Permit CITY OF TIGARD 0 MECHANICAL PERMIT
; '! L COMMUNITY DEVELOPMENT Permit #: MEC2010 -00572
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2010
T1;+GARIm Parcel: 2S111 CB00300
Jurisdiction: Tigard
Site address: 14875 SW 103RD AVE
Project: Dickey Subdivision: DEL MONTE SUBDIVISION Lot: 2
Project Description: Installation of gas insert, venting & gas line. 11/15/10, adding additional gas line for range.
Contractor: SHAMBURG HEATING LLC Owner: DICKEY, TIM & KEENAN, LISA
PO BOX 829 14875 SW 103RD AVE
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -5563
PHONE: 503 - 575 -6927
FAX: 503 - 691 -6855
FEES
Specifics: Description Date Amount
Gas Fireplace 11/10/2010 $33.39
Type of Use: SF Chimney /Liner /Flue/Vent 11/10/2010 $33.39
Class of Work: ALT Type of Const: Fuel Piping 11/10/2010 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 11/10/2010 $10.80
Stories: Minimum Fee Adjustment - Mechanical 11/10/2010 $9.07
Fuel
Fuel Types:
Gas Pressure:
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 -0090. You may obtain a copy of the rules
or dire . estions to . NC b calling 503.232.1987 or 1.800.332.2344.
Is uedBy: / � 4 � Perm ittee Signature'
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
CITY OF TIGARD MECHANICAL PERMIT
1114
a COMMUNITY DEVELOPMENT Permit#: MEC2010 -00572
T i G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2010
Parcel: 2S 111 CB00300
Jurisdiction: Tigard
Site address: 14875 SW 103RD AVE
Project: Dickey Subdivision: DEL MONTE SUBDIVISION "Lot: 2
Project Description: Installation of gas insert, venting & gas line.
Contractor: SHAMBURG HEATING LLC Owner: DICKEY, TIM & KEENAN, LISA
PO BOX 829 14875 SW 103RD AVE
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -5563
PHONE: 503 - 575 -6927
FAX: 503 - 691 -6855
FEES
Specifics: Description Date Amount
Gas Fireplace 11/10/2010 $33.39
Type of Use: SF Chimney /Liner /FlueNent 11/10/2010 $33.39
Class of Work: ALT Type of Const: Fuel Piping 11/10/2010 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 11/10/2010 $10.80
Stories: Minimum Fee Adjustment - Mechanical 11/10/2010 $9.07
Fuel
Fuel Types:
Gas Pressure:
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 wit be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or • t . is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility k • ification Center:'- rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or •" ect questions to OUNC b. • 'g ' - .232.1987 or 1.800.332.2344.
-suedB ' ! PermitteeSi
r i -
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
11/09/2010 13:42 5036916855 RECEIVE , SHAMBURG HEATING LLC PAGE 01/02
Mechanical Permit Application NOV 9 ►• t o►z t 1l. ►• ►i : ►.: 1,s i.. t ►N l :1
Cary of Tigard 2 0 10 Dat // LEIB R" Penult N°.: /
13125 SW Hall Blvd., Tigard, OR 97223 L'
° � 1 i ' ' • Plan Review
Date/ 13y. Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Bur.
T IC, .4 R tl Inspection Lino; 503.639.4175 B[Ju.L[N Df VISI I !' ruts E1 see page 2 for
Internet: www.ngard- or.gov Supplemental Informatiou
rr,•t. •+r• ,. - - .. i+t t t ,.I ,lif Fj. I I :+^at :ttt':•m:rcu,I.ti „na. ;: ^7:r -
,p .,tp.
.... } 11 S ��ttp t 11
, 1 . :,. �•it " „ "�'. . ��t„i { '1� } ' 1 i 11� t t .l it }11 Y { 1{{[[ .t li.l it �.. ' + �fit,.ti, {. . cjj ) ..it ' �?f!' r
17 .: } r ::1 q t � rx t , 1, .. of > Y i l?ii _!;,i,:![;
t! f�, ., I .i:l t 1 { f} `rt. f ,, r I e , I i. t� f.�1t rt !r f 1{1 .1 1•r }., 1 ! ucrtrt yf L kr ( t "} { . � r:1i t t.. t t { { .
