Permit CITY OF TIGARD MECHANICAL PERMIT
. COMMUNITY DEVELOPMENT Permit #: MEC2011 -00496
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439
Date Issued: 11/03/2011
Parcel: 25101 DB00400
Jurisdiction: Tigard
Site address: 13085 SW 76TH AVE
Project: Fields Subdivision:CONDO SUPPLEMENTAL PLAT NO 4: Lot: 22830 -2
Project Description: Oil to gas conversion for replacement boiler This permit is for 25' of gas piping and venting
Contractor: ROBBEN & SONS HEATING INC Owner: FIELDS, FRED W REVOCABLE LIVING
2214 SE 8TH AVE 1149 SW DAVENPORT
PORTLAND, OR 97214 PORTLAND, OR 97201
PHONE 503 - 233 -5841 PHONE: 503 - 288 -7084
FAX 503 - 238 -8849
FEES
Specifics: Description Date Amount
FlueNent For Any of Above 11/03/2011 $23.32
Type of Use: SF Fuel Piping 11/03/2011 $14.15
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/03/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/03/2011 $52.53
Stories:
Fuel
Fuel Types Natural Gas
Gas Pressure:
Total $100 80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or direct stions OUNC by calling 503.232 1987 or 1.800 332 2344.
Issued Permittee Signature: i f
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Nov. 2. 2011 9:51AM Robben & Sons Heating Inc. No. 6669 P. 1
Mechanical JPermitAul�licatio>It -.
-- I tilt ctl l WI t �I -: 0\1.} City of Tigard Received
K 13125 SW Hall Blvd„ Tigard, OR 97223 \\
atate/By. 0!���II M Pe—"No: ii ,_ , '4
Phone; 503.639.4171 Fax: 503.598.196 p �
1,1 t ; r.I s: Inspection Line: 503.639.4175 % " ' other Permit:
Internet: www.11gard�cgov , �Ge+ " `
S see Page a for
��� `- \ uppletneor Informahoo •
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El New construCtlon r Additjon/8ltaratioq / rep � ts �� tlt Mechanical permit fees° are based on the value of the work
performed Indicate the value (rounded to the nearest dollar) of ail
0 Demolition 0 Other;
mechanical materials e. ui ment labor overhead and 'rout
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" Value S
l '' v a. YST'EM5'FE
P - and 2-family dwelling ❑ Commercialindustrial 0 Accessory building " *�c % � : a' 1 , iVIENT�$ gs °,
❑ Multi- family 0 Master builder 0 Other: For special information use eheckl;sr
Descri . lion
'.JO1i,$Slr -"1 ; 0• •; Al, r,.i; i s ,.,.r Qty. Ea. Total
����;w Hearin: Coaling
Job site addressVf 4 , Ait conditioning
�' 4.1 .uires site plan showing placement 46.75
City /State/ZIl':'r ` �.+ II S. Furnace 100 000 BTU duets/vents 46.75 ill II
Suite/bldg, /apt. no.: Project name: furnace 100 000+ BTU ducts/vea 3 '� 54.91
._ Heat pump 61 III
Cross street/directions to job site: Duct work 23.32
H dronic hot waters stem 23.32
eau ,
dron 23.32 �I
Unit heaters (fuel -type, not electric), Ill
in wall in -duct suspended etc. 46 75 MN
Subdivision: I Flue/vent for an of above
Lot nt).: -
Other: 23 23.32
Tax map /parcel no.;
Other fuel appliances
= --. , , • �,,• y ;' it ;, 1 .` ; ,`' ��,; t , ESdR Of(1h9 ;'° 0)04 331,151.3W7 " i ' Watcr heater
23.32
• Gas fire. lace 33.39
P' ifie1 * 6 Flue vent for water heater or gas
s
�'` �, fire' lace 23 32
��# , Log lighter (gas) 23,32
�� ∎— 11.4%. 1111P.‘ A . - Wood/. cllct stove MI 33 39
Wood fireplace/insert 23.32
:;: dt 'pTt �ll 1t.:pVVD7tl i` ;;. ;. 1 :,ciN�3 "v3:'''' .. ,x . -a' .'' n ran. ;.'., ChiRRIO Alner /ftue/vent 23.32
Narita_ '''''g!' 1 '
Other: 23.32
s► ' A.. Environmental exhaust and ventilation
Address; Range hood/other kitchen
!� 01,—.1.— r A e • ui • ment
City /State/ZIP; Y'1 ^ 0 - 33.39
��..l�i � a Clothes dryer exhaust
Phone;) tP� Fax: ( toilet coms artments utili rooms) 23.32
) Single -duct exhaust (bathrooms, Ell 33.39
_ ICI � .�w yu y )
., ; >,E1:;, ' ,4,, l w•t•H� yi ;b,Rtt{Iti 1 A
:; � + ,. , , ,. a' ". �A�;4;..:,�h�M Attic/crawla pace finis 23.32
Business name:
�`�' i�l� 1•r �t I Other 23 32
Fuel piping
Contact name. 1
.d.'IM,•N =— — WI 514.15 for first four. S4.03 lbr each additional
Furnace etc.
Address: r.. ir� ;��
-
City/State/ZIP: �" Gas heat pump
ail
����` a u \ Wall/sus.ended/unit heater
Phone: �� ` i 41 .• Water heater
.,� , Fire
E -mai � �
.%,'...,:"'' '•�•:., ,,= ; . }• , Range
' • :. .',;if �It IY i' >'.o11 nA / r s• t - Barbecue
Business name:
Address: Trim e ,, t•� fl,;�s � �� 1
Clothes dryer (gas) ��
/�
Addre
*� �i_1� I f M »��t
lliko , dm City/Stete/ZI'; _+ a Subtotal v
A ..� /� bt �j�r
Phone.
s1+Y0 y� r ,� y ,N Minimum permit fee ($90,00) M
CCB lie.: ` Plan review (25% of permit fee) 11111.1111111
State surcharge (12% of permit fee) r Rt ' Y
TOTAL PERMIT PEE
Authorized signature: ` ti. Ma r
dia . i. This permit application expires If a permit is nor plet • within 180
1 �r:.� days after it has been accepted as complete.
'- • +� rr1 , ik Dal .' • • Fee methodology set by Tn- County Building Industry Service Board
r\a uJdinBIPsrmIts1 EC PennitAppdoo 10/01/09
440 -46 t7t (I I /02/COMAypnn