Permit .F v CITY OF TIGARD MECHANICAL PERMIT
'''! a. COMMUNITY DEVELOPMENT Permit #: MEC2009 00189
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/30/2009
Parcel: 1 S134BD11100
Jurisdiction: Tigard
Site address: 10957 SW 118TH CT
Subdivision: PENN LAWN ESTATES NO.2 Lot: 39
Project: Brokke
Project Description: Install coi and central a /c.
Owner: FEES
BROKKE, CHRISTIAAN J & Description Date Amount
BROOME, DIANE M, 10957 SW 118TH CT Air Conditioning or Heat Pump 04/30/2009 $14.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 04/30/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 04/30/2009 $58.50
Contractor:
ROSE CITY REFRIGERATION HTG & AIR
PO BOX 19207
PORTLAND, OR 97280
PHONE: 503 - 636 -5371
FAX: 503- 655 -4669
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressue
Total $81.20
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 -0100. You may obtain a copy of the rules
F
Issued By: � k n f � Permittee Signature: 4\ � — � ` V
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. (�'
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 RECEIVE rc)ll OH1( t 1L (apt
City of Tigard Received ^ n.
Date /By: s p( 1 ` ( _ Permit No.: all
13125 $W Ilan Plan Review 131vd..'figard, OR 97223 APR 2 8 200.. V , •
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
TI G A it 17 Inspection lane: 503.639.4175 CITY OF TIGARDDate Ready/By: hnss: H See Page 2 for
Internet: www.tigard- or.gov f ifi«1Rvlcthod: I n� Supplemental Information
BUILDING DNISIP l `
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
E1 New construction 0 Addition /alteration/replacement Mechanical permit fees* are based 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.
CATEGORY OF CONSTRUCTION Value: $
CI 1 - and 2 dwelling ❑ Commercial/industrial ❑ Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Multi family ❑ Master builder ❑ For special information use checklist.
Other:
Description 1 Qty. I Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
lob site address: 10957 SW 118 court
(requires s an plan showing placement) 1 14.00 14.00_
(mot P 8P )
CitY/State/ZIP: Tigard, OR 97223 Furnace 100,000 BTI.1 (ductshronts) 14.00
Furnace 100,0004- BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: Brokke A/C Gas heat pump 14.00
Cross street/directions to job site: Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Flue/vent for any of above 6.80
Subdivision: Lot no.: Other. 10.00
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
Gas fireplace 10.00
Install coil and central A/C unit Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.(10
Wood/pellet stove 10.00
Wood fireplace /insert 10.00
Chimney /liner /flue/vent 10.00
❑ PROPERTY OWNER ❑ TENANT Other: 10.00
Name: Chris Brokke Environmental exhaust and ventilation
Address: 10957 SW 118 Court Range hood /other kitchen
equipment 10.00
City/State/ZIP: Tigard, OR 97223 Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: (503)435 -7252 Fax: ( ) toilet compartments, utility rooms) 6.80
El APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 10.00
Business name: Rose City Heating & Air Other: 10.00
Fuel piping
Contact name: Jeff Panghorn $5.40 for first four, $1.00 for each additional
Address: PO Box 19207 Furnace, etc.
Gas heat pump
City/State/ZIP: Portland, OR 97280 Wall /suspended'unit heater
Phone: (503) 636 -5371 Fax: : (503) 655 -4669 Water heater
Fireplace
E -mail: rosecityheatin 'comcast.net Range
CONTRACTOR Barbecue
Business name: Rose City Heating & Air Clothes dryer (gas)
Other.
Address: PO Box 19207 MECHANICAL PERMIT FEES*
—
City /State/ZIP: Portland, OR 97280 Subtotal 14.00
Minimum permit fee (572.50) 72.5
Phone: (503) 636 -5371 Fax: (5113) 655 -4669
Plan review (25 °0 of permit fee)
CCD lic.: 161325 State surcharge (12% of permit fee) —84. 4• - 74'
TOTAL PERMTI FEE
Authorized signature: per application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
a '10 I1(, I * Fee methodoloev set by Tri- County Building Industry Service oard
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