Permit CITY OF TIGARD MECHANICAL PERMIT
- 2 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00176
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/22/2011
Parcel: 2S111 CA11500
Jurisdiction: Tigard
Site address: 9589 SW LAKESIDE DR
Project: ROMANO Subdivision: LAKESIDE PLACE Lot: 6
Project Description: Furnace replacement.
Contractor: MECHANICAL INC Owner: ROMANO, KENNETH W & KAREN R
PO BOX 19569 9589 SW LAKESIDE DR
PORTLAND, OR 97280 TIGARD, OR 97224
PHONE: 503 - 244 -1730 PHONE:
FAX: 503 - 245 -7613
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 04/22/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 04/22/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/22/2011 $43.25
Occupancy Grp:
Stories:
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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ��. / Permittee Signature:
Call 503.63'. .y 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.
Apr. 22. 2011 8:22AM No. 4566 P. 1
Mechanical Permit Application MR 4 )IF 1 1 1 iSI. U I..'
City of Tigard Received
1114 -- q 13125 SW Hall Blvd., Tigard, OR 97223 -C)S) Date/By Iffrf // /sly Petttlit 14° (r Vi•--rw) I 7 &
Plan Review
II Phone 503.639.4171 Fax, 503.598.1960 1--■ Date/sy: Other Pit:
-
i i i.; A Pp 111Spection Line: 503,639,4175
`1
a , %\ Date Ready/By tura: lill See Page 2 for
Internet: www.tigard-or.gov _
.0 - Notified/Method. Trr Supplemental IdennatIon
IC.14 0 )
.', °. REM . , IF,57:, ittEMENEENSIMIM. , 'I4
Mechanical permit fees* are based on the value of work
0 New construction g Addition/alteration/rOsteMillt
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition Other; t .,„. \:\
mechanical materials, equipment, labor, overhead, and profit.
Vilarliffitair ' m3 !"9 'III. r ''' 761 ' '. :'i " "" 7 ".1 N MINTREIN Value: $
,41, 1 i 1.1[ ■ , • ' ..r.,-,. , , ,,,•• 4•;,,,, ,“•,,,, .. " Aral ^ a til 1 ' 'i, ■ I: 1 1. luntirimookiciimeniruifitioilakaratAinymanzsmnraginfiw
1- and 2-family dwelling 0 Commercial/industrial Ej Accessory building
For s tal in
Multi 0 Master builder 0 Other: 'slifEllih.41111111:4414,VgifiScighikitc.AMI irgailMILItill
cformat ion use checklist,
Description I Qty. Ea. J Total
Mil V , IT 't'i 1411N5 1-",,,' Heating/cooling
Air conditioning
Job site act:tress: ci 5 8 GI 3L) Lo,kes tele 7)17_ (tequires site plan showing placement) 46,75
City/State/ZIP: --t- t, e 4 q -0.2 (.1, - Furnace 100,000 BTU (ducts/vents) 1 46.75 it 4 ,115
Furnace 100,000+ BTU (duets/vents) , 54,91
Suite/bldg./apt. no.: I Project name: . '"R 0 m 0_40
_ Beat pump 61.06
Cross street/directions to job site; Duet work 23.32
o P - F 9 9 ■i t A Rai' -- otkrioct vri erl Hydronic hot water system
23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel not electric),
in-wall, in-duct, susurided, etc. 46,75
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
-
Tax map/parcel no.: Other fuel appliances
rigraillEMEMZEREMESITEMiur 1 111 .11 1 , ''' l' NUE Wa""cat" 23.32
Gas fireplace 33,39
a( 0 -cu.ev\tic.g..._. Flue vent for water heater or gas
firellace 23.32
. . Loth test(r gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
ENEEF2g1;7 t qi . q71111 l Other: 23.32
Name: KiLVVA-e41 al• Ka-G2-4 ' AA 0-0-0 Environmental exhaust and ventilation
Range hood/other kitchen
Address: Gt 5s-i 5 L1/4) rake s c , , 2 , 0, ?....
equipment 33.39
City/Sutte/ZIP: r CC_ * S7-4- ,3�. , Clothes dryer exhaust 33.39
• Single-duct exhaust (bathrooms,
Phone: (731) ten 3).. Fax: ( ) toilet compartments, utility rooms) 23.32
PICEA ffl,MEMEEMEEIFaEIETEFISEEMEEM Attialcntwi5PaCe fans 23.32
Other: 23,32_,_
Business name: S c.. z.e r _ 0,61.1A.51-. C)& 0,w ii , c ,... v . ) l c o
Fuel Plain
Contact name: jp t c ' _co ii-j‘ cs
$14,15 for first four; $4.03 for each additional _
Furnace, etc,
Address: e 0 f oo , IL 1 c s4 , Ci
Gas heat pump
City/State/ZIP: • -V.' tia_‘■\ 4 (t- 1 1230 WalVsuspended/unit heater
Phone: (601) ,, n so Fax : (6 07‘tS. 74,1 2 Water heater
Fireplace
E-mail: 42.r V ' c.e_ ( m eckel 1 C. tot 7.- Range
gall& ,t,',11' t,1,1 tarifilEENIMEE,,,', t' c't NErittlii:il gall Barbecue
Clothe dryer (gas)
ill
Business name: Cl
Other
Address: ----- A 4 3/ 9\---e-
,", 1 1 7.: 3 't". i. ' ir Megla .
City/StateJZIP: --. Subtotal
Minimum permit fee ($90.00) 90,0C>
Phone: ( ) Fax: ( )
Plan review (25% of permit fee)
CCB lic.: 1 .D.4 g5 . State surcharge (12% of permit fee) 1 0 111
TOTAL PERMIT FEE i 00 , i)
Authorized signature: JikciA42/4. Thh permit application expires Ifs permit is not obtained within 1/10
days after It has been accepted as complete.
i
Print name: Sle e C c %lei , Date: 1-1-.2,--ir • Fee methodology set by I'd-County Building Industry Service Board
1. Suilduagemuts■MEC-PercretA09,doo 10/01/09 440-4617f (11/02/Com/WEB)