.
. ..:..........8 fli.h_r., rF r. , 1,.!:h }'.rl i, { +!I .. - i . "1 1:- _,.Lr.... +f. .. . ,, r +1.: ,,,. ., - .,.. _ 1; ,,,. ,, ....i. a ... a {,. . fa .:lf . .,.i... . n r... . 1;i,r.,lrnL, uh l.rn }1(t,,.. ..,1:,7..( „ � . ,.J. t1.... li � , . Ld7. •eh..i i,.L.L4. „,,taV. t, ,,aD 1 ,..;6.. , r[,
12 New construction �ddition/alteration/replaccment Mechanical pernllt f ees• are base on t he value of the work
performed Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and proOL
:ar, " , :'il i + u1 ! "•i'i PIli"11 ;ih:•f1i i ir :i; ti.774 - 1"a^: ; - ./pi 1 : ;nand 7! ,;r:ptt ,7,Ts.mr,,tr r:a• •R:iL .re Tini(fl)mt� f =tNi;; !„11,1,,gn
t iii ° ,L i . ;,llp,f,! :> t ;ir , t r f 1 r{ . t I , r r , i ti. f, ' ht;, tl j i , } Ifr u 1 ,, Value: ( fb t 1 1 1 1' 1 , t 1 f 1 f t p] r.'9t.;.r'1"q.- .,,:., , r nh:.,, VSI $
r .1 L...i.. rl H.,n P.tr:t e,,... ,.,,,rr.
},;!}al � 4,L1 rt t.4 ?:, .} { , +r� } ,h 1 ,,.. . . t r . ^: ntn:• .r.::1.I1, ,n.r,,t f l�r,} E1 1fY...r. llj,.. c�..,.:,1 I:r�rin,t ■,.t}�tf4,1 n fl{ 'itr� .t h 1 ITT: } ,l � f 1 } I � r ' 1 r I t r 1 L 1 f ,I,.4:tr
M - and 2- family dwelling In Commercial /industrial DI Accessory building sir:c, t::,:� :+..::n: ar- :aaa:. t;:..;I -:w fi c, t ; a {aha #i i'a,ii .is;
For special v formation u_ se checklist.
❑ Multi family ❑ Maser builder ❑ Other tion Descrip
R + I 7 r t ! + 111 e l 5 � G, • H.0 , ! . „n i 11 i t r } I ! { I �c� Ea. Total
I!1 I i i ,{ lT4 i , .. d H , iI , i t t 1 y i ) , i Iti t i{l rlt {t1 } ; . •} }!1 { F f1 t li �t t{' ,
ul 9i,: } :►il i f, 7 , 1,,, . , � .:,, ... L } „ 1 t,l,i ii,,.,,i7b. rua ?,ti.. • r � i► ,e 7F1.nr � { ,i,m,a4 r.iha Heating/cooling - ---
: ? A 1 03 / d ( �� d 9 c o p an
Job site address: y:75 showing placement) 46.75
City / State/ZIP: /I owa , . el 222y Furnace 100,000 BTU (ducts /vents) 46.75
Suite/bldgJapt no.: Project name: Furnace 100,000+ BTU (ducts/vents) 54.91
Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
Ilydronic hot water system 23.32
Residential boiler (radiator or
bydronic 23.32
Unit heaters (duel -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 a . . (lances
tV j N ,:1 i � } +, •ill li}(( I d ,7.1.71 i tf! 71 .. I mt r 173 1 7 7 •11 4 r , ,7,, p y t tt Y r i ,t } il l }ul rr t dl a L IL:il IF
Gas fireplace Water heater C y 23.32
LLA l,.',iili.11,1tiiicljt...iii :1ti 12,∎;,ithi.iii3...a r :'..`4,':!.
