Permit AY
, CITY OF TIGARD MECHANICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: MEC2009 -00430
Date Issued: 08/18/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S103C805600
Jurisdiction: Tigard
Site address: 12201 SW HOLLOW LN
Subdivision: Lot: 0
Project: Pitts
Project Description: Install A/C Must maintain 3' rear and side yard setback
Owner: FEES
CAPUA, DEBRA S & Description Date Amount
PITTS, GERALD RNERNA J, 12201 SW Air Conditioning or Heat Pump 08/18/2009 $14.00
HOLLOW LN
12% State Surcharge - Mechanical 08/18/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 08/18/2009 $58.50
Contractor:
ROBBEN & SONS HEATING INC
2214 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 233 -5841
FAX: 503- 238 -8849
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
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: C J' 1 4 Permittee Signature: 0li U �l��l -riL
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. (J
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.
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' IVMechanical Permit 412p1 z T'. - onC � � - FoR Ot'r'ict; USE .ow',
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City of Tigard 1 2p09 Re eive Permit No,: 1 E� q -��� Q
i n q 13125 SW Hall Blvd., Tigard. OR 9722 \UG - Plan Review •
Phone: 503.639.4171 Fax•, 503.598.196D t3 Date/By' Other Permit:
'I' I Ci A R D Inspection Lind: 503.639. ^ ! 0 �� r1 � � 11 i bare ReadylBy'. Ions: la See Pap 2 for
Internet; www.tigard or•gov Cr 0.0.11 G \V i EEt - s 1v 1 otitied/Mcthod: SupplementalIoformadon
PLANNING' NtJ 1
t ,. i ,: vf; ;,' ?'! , : '•, ? c'.e. ir '�:<;,la)! s -i " , „2,. ,`rr'� %; ;�5t t'CQl!'Ilyl1�Il;CIA F''`3CHEDULE' �; TJSECHFC'KLtST
,•.. ".::. : -,- ; , - '1<'YPE OF • WORD ,.: rc 1 ...- ..,',inky �Y..:..�•L. . ,_'...
❑ Ncw Construction A�d Mechanical permit fees • era based on t he value of the work
performed, Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
r•
. Value! $
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CATEGORY OF... COr 4p. ;
g`t4 1 }E [AI. EQUIPMI♦NT / SYSTEMS F .
- - amt y dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist.
❑ Multi- family ❑ Master builder ❑ Other: ' Description Qry.1 Ea, Total
. .t' . '. JO SITE ; AVFORAfAT1<ON AND; LOCATION rti +' ,: M4 yXt,:, HeahnpJCOOIIng
Air conditioning or heat pump
• Job site address: •
��� Ma ' • , t . � {requires site plan showing placcmcn 14.00
City /State /ZIF: Furnace 100,000 BTU (duets/vents) 14.00
�� � • r / ' 1 Furnace 100,000+ BTU (ducts /vents) 17.90
Suite/bldg./apt. no.: Project name: , lb 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
hydronic) 14
- 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
O ther fuel appliances
Tax map/parcel no.: - 10.00
WORK?:' " ' `',i:;.'�r•i u' +'q,'lcr fit: ( +}:��;,\�a K j �y� r Water heater
t” :l?ESCRIPT'I0111'UY?;' � +. ;f;' Y ,A� ; �'.�b:_�` „a. fir /. %,fr,�;(:nR�,� "�'
Gas fireplace 10.00
z J Flue vent fbr water healer or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fireplace /insert 10.00 .
C� u^ „ „J Chimney/liner /flue /vent . I — I rk . , 10.00
EItTX:.OW ,,;' d.'? ANTt'ai°.�`,?
t
,: ... ....,. ... .; ,, • Other. 10
Name: , Environmental exhaust laud ventilation
Range hood /other kitchen
Address: • 410 1.- Ai. ' .a .d! . ' equipment . - 10.00
City /State /ZIP: 'I ( C1 1'72A Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone:” ; . (. , Fax: ( ) toilet compartments, utility rooms) 6.80
4 :,; t ;. corv'rnc'r F " ;.'' + f ; Attic /crawls+ ace fans 10.00
` . ►r _ - 'PERSQi >' ^.�
1 Other 10.00
Business name: -- JAR 4►Q_('J of/ : - 4 I Fuel t iu
PP g
Contact name: ` +l $5.40 for first four; $1.40 for each additiona
l { �,h Furnace, etc.
C
Address; `-C -
_^ Gas heat pump
City /State/ZIP: ' 111 0 J - ■ Li , Wa11 /suspendcd/unit heater -
Water heater
Phon I r �� ) Lf Fax: 7 j Fireplace 4.
E-mail: A / tt a e '. - -/ /j` l
-- - (.,.41� Range '':/ .''. CON'IRACTOR ` '; ;;w; ,i, 'g'i 0ri 'H'l; t` k: as i1 Barbecue
Business name: Clothes dryer(gas)
► �� A •Q 1L/� iVJ �� ( Other:
Address: � ,� •" �� Q V ii'i ti":.”; f ; "':`'M);Cd "'•
City/State /ZIP: (V 1 4 e, Subtotal
Minimum per
h°T'I !h`.' )7:-.7-- 4 , l .tjr■ Plan review (25% of permit fcc)
GCB lic.: f State surcharge (12% of permit fcc) �,�7
6 �`` TOTAL PERMIT FEE r
\` This permit apptr'cation expirrs if a p is not obtained wit • in ISO
Authorized signa ih . ! . ( days after It has been accopred as complete.
Print name: . A k-ti\ f\. k• V`k gate: Fee methodology set by Tri- County Building Industry Servica Board
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. Robben & Sons, Inc.
. Site. Plan
Prepared by:. 11 4k • Date:. -.--
Customer Name: Pl HT j
Address:
t��) 9A v ) 40/1. '" ?
alp WI- a1 - 11;13 r
Customer Phone:., 501 -544 Ago:
Property Bouno31) Line I
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