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Permit
CITY OF TIGARD MECHANICAL PERMIT - Permit #: MEC2010 -00611 COMMUNITY DEVELOPMENT Date Issued: 11/23/2010 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 T1CrAR Parcel: 2S104DB02500 Jurisdiction: Tigard Site address: 13133 SW ROCKINGHAM DR Project: Dicken Subdivision: Lot: 0 Project Description: Replace gas furnace. Contractor: ABLE HEATING & COOLING Owner: DICKEN, KEVIN 8900 SW BURNHAM F -5 13133 SW ROCKINGHAM DR TIGARD, OR 97223 TIGARD, OR 97223 P PHONE: 503 - 579 -2250 PHONE: 503 - 840 -7271 FAX: 503 - 620 -3980 FEES Specifics: Description Date Amount Furnaces < 100K BTU 11/23/2010 $46.75 Type of Use: SF 12% State Surcharge - Mechanical 11/23/2010 $10.80 Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 11/23/2010 $43.25 Occupancy Grp: Stories: Fuel Fuel Types: Natural Gas 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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. / Issued By: r _ Permittee Signature: ( 9,,/ O / e� �e � V 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. `` Mechanical Permit AppIicatianc , " FOR OFf i E ;USI ONLY ' " .. - City of TlgsiPt� � Recei a~ g �' , ( '' ® PI u R ved y: 1` �3 /lO - PermiiNoJ��/%r).a/I/ — ©�tO/j 13125 S W Nall Blvd., Tigard, OR 972 ra ` e r a. Zo Phone: 503.639.4171 Fax: 503.598.1960 �� +� °, a gv : Other �j1 Date 6v: Permit: - TIGARD,, Inspection Line: 503.639.4175 ( c . $ ., ._•\ ' 1 lnleruet: www- tigard or.gov 6 . Date Ready /By: i S upplcraenial information See Pug* 2 for � 1 G Notified./Method: 7 l /, `� C'S S TYPE OF WORK VV.- COMMERCIAL FEE* SCHEDULE — USE CHECKLIST El New construction Addition /alteration /replacement Mechanical permit fees° are based on the value of the work E] Demolition performed. Indicate the value (rounded to the nearest dollar) of all ❑ Ot 6er: mechanical materials, equipment, labor, overhead, and profit CATEGORY OF CONSTRUCTION Value: 5 i -and 2 tbsniiy dwelling 0 Commercial /industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES* El Accessory building ❑ Multi- family © Master builder ❑ Other: For syeci�l information use checklist Description Qty" E a. Total JOB SITE INFORMATION AND LOCATION Heating/cooling Job site address: ,:6\ ,....„ Q Air conditioning .,„,A,,, � �++ 1 (requires site plan showing placement) _ 46.75 City /State/ZIP: \ ,, ) V - �n . Furnace 100,000 BTU (ducus:vents) k 46.75 1 Suite /bldg. /apt. no.: Project name Furnace 100.000i- BTU (ducts /vents) 54.91 '' 6 Heat pump J 61.46 Cross street/directions to job site: Duct work 23.32 1 lydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 L Unit heaters (fuel -type, not electric), in - watt, in -duct suspended, etc. 46.75 • Subdivision: Flue /vent for any of above 2332 1 Lot no.: Other: 23.32 Tax map/parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 � 1 �� `~ 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 ❑ TENANT C llinerlflue /vent 'fY OWNER Y 233_ OPER Other: 23.32 Name: 'F.,1; l 411ele-ii Environmental exhaust and ventilation Address: ` \ _� t; 3,...) . �4 k Range hood/other kitchen I- \ equipment 33.39 City /State/ZIP: [..Q c \ r \ a,a,' Clothes dryer exhaust 33.39 �' t `1 � I� l } l Single -duct exhaust Phone: 7 „_ ��` Fax: ( } (bathrooms, toilet compartments, utility rooms) 23.32 ❑ APPLICANT ❑ CONTACT PERSON ' Attic /crawlspace fans 23.32 - Business name: Other. 23.32 Contact name: Fuel piping $14.15 for first four; 54.03 for each additional Address: Furnace, etc. City /State/ZIP: Gas heat pump • Wall/suspended/unit heater Phone: ( ) I Fax::( ) lbaterheater E -mail: Fireplace Range CONTRACTOR [ Barbecue ' Business name: , , T I, 1 e or, A n � Clothes dryer (gas) Address: CC t �' Other: �77 A � ��ttf� \ — — MECHANICAL PERMIT FEES* City /State /ZIP ; ` a r 1 1 ( \ G1 /\ . � I Subtotal Phone: ( Fax: " c � p Minimum permit fee ($90.00) -- 6 — �` (� kav -- 1 rj n Plan review (25° /a ofpermit fee) CCB lie.: \ aW uVV � p � � r � l l i F / p � y / i � - . State surcharge (12 %of permit fee) TOTAL PERMIT FE , Fx) , Authorized signature: i . This permit a p p ss�! I application expires if a permit is not obtained within 180 AW∎111 , _.y...., days after it has been accepted as complete. =In — '- Date: `A _ \'D • Fee methodolog set by Tr- County Building Industry Service Board : ^Buildi:gTormitsttv£EC Permit App.f . c 10/01/09 449- 4617T(11/02/C0}A/1VE13) ONI�000 ONV JNIlb�H a 4 99 Zl o . ZZ ^�N 6'd 170666L9C09