Permit CITY OF TIGARD MECHANICAL PERMIT
, * COMMUNITY DEVELOPMENT Permit #: MEC2011 -00082
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/24/2011
Parcel: 2S102BB00809
Jurisdiction: Tigard
Site address: 10210 SW BROOKSIDE PL
Project: GREENWELL Subdivision: BROOKSIDE PARK Lot: 3
Project Description: Gas furnace replacement.
Contractor: REX HEATING & A/C Owner: GREENWELL, EDDIE
14015 SE STARK 10210 SW BROOKSIDE PL
PORTLAND, OR 97233 TIGARD, OR 97223
PHONE: 503 - 255 -7233 PHONE:
FAX: 503 - 257 -6317
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 02/24/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 02/24/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 02/24/2011 $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 ....--__ Permittee 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.
Mechanical Permit Application I-1)1i ( FI1( F. t SI: c,\l A
City of Tigard R.ce1.u► ..
y ✓ Permit No,: '/ . yam /
13125 SW Hall Blvd_, Tigard, OR 97223 il ll it - -: batelB : �I L s�l� •
Phone; 503.639.4171 Fax: 503.598.1960 Platt Renew
,, Inspection Line; 503.639-4175 FE6 2 3 20 Dfl°�Y` Other Permit:
Internet: www_tlgard-or.gov Data R S/8Y: @ See ne for
NotNotified/Method;
IMII SapplemePaata t tiormalion
TYPE F %WORK' +. --1 �'I 11E ";E�:E $CULE' = CHECKLIST
❑ New construction ddition/alteration/replacement Mech
echanical permit foes• arc based on the value ° #'the work
❑ Demolition 12 Other: performed. Indicate the value (rounded to the nearest dollar) of all
— _ m_ echanical materials ipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
and 2- family dwelling ❑ Commercial/industrial RE SWENTIAL.EQUIPA1EI�T•/ SYSTEMS FEES'
❑ Accessory building
❑ Multi - family El Master builder ❑ Other: For special trlforr mrto„ use checklist.
--- . Description 1 Qty. I Ee,7 Total
JOB SITE INFORMATION AND LOCATION HeEing/cooiing
Job site address: 1 sta, Q W C3R.n 4,►7 = Air conditioning or heat pump
� (Yequirea site plan showing placement) 14.00
City /State/ZIP: 'N t 0 Furnace 100.000 BTU (dunnive ss) 1 14.00
- Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. nn.: Project name:
-
_ Gas heat pump 14.00 _
Cross street/directions to job site: Duct work 10.00
Hxdronic hot water system 14.00
Residential boiler (radiator or
hydronlc) 1
Unit heaters (fuel -type, not electric),
in -wall, induct, suspended, etc. 14.00
Flue/vent fbr any of above 6
Subdivision: Lot no.:
Other: _ _ 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORT{ Water heater I 10,00
Gas�lac 10.00 �` f t, b G'xc1 i' v �• . c-v v, W 1Th Flue ven for water 0.00
- -, - �.- -, er hesoor or gas
V■C..a2 ° (. _ ►. fireplace 10.00
I. lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
. PERTY OWNER I
0. xENANT Chimney/liner/flue/vent 10.00
Other. 10,00
Name. C , . ' ,i I` Environmental exhaust And ventilation
Address; Range hood/other kitchen
equipment 10.00
City /State /ZIP: Clothes dryer exhaust - 10,00
Phone: ( ) Fax; ( ) Singlc-duct exhaust (bathrooms,
toilet compartments utility rooms) 6.80
•
tir ►PPLICANI a CONTACT. PERSON Attic/crawlspace fans 10,00
Business name: } A Other: 10,00
/ Fuel piping
Contact name: C.Q q ^-c Q,i,c_o_ ".40 ror first four $1.00 for each addlti.onal
Address: 1 L10 l~ £Writ. c,----. - Furnaoo, etc.
City /State/ZIP: Gas heat pump
cioQ- TyclA‘ t 0 2 3j 91 2. Wallsuspended/unitheater
Phone: (5 ZS S-_ 12.3 3 Fax:: (b`47) 2 0 A --11 Water heater
r�
Fireplace
E lr A Q Ct - 1r , &INN." .
CONTRACTOR Barbecue
Business name: 126...,,- ` 1 + �1 .._ Clothes dryer (gas)
Address:
L Other:
. ;MECIIANICAL PRRMIT FEES*
City /State/ZIP: _ Subtotal
Phone: ( ) g am; ( ) Minimum permit fee (172.50) /rl i.,0
/ Plan review (25% of permit fee)
CCB lie.: l.0 ( i - 1 State ourcharge (12% of permit fee) ici: nj
TOTAL PERMIT FEE /c)(; , , -rt
Authorized S This permlt appnutloe expires if a permit b not obtained within ISO
l r. 7 _ 3 days after it has been accepted es complete.
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