Permit CITY OF TIGARD MECHANICAL PERMIT
..,_ COMMUNITY DEVELOPMENT Permit #: MEC2010 -00524
T [ G ARE) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010
Parcel: 1 S 133CD09300
Jurisdiction: Tigard
Site address: 12014 SW WILTON AVE
Subdivision: Lot: 0
Project: Boone
Project Description: Gas furnace installation.
Owner: FEES
BOONE, JOHN P & LORI L Description Date Amount
12014 SW WILTON AVE Furnaces < 100K BTU 10/26/2010 $46.75
TIGARD, OR 97223 12% State Surcharge - Mechanical 10/26/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 10/26/2010 $43.25
Contractor:
ROSE CITY REFRIGERATION HEATING & AIR
LLC
PO BOX 19207
PHONE: 503 - 636 -5371
FAX: 503 - 655 -4669
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:_ _s
iy
Call 51 . • •.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.
10/22/2010 07:41 5036554669 ROSECITY PAGE 02/02
Mechanical Permit Application RECE i FOR OFFICE USE ONLY
City of Tigard Received
ty g �C , DateBy: ii .1.7" �p �- PermitNe.: EC�K)„ ?—
a
13125 SW Han Blvd,. Tigard, OR 97223 2 2 20 t plan Review Ov
' ii Phone: 503.639.417 Fax: 503.59 8.1960
Date /By: Other pu mil;
T t G A R D Inspection Line: 503.639 CITY OF TIG : a ate Rcady/By: "— lurl ® Page 2 for
ra
Intect: www.tigard- or.gov BUILDING DIVISII i 'fed /Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE – USE CHECKLIST
❑ 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: $
®t and 2-family dwelling ❑Commercial /industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Accessory building
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description Qty, I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 12014 SW Wilton Avenue Air conditioning
(require$ Site plan showin placement) 46.75
City /State/ZIP: Tigard, OR 97223 Furnace 100.000 BTU (ducts/vents) I 46.75 46.75
v Furnace 100,000+ STU (duas/vcnis) 54.91
Suite/bldg./apt. no,: Project name: Carefr t ton Q ` APE_ Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type. not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: Lot no.;
Flue /vent for any of above 23.32
Other: _ _ 2332
Tax neap /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23,32
Install 80% gas furnace (like for like) Gas fireplace 33,39
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
® PROPERTY OWNER 1 ❑ TENANT Chimney /liner /flue/vent 23,32
Other: 23.32
Name: John Boone Environmental exhaust and ventilation
Range hood/other kitchen
Address: equipment 33.39
City /State/ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms.
Phone: (503)481 -6916 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT _ ® CONTACT PERSON Attic/crawlspace fans 23.32
Business name: Rose City Heating & Air Other: _ 2332
Fuel piping
Contact name: Jeff Pangborn $14.15 for first four: 54.03 for each additional
Address: PO Box 19207 Furnace. etc.
Gas heat pump
City /State/LIP: Portland, OR 97280 Wall /suspended/unit heater
Phone: (503) 6365371 I Fax: : (503) 6554669 Water heater
Fi
E -mail: jeft@rosecityheating.com R ang
Range e
CONTRACTOR Barbecue
Business name: Rose City Heating & Air Clothes dryer (gas)
Other:
Address: PO Box 19207 MECHANICAL PERMIT FEES*
City /State/ZIP: Portland, OR 97280 Subtotal 46.75
Minimum permit fee ($90.00) 90.
Phone: (:503) 6365371 Fax: (503) 6554669
plan review (25% of permit fee)
CCB Iic.: 161325 State surcharge (12% of permit fcc) 10.8
TOTAL PERMIT FEE 100.80
Authorized signatute.rT This permit application expires if a permit is not obtained within 180
`/ice/ days after it has been accepted as complete.
Print name: Jeff Pangborn I Date: 10/22/10 • Fee methodology set by Tri- County Building Industry Service Board
1:18u1ldtny ■P* mi,9lMEC- Perm{tApp.doc 10/01/09 440 - 4617T (11/O2/COM/WEO)
-. j e&' L . PG,.) b o wJ