Permit III CITY OF TIGARD MECHANICAL PERMIT
i
' °, COMMUNITY DEVELOPMENT Permit #: MEC2010 -00646
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2010
TAG ,.. ' Parcel: 1S136DC00300
Jurisdiction: Tigard
Site address: 11550 SW 72ND AVE
Project: Alcorn Subdivision: FRUITLAND ACRES Lot: 16
Project Description: Install gas furnace, venting, ductwork & gas piping.
Contractor: RCG SERVICE LLC Owner: ALCORN FAMILY TRUST
11235 SW 83RD AVE. 19325 SW ROSA RD
TIGARD, OR 97223 ALOHA, OR 97007
PHONE: 503 - 888 -9849
PHONE: 503 - 926 -7358
FAX: NA
FEES
Specifics: Description Date Amount ,
Furnaces >= 100K BTU 12/10/2010 $54.91
Type of Use: SF FlueNent For Any of Above 12/10/2010 $23.32
Class of Work: ALT Type of Const: Fuel Piping 12/10/2010 $14.15
Occupancy Grp: 12% State Surcharge - Mechanical 12/10/2010 $13.88
Stories: Duct Work 12/10/2010 $23.32
Fuel
Fuel Types:
Gas Pressure:
Total $129.58
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 i wod s suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No i cation Cen Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direc questions to OU y c 1 t 503.232.1987 or 1.800.332.2344.
Issued y: K ,.... 1 4. Permittee�'.nature: �,! /,! /�' /, /�� L___.--
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.
1),,.: `c-c-vi ,3 -7 -- 2y3q_.
echanical Permit Application FOR OFFICE USE ONLY
Received
City f Tigard PerniitNo.: �
Y g Date/By: /%Z I d %l
Plan Review
�O �� ;
II 13125 SW Hail Blvd., Tigard, OR 97223
Other Permit: A'C
Phone: 503.639.4171 Fax: 503.598.19 \ \ : \CCe
Date/By
T GA R D Inspection Line: 503 - 639.4175 �Q� Date Ready /By: Jurist P1 See Page 2 for
Internet: www.tigard- or.gov �® O Notified/Method: Supplemental Information
4: °'V , 4 4. V. -r .: rigi'; ,TYPE OF WORK , j' C1 , � •�- t TdCOl ERCLkLi SCHE US E CKL
CHEI ST
❑ New construction ❑ Addition/alteration/r� �I � ; a ,60, :k -�' Mechanical 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.
, t r „ -^ ,• '.* CATEGORY OF CONSTRUCTION "Jn } 1 ri ? ` '- ri ,n,-0--,.;,. * Value $
z , RESI EQUIPMENT / SYSTEMS FEES* I'
] -and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building DEN F1A i
For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: Description Qty. Ea. Total
1 '' '. `' - u aJOB, INFORMATION A N D LOCATION " ' 4 A ' • H eat i n coolie
Job site address: /7 S " - S :� ..c.'‘-. 7 2_ :v 'f) t p -
Air conditioning
(requires site plan showing placement) 46.75
City /State /ZIP: '77. G ce .--- - 9 C Z z___-__3 Furnace 100,000 BTU (ducts /vents) 46.75
Furnace 100,000+ BTU (ducts/vents) r 54.91 _-
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross - street/directions to job site: Duct work Pi 23.32
? 11 4 � ) _ 7 -i A £, �/ f ` Hydronic hot water system 23.32
/ 7 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 reap /parcel no.: Other fuel appliances
y it :' ., . ,�. - -` n , f J �, s , Water heater 23.32
?�i. `Sk_ „ , , : 4 i . 2.-:,;4'' DES C R I P TION OF WOR , _:;i ?
K :F; f • - .t.'
l r j Gas fireplace 33.39
/ � � �` /,; C ca �� � 1-„--, Flue vent for water heater or gas
C 2 e. C-;--A-L-42 r `"� ._��� f � 1- fireplace 23.32
l y j Log lighter (gas) 23.32
� 'e •!" L=-e' Wood/pellet stove 33.39
Wood fireplace /insert 23.32
t? ' ® PROPE , RT ,OWNER � , `i sa . ® TENANT + , k � w, ,r-u Chimney /linerlflue/vent 23.32
; ,..�, Othe 23.32
Name: .. ,4,,_,..e . ..., - ,4-(_(2,,, Environmental exhaust and ventilation
n Range hood/other kitchen
Address: la, 22...---5 ‹ J i �CJV --/ - . equipment 33.39
City/State /ZIP: '9 G�/ - / c L ,S C Clothes dryer exhaust 33.39
��-- -- // Single -duct exhaust (bathrooms,
Phone: (6) 7Z(% 7 „� ! Fax: ( ) toilet compartments, utility rooms) 23.32
i; as'` a - �' +� '' ` 'r . -' tm • 5 ' **, c+ , i » d - n �'° Attic /crawlspace tans 23.32
ICANT ❑ : "CONTACT P PERSON a a s
_��zn,tt`� u,� � - ._,. .tit ...�t_sr ,, a.` •. .. :... r ..,.,. .r. ..,,,.,?�a",.- '�«�ta '
Other: i 23.32
Business name:. -El ¶ r °--t/• c;< 4.,i-e piping
t p
/ p g
Contact name: te r?. - ' -� ' $14.15 for first four; $4.03 for each additional
Address: e 7-3 S �-• � ,r--t Furnace, etc.
n ES Gas heat pump
T , U� ,�Z z �
City /State/ZIP: r7 „ Wall /suspended/unit heater
/ .� r^ t
Phone: (512 ) Rt j .? ,rtp/ Fax: : ( ) Water heater
/ Fireplace
E -mail ( L.e 54-7,--.._ L ' G� . r . e-- °''� Range
z w` 1 c , ; :°r b %fCON -N I �� °t `. '
" t •�: Barbecue
I Clothes dryer (gas)
Business name: i cy` �e_✓i' C
t Other
Address: l' 7_4 ) Svc !`r1/ _ : , „ " MEC PERMTT FEES _, ' §b `
City /State /ZIP: s « ,- Ur° ,,l'l 7- z z 3 Subtotal / f 0 . 7:
/ Minimum pet fee ($90.00)
Phone: (S4.-7a'), e3 S nni
_'', e' Fax: ( )
La , Plan review (25% of permit fee)
CCB lic.: `• , ��' State surcharge (12% of permit fee) /, ,
t TOTAL PERMIT FEE Q
- Authorized signa e' This permit application expires if a permit is not obta G t 186
\ : - ■ , i t , days after it has been accepted as complete.
Print [tame: '' , , % .. 1.�� Date: 1 * Fee methodology set by Tri- County Building Industry Service Board
I:\ Building \Pennits\MEC- PermitApp.doc 10/01/09 440 -4617T (11 /02/COM/WEB)