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Permit II CITY OF TIGARD MECHANICAL PERMIT �' a COMMUNITY DEVELOPMENT Permit #: MEC2010 00637 T 1, ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/08/2010 i Parcel: 2S114BA14500 Jurisdiction: Tigard Site address: 16160 SW COPPER CREEK DR Project: Kitchell Subdivision: COPPER CREEK NO. 4 Lot: 110 Project Description: Gas furnace installation. Contractor: ROSE CITY REFRIGERATION HEATING & AIR LLC Owner: KITCHELL, BEN PO BOX 19207 16160 SW COPPER CREEK DRIVE PORTLAND, OR 97280 TIGARD, OR 97224 PHONE: 503 - 636 -5371 PHONE: 503 -524 -6946 FAX: 503 - 655 -4669 FEES Specifics: Description Date Amount Furnaces < 100K BTU 12/08/2010 $46.75 Type of Use: SF Flue/Vent For Any of Above 12/08/2010 $23.32 Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 12/08/2010 $10.80 Occupancy Grp: Minimum Fee Adjustment - Mechanical 12/08/2010 $19.93 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 1.800.33 Issued By: / // Permittee Signature: c/> / Call 50 '• "': • 5 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. 12/07/2010 16:41 5036554669 ROSECITY PAGE 02/02 Mechanical Permit Application oil roR;orrrcF 1JCF olvr Cl Of Tigard f4 Received Fcr)mt 1Jo b D ol e /By: I e - MI // V - _. . • n 13125 SW Hall Blvd., Tigard, O 7223, '�% Plan Rcvw ic Phone: 503,639,4171 Fax: 503. ' t rl Other Permit; TlGAK17. A Inspection Line: 503.639.4175 � Date/By: Date Ready/By: Y: El See Pape 2 for Internet: www.hgard or',gov O < i �� \�? 4et Notified /Method: Supplemental Information TYPE OF WOR!\'s \\*i COMMERCIAL FEE" SCHEDULE — USE CHECKLIST ``� Mechanical permit fees* are based on the value of the work ❑ New construction ® Additionlalteratitrk�Jiacement performed. indicate die value (rounded to the nearest dollar) of all ❑ Demolition C7 Other: mechanical materials. equipment, labor, overhead, and profit. CATEGORY OF CONSTRUCTION Value: $ RESIDENTIAL EQUIPMENT / SYSTEMS FEES`r ® 1 - and 2- family dwelling ❑ Commercial /industrial © Accessory building For special informs/ ion use checklist. ❑ Muhi family 0 Master builder © Other: Descri tion p Qty. Ea. Total .100 SITE INFORMATION AND LOCATION Heating /cooling ,lob site address: 16160 SW Copper Creek Drive Air conditioning (renutn!s $tie pion $hewing placement) 46.75 City /State /ZIP: Tigard, OR 97224 Fumace 100,000 BTU (ducts /vents) 1 46.75 46.75 ,/� � Fumacc 100,000+ BTU (duct;/v @ »t5) 54.91 Suite /bldg. /apt. no.: Project name: 1V s ICI fr �e -(1 Heat pump 61.06 Cross street/directions to job site: Duct work 2332 jydronic 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 Flue /vent for any of above 1 23.32 23.32 Subdivision: Lot no.; Other: 23.32 Tax map /parcel no.: Other fuel appliances DESCRIPTION OF WORK Water heater 23.32 Install 96% Efficient Gas Furnace FIu e v ( venent t f foor r 33.39 Flu water heater or s;as fireplace 23.32 Log lighter (gas) 23,32 Wood /pellet stove 33.39 Wood fireplace /insert 23.32 ® PROPERTY OWNER ❑ TENANT Chirnne� /liner /flue /vent 23,32 - - -._ Other: 23,32 Name: Ben Kitchell Environmental exhaust and ventilation Range hood /other kitchen Address: 16160 SW Copper Creek Drive equipment 33.39 City /State /ZIP: Tigard, OR 97224 Clothes dryer exhaust 33.39 -- Single -duct exhaust (bathrooms, Phone: (503)524 - 6946 Fax: ( ) toilet compartments, utility rooms) 23.32 ® APPLICANT © CONTACT PERSON Attic /erawlspace fans 23.32 Other: 23.32 Business name: Rose City Heating & Air — Fuel pipkig Contact name: Jeff Pangborn 514.15 for first four; 54.03 far each additiona[ Address: Furnace, etc. 1 Gas iteat pump City /State /ZIP: Wall /suspended /unit heater Phone: (503) 636 -5371 Fax :: ( ) Water heater __ T Fireplace E -mail: jefti[ rosecityheating.com Ran €e "— CONTRACTOR Barbecue Clothes dryer (gas) Business name: Rose City Heating & Air ,._- � Other: _ _ Address: PO Box 19207 MECHANICAL PERMIT PEES* City /State /ZIP; Portland, OR 97280 Subtotal Minimum permit fee ($90.00) 90.00 Phone: (503) 636r - 5371 Fax: (503) 655 - 4669 Plan review (25 °l° of permit fee) CCB tic.: 161325 State surcharge (12% of permit fee) 10.8 — TOTAL PFRM1T FEE. 100.8 'Phis p ermit a expires if a permit is not Obtained within it3p Authorized signature: days after it has been accepted as complete. Print name: Jeff 1'angborn Date: 12/7/10 " Fee methodology set by Tri County Building Industry $ervice Board 1: 1Building \PermitslMEC.P°rnitApp.doc I0/01/09 440-4617T(11 /02 /COMAVEB)