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Permit CITY OF TIGARD MECHANICAL PERMIT 11., COMMUNITY DEVELOPMENT Permit #: MEC2010 -00531 T1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010 Parcel: 2S 111 CCO5300 Jurisdiction: Tigard Site address: 15910 SW CENTURY OAK CIR Subdivision: SUMMERFIELD NO. 1 Lot: 76 Project: Eischen Project Description: Interior remodel. Owner: FEES EISCHEN, STAN Description Date Amount 9445 SW BRENTWOOD PLACE TIGARD, OR 97224 Gas Fireplace 10/26/2010 $33.39 Range Hood /Other Kitchen 10/26/2010 $33.39 PHONE: 503 - 440 -2095 Single Duct Exhaust (Bathrooms, Toilet, 10/26/2010 $46.64 Utility Rooms) Contractor: Fuel Piping 10/26/2010 $14.15 STAR HEATING INC. 12% State Surcharge - Mechanical 10/2612010 $15.31 2410 NE 172ND. AVE. VANCOUVER, WA 98684 PHONE: 503 -704 -1545 FAX: 360- 828 -5370 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas Gas Pressue: Total $142.88 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 o tain a copy of the • ' or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: • — ittee Signature: CaII 50 . • 5 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 Application I OR orI:Ic[ (SE ()MN City of Tigard �� Received III Date/By: W(� /O /37 Pennit Na: r►11 =c. 1n _( • 13125 SW Hall Blvd., Tigard, OR 97223 l C Plan Review Phone: 503.639.4171 Fax: 503.598.1960 p Other Permit: r 1 G A It D Inspection Line: 503.639.4175 q 6 1 410 Date Ready/By: Juris: ® See Page 2 for Internet: www.tigard-or.gov Q� r.gov C© rs Notified/Method: Supplemental Information S OF� �•A-wJ� TYPE OF WORK C.- G �tJ 1 COMMER FEE* SCHEDULE - USE CHECKLIST ❑ New construction Addition/alteration/ men 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: $ dwelling RESIDENTIAL EQUIPMENT / SYSTEMS FEES* 11..1- and 2-family g ❑ Commercial/industrial ❑ Accessory building Multi - family ❑ Master builder ❑Other: For special information use checklist. Description 1 Qty. 1 Ea. I Total JOB SITE INFORMATION AND LOCATION Heating/cooling Air conditioning Job site address: )590 CW /' 4 .4 0 C I � ( g (requires site plan showing placement) 46.75 City/State/ZIP: '" �'� fJ 6iL X 1122 �f � Furnace 100,000 BTU (ducts/vents) 46.75 Furnace 100,000+ BTU (ducts/vents) 54.91 Suite/bldg. /apt. no.:''' Project name: .j.7.ctxty..N Heat pump 61.06 Cross street/directions to job site: Q „At I, ci 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: 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 JJ Gas fireplace [ 33.39 33.11 Kr T2 Iv r 0 LotL.r ' / NC', i (� AV, 'P.m)/ G As 1 he -#D 4), fe e xitp. Flue vent for water heater or gas 1+ Ve (A6 Le fireplace 31 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 PROPERTY OWNER I Chimney/liner /flue/vent 23.32 ❑ TENANT Other: 23.32 Name: 5 i9a Environmental exhaust and ventilation Address: 9 1 CIS. Sw di Pl ' Range hood/other kitchen fQV1� t.t/O ` equipment 1 33.39 3 City/State/ZIP: I j v `A 0q. giZZiI Clothes dryer exhaust 33.39 y Single -duct exhaust (bathrooms, 2. (a Phone: (503) yy ,,� 9 5 Fax: ( ) toilet compartments, utility rooms) 23.32 ,IN A v ❑ APPLICANT D3 CONTACT PERSON Attic /crawlspace fans 23.32 � t 11� Other: 23.32 Business name: la_ R„ d� co i InGTt dN Zn. L Fuel piping Contact name: '7:- An Lct) ur $14.15 for first four; $4.03 for each additional Address: P. 0. R 0 X y51 Furnace, etc. Gas heat pump City/State /Z[P: (,,j j g 6kp h 0 .. gd71 Wall/suspended/unit heater Phone: Vd3) q g l • L� Fax: ( ) Water heater (�, (S + 1 , l G /� r Fireplace -"t313 -"t313 E -mail: 17_, o A .\ pQry,,, C(. W bAn Range • ONTRACTOR Barbecue Clothes dryer (gas) Business name: .1...0. 9.x -1. 1 ,.\so �V a c t t' 15 t n Other: Address: 2J 3 6 3g /77 3 al Portie,h OR 97 j L 3 MECHANICAL PERMIT FEES* City /State/ZIP: 1` I Subtotal . 1 1X7.51 Minimum permit fee ($90.00) Phone: (503) l oci .15 v Fax: ( ) Plan review (25% of permit fee) CCB tic.: / L1 l pqi State surcharge (12% of permit fee) ' i j 3 i TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtain within 1 -- ..A days after it has been accepted as complete. • ) vsn Print name: / 7 r yt L. ci L - Date: /o . zo , Jo • Fee methodology set by Tri- County Building Industry Service Boar I.\ Building \Permits\MEC- PermitApp.doc 10/01/09 440-4617T (1 I /02/COM/WEB)