Permit ,, CITY OF TIGARD MECHANICAL PERMIT
`'1 s :- - COMMUNITY DEVELOPMENT
Permit*: MEC2010 -00560
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2010
• • Parcel: 2S110DD08700
Jurisdiction: Tigard
Site address: 15810 SW HIGHLAND CT
Subdivision: Lot: 0
Project: Stark
Project Description: Install new furnace
Owner: FEES
STARK, RONALD F & Description Date Amount
15810 SW HIGHLAND CT Furnaces < 100K BTU 11/04/2010 $46.75
TIGARD, OR 97224
FlueNent For Any of Above 11/04/2010 $23.32
PHONE: 503-639-9198 12% State Surcharge - Mechanical 11/04/2010 $10.80
Minimum Fee Adjustment - Mechanical 11/04/2010 $19.93
Contractor:
RCG SERVICE LLC
11235 SW 83ND AVE.
TIGARD, OR 97223
PHONE: 503 -888 -9849
FAX: NA
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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. /
le
Issued By: A( /� Permittee Signature: "Al � / C -77 N
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.
Mechanical Permit Applic FOROI FIDE USE- OiNI:V - --
I City of Tigard w Da temyy: iy 9 /� ', Permit No 56 Q
q ��Lr�O /0 " 41
13125 SW H all Blvd., Tigard, OR 7 Plan Review
C - Phone: 503.639.4171 Fax: 503.598.1 OV 3 2010 Date Other Permit:
Inspection Line: 503.639.4175
T I G A R D. Date Re ReadyBy: Awls: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
CITY OF TIGARD 4
TYPE O F' )KK C DIVISION .
COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction �ddition/alteration/replacement
performed. Indicate thc value (rounded to thc nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
•
Lam- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT:/ SYSTEMS FEES•'
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other:
Description I Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: / / 0 ,5 I. e 4 L ,✓„ p C . f - Air conditioning
J (requires site plan showing placement) 46.75
City/ State/ZIP: `, G . 5 2 ( 7 7 Z t1 Furnace 100,000 BTU ( ducts/vents) / 46.75
1 / Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
P c---1 Q �L4 se-43, / A � Hydronic hot water system 23.32
�E 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
Z- S ihr ( ,i`,� Y��J S I ,� c Gas fireplace 33.39
/ ` y 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 ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: g6,1 5 7---A-,e.__ Environmental exhaust and ventilation
Address: 5-6( O st�.J Sri
a G Range hood/other kitchen
cJ equipment 33.39
City/State /ZIP: 7-1 A-.4.„. a-K_ '7 7 2-Z-,4 Clothes dryer exhaust 33.39
q � q � i / / Single -duct exhaust (bathrooms,
Phone: 6743) 3 r - - Cef d Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT - • • • ❑ CONTACT PERSON Attic /crawlspace fans 23.32
n � Other: 23.32
Business name: l� s&J2.4,/t L L L Fuel i m
Contact name: ,Z.4:9- �� S p p 514.15 for first four; $4.03 for each additional
Address: /(2 s- s a 3 �.7,C Furnace, etc.
Gas heat pump
City/State/ZIP: — ` f, ,4 �"--- ? 7- Z Z 3 Wall/suspended/unit heater
Phone: (fq B-�- _ 7'z -- Fax: : ( ) Water heater
� /J Cs . �r � / Fireplace
E -mail: ( 2„, G .0 –/L
S d ( z_ja G..c.a . C c---'�.l Range
CONTRACTOR Barbecue
Business name: kL C 5 - : mod/ c - • L L. L Clothes dryer (gas)
/ Other:
Address: / (2 7 j 5 s`--4 $3 Cel MECHANICAL PERMIT FEES* Z
City/State/ZIP: 1 Zs€ 9 �. Z Z� Subtotal 7
t Minimum permit fee ($90.00) 9 O, a 0
hone: ( s6j �r 7 Fax: ( )
Plan review (25% of permit fee)
CCB lic.: / 7 a z icy . 5 f v
( State surcharge (12% of permit fee) /1: 5rO
TOTAL PERMIT FEE l// V This permit application expires if a permit is not obtained within 180
l c ) Authorized Si e: U C��. �� days after it has been accepted as complete.
Print name: cp l c. Gl1 Fr % 17�s Date: r( it Z - a/ a ' Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \PerrnitsUMEC- PennitApp.doc 10/01/09 440-4617T(I1/02/COM/WEB)