD01500
Jurisdiction: Tigard
Site address: 8755 SW PINEBROOK ST
Subdivision: PINEBROOK TERRACE Lot: 12
Project: Powell
Project Description: Gas furnace installation.
Owner: FEES
POWELL, STEVE Description Date Amount
8755 SW PINEBROOK DR
TIGARD, OR 97224 Furnaces < 100K BTU 10/15/2010 $46.75
12% State Surcharge - Mechanical 10/15/2010 $10.80
PHONE: 503 - 318 -8730 Minimum Fee Adjustment - Mechanical 10/15/2010 $43.25
Contractor:
TOTAL SYSTEM SERVICES
1220 SW THIRD AVE B78
PORTLAND, OR 97204
PHONE: 503 - 227 -5955
FAX: 208- 376 -1395
Type of Use: COM
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: / / ...0 01001 1 iv ia Permittee Signature:
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.
10/14/2010 15:41 2@837b1395 TOTAL SYST PAGE @1/@3
Mechanical Permit Application RECEIVE I Fok oFFT(:).... IF: oNi.).
City of Tigard Roceived
"I 13125 SW Hall Blvd. Tigard, OR 97223 Daionly:
0 - t. , ' L Plln Review
I Phone: 503.639.4171 Fax: 503.59ft. t 960 0 r`: T 1 - ' '
I'll p-itimitzumeme
oth, Permit:
T i (:; A iz (1 InsPection Line: 503,639.4175
Internet: www.tigard-orgov CITY OF TIGARIatiss
1 , S
r i'gV/E.,'„'..:.: : '; ', .::.:': ' ; ' ;..;':',! : ::':: : :1 : ... f : U; .•..,.::',:.;... ',..1 11 ..:!,.. D . I. 1\l G 1-31 I. :. :.'..•tolvit.404iiiii;4%0E±;kiitiklf§t01:1WFielj"I#
0 Ncw construction 0 Addition/alteration/replacement Mechanical permit fees* are based on thc value of the work
performed. Indicate thc value (rounded to the nearest dol)ar) of all
0 Demolition 0 Other: mechanical materials, equipment. labor, overhead, and profit.
' ' : ..... . . ' ' . ' Val $ 53,108'00
. . . . .
.,.. •.400:011:34.;•01:00*IVIllt.t.0104:rnta.,41.
El 1- and 2-family dwelling El CornMereial/industrial 12 Accessory building
For special information use checklist
0 Multi-family 0 Master builder 0 Other:
Description Qty. 1 Ea i Total
iCi#:•Stri`:41 •kk)'':i::45Ciitioi■i :..: .' ...: ' : . :'..•.. : . • : Heating/cooling
Air conditioning
Job site address: 8755 SW Pinebrook St
(require* site plan showing placement) 46.75
City/StatcfZIP: Tigard, OR 97224 Furnace 100,000 BTU (ductsivonis) 46.75
Furnace 100,000+ BTU (duets/vents) 1 54.91 54.91
Suite/bldg./apt. no.: i Project name: Powell
Heat pump 1 61.06
Cross $arect/directions to job site; Duct work i 23,32
Hydronic hot water ._gstem 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fucl-typc, not electric).
in-wall, in-duct, suspended, etc. 46.75
Flue/vent for any of above 23.32
Subdivision: Lot no.;
_ — Other r 23.32
Tax map/parcel no.: Other Ind appliances
. : ":....• . , .!!.iiit a kek1iptij : eitNytoltit :1.,.1. :i: ..,.., .: • . i , ::' :::.:' . ": ., ' ..! Water heater 23.32
Gas fireplace 33.39
Inabal gas furnace
Flue vent for water heater or gas
_place 23.32
— —
j lighter (gas) 23.32
Woad/pellet stove 33.39
Wood firetslace/inscrt 23.32
. • , , • . .„ Chimney/liner/flue/vent 23.32
'',;•' ilti*PElittO*1`1**: ., . .*:'1 ..=,''. , • ' ':.: .-.'.'" •H EIJI.NAN't.::-. : .:. - .':
Other:
23.32
Ntimc: Steve Powell Environmental exhaust and ventilation
Range hood/other kitchen
Address: 8755 SW Pincbrook St.
equipment 33.39
—
City/State/Z1P; Tigard, OR 97224 Clotho dryer exhaust 33.39
— Single-duct exhaust (bathmoms,
Phone: (503)3184730 Fax: ( ) toilet compartments. utility rooms) 23.32
,..:;r::',."..::' ,'•.:. ,;,''. if::: ' : i . ::'..': .i:' '. . t Of)Ntiitt... ptHEnjiii .. .., :• ' Attic/crawlspace fans 23.32
Other; 23.32
Business name: Total System Services
Fuel piping
Contact name: Lynette 514.15 for first four; 54.03 for each additional
Address: 911 NE III* Furnace, etc. Ave., Ste. B611
Gas heat pump
-
City/State/7.1P: Portland, OR 97232 Wall/suspcndcd/unit heater
Phone: (503) 227-5955 Fax: : (208) 376-1395 Water heater
Fireplace
E -mail: lialliss@tsshvae.enm
Range
1. ... ...t0t : '': :.' : :... . : : *. ::: : : • ;.. Barbecue
Clothes dryer (gas)
Business name; _Taint. as ci
Other:
Address:
:)..... .,..1' .4.4i,!Xi•;0040,1000:::k::::4-51.:1,:..l;
City/State/Z1P: Subtotal 54.91
Phonc ) Fax ( -------
Minimum permit fcc (590.00) 90 00
- : ( : )
lan
CCB lie.: j 5
c f l
----- : - State surcharge (1 rx, of permit fee) ....-Rier -WO
TOTAL PERMIT FEE
- ilia permit applica cx:reo
isnn obta ,thin Authorized si r3 in OM
t der after it has been accepted as complete.
gna
Print name: Lynette a 4
lliss Date: 10/14/10 • Fee methodology set by Tri-County Building Industry Service Board
tmoionompermitemec.PermhApp.doe Ion f /00 440.46171' (1 I /02/C ONWP.11)
10/14/2010 15:41 2083761395 TOTAL SYST PAGE 02/03
Mechanica Per mit Application - City of Tigard
Page 2 - Supplemental Information
Commercial & Multi - Family Fee Schedule:
$0.00 to $500.00 Minimum fee $69.06
$500.01 to $5,000.00 $69.06 for the first $500.00 and
$3.07 for each additional $100.00 or
fraction thereof, to and including
$5,000.00.
$5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and
$2.81 for each additional $100.00 or
fraction thereof, to and including
_ $10,000.00.
$10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and
$2.54 for each additional $100.00 or
fraction thereof, to and including
$50,000.00.
$50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and
$2.49 for each additional $100.00 or
fraction thereof, to and including
$100,000.00.
$100,000.01 and up $2,608.71 for the first $100,000.00 and
$2.92 for each additional $100.00 or
, fraction thereof.
Note: All new commercial buildings require 2 sets of plans.
1 ; 18 uildineermi ka lMEC- PcnnitApp.doe 10/01/09 2