+ aj. i,r. ;f.,. w: +1•'t l r,! ,.L I!,,rt,, I ll ,t!ilttiitlih.7,f ;ti<ju,.;R p 1 r 9 1 33.3 3,3 3
/ v S AS //251re" / /.5 '11 �' ✓' . / Flue vent for water heater or gas
I" fi ' .lace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fircplace /insert 23.32
10 7t h lim it } T7 rt ,1 s 7 rt�r I n ri r� , f t r n t tI °7i rt } r 1E' r1r firs 7 +} t {' �rpI {1 r �i u } l,} i I t it F I t n qt � i t ii t { } r Chir11n liner /flue/vent 23.32 10•
},.1; &. t u,tu,, , ,, ,,,,,,, tl., ,,1 t..; t, t . :::1,t:: : ,t, : ;1.. a i.i,IlikAitt } i ;i1. 1,1;1 .... . i' r.. ii %L;1- wii9,i.,, tl. Other: 23.32
Name. /t 4 Environmental exhaust and ventilation
Address f (47 , _ /03 id Range hood /other kitchen
equipment 33.39
City/State/ZIP: ---', , d oz `f 7 Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (10.3) C_. ot, 9L 7 Fax: ( ) toilet compartments, utility rooms) 23,32
17 F! r -t) r rtti 1 r , r 1 } , x 1 7 v tg •IIr lfq nee Y at q 7 ,+ i!..1; ,
}'l .ij',' t1t lt �l' kgiZi.(t f ' 1 off i r }(( RP 1 371 fu I: t � i1 i . r1 ri 1 f i, „ } , i v } k,l >i i e q ) d {ih Atticicrawlepace falls 23.32
a n,..ti, i1,, r i t!i 11'11( . V4, , ia.1n, tt.u..tt t...k! r.,ilIE: ,. ..I:uti i ,••: Ir} r,�u,,,a. i , .. ,c..:Ini ,, , t fis4 r Ea ,n... , i
Other: 23.32
Business name:
Fuel r .1
Contact name: $14.15 for first four; $4.03 for each additional
Address: Furnace, etc.
Gas heat pump
City / State/ZIP: Wall/suspended/unit heater
Phone: ( ) j Fax: : ( ) Water heater .. -
fireplace _ i
E-mail: _ Range
rvii pv.(4 :: l
, i: in ; i',:`7 ?I. l7P7 n - ^ 177 ' 7 , ':;r,, l ;:,';' : ,i { It: ±i i1' ;'5% Iii {{ lC:°r,' m•$ r :,, T
;:f :: , t i{ , q1 r 2 r F } f{ 1."i , 1 ri ( t`t I i ;}t II { i it } ,:i i , I t :ii� , i•{1 i f iar i 1" ,i Barbe
a i::ii i ...th . },6,t I I L.:,:.., i} } o ..i. , h ,... ..lf: .. J fC..•..I ,..,, i,l . , . ,, . . , a, ,.(d .r .. r., , , , n . .1 Nit;;;!.
Business name: Ain h H i y u ' Clothes dryer (gas)
Address; Po 60 7 �* r i ' 11 ? ; °a1��I fii l.r r g , . li i t „ v It � r , a I t r N i ll t 1 i l 'i r 7•
pp ,
�� iE'1itli11.9r1 ■.tl... � 't F .r, .: ,:, i;t r,, [ „ .,fnt rr l {. ,i I.! Intl „
City / State/ZIP: 2 L/C:[ A, D� 9'04 „ p 5 ubtotal 'Q,
tj'p // ,- 7 Fax: ( 1/ `e an review
Minimum (25% of mil t'ee f*f D. C L'
Phone: (
� ��'��V.7 P l anrevicw(25%of.ermitfee)
CCB lic.`' State surcharge (12% of permit fee) /Q. ,'
TOTAL PERMIT FEE /00. /Q % l
Authorized signature: This permit opplionnon expires if a permit is not obtained within lRfl
days after it has been accepted as complete.
Print name: ..‘e..071f s`fk.97 .6 ✓ Date:/i9,/e) • Fee methodology set by Tri- County Building Industry Service Board
A4tLAA rr (11 m9,rnfll w R\