Permit CITY OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: MEC2012 -00040
•
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2012
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Parcel: 2S110AC01000
Jurisdiction: Tigard
Site address: 11545 SW BEEF BEND RD 20
Project: Wellington Estates Subdivision: 2003 - 083 PARTITION PLAT Lot: 2
Project Description: Furnace replacement.
Contractor: ROBBEN & SONS HEATING INC Owner: FERN VALLEY PROPERTIES LLC
2214 SE 8TH AVE BY CAMBRIDGE REAL ESTATE SERVICES
PORTLAND, OR 97214 PO BOX 2968
PORTLAND, OR 97208
PHONE: 503 - 233 -5841 PHONE:
FAX: 503 - 238 -8849
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 01/19/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 01/19/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/19/2012 $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 503.639.4175 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.
Jan. 18. 2012 11:31AM Robben & Sons Heating Inc. No. 7657 P. 1
Mechanical Permit A lication
I ou U1 1(1.1 fit (1 \1.1
.c4.) N....... City of Tigard Received
13125 SW Hall Blvd., Tigard, OR 97223 Date/13y; P ermit No.
Phone: 503.639,4171 Fax: 503,59 Plan Review ��C l�'tl�t3 :
t i; 1 i , 1 Inspection Line: 503.639.4175 \�. Dat Other Permit;
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Notii{ed/Method: Supplemental Information
� Date !?3 3eePe Page
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O New construction f7r • ���� . , :`���°ttl:���e,;17SE Cf�C
Addltjon/alteratio cli so t Mechanical permit fees* are the on the value of the work
0 Demolition ❑ Other: % performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials e•ui•ment labor ov
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1. overhead •
•CA Gt5R'12' a�S,`� � . '�'c;> : :�: ,, :;� and • rofit.
::d:.. , - .?,V ..... , . `+ . ? }. r4f;` ;i,. ,f�`n;1r1+ :0 ;:i�, .1;t ,,i����
r 1- and 2- family dwelling ❑ CommerciaUindustrial [] Accessory building " :M: r S "FE)u$
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0 Multi - family ❑ Master builder 0 Other: For special lry/ermarfon use checklist.
: 'cJIb13's r''fuf't -1 9 s ? Descri'lion
.,�. , - 11i}F ? ' . QtY- Total
` °� t.� ",r"s, �.�'�: , Heath_ co olln :
Job site addre &s. 1 - 1.111,4r- -� Air conditioning
iii re r Ian ahowin:.laeemenr
ri ► . 111,..' Annex 100 00013TU ducts/vents .�
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S u i te/bidg. / apt. no.: p ro j ect name. 1 I f Fumaee 100 000+ 13TU dva 54.91 Mi
Cross street/directions Co Job site; 6
Duet work MI
H dronic hot water s stem NM 23.32
Residential boiler (radiator or
h dronic 23.32
Unit - (fuel-type. not electric),
in-wall ll in in -dd uct t sus .ended nded etc. 46.75
Subdivision: Lot no.: Ot Flue/vent for an of above �
Tax map /parcel no.: Other: 23.32
NM
, t;; • y� p/ , Other fuel a "lioness
•• ;• a 7 rc 7 i,* 1;#0,' 0 .:i r . . f 7 .u�i '' i tl6 7'''''' Water heater 23.32 MI
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Gas fire k lace �
It ���` o ....ir Flue vent for water heater or gas
fire' lace 23.32
Log lighter (gas) 23.32
Wood/ .cllet stove _ _ 33.39 al
Woad Gm.lace/insert 23.32
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�o" .0.r rl ∎ rayA. 1 Environmental exhaust and ventilation 2332
Address. `1 r Range
+ -��` '� ��� a in hood/other kitchen
^ meet 33.39
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1>,} •(r. o � .. Clothes d er exhaust
Phone: ,�� fir FaX: ( ) Single -duct exhaust (bathrooms, - 33.39 MI
. 1 µ';, .., �.,. ;i y. ,� �, r a toilet torn. ertments utili rooms
:, ..... .G "`� r'� ,t sit COQ h .ct� 6 ` Attic/crawls, 23.32
l�i�,,., C•; 1 , ace fans 23
� .32 EMI
: it 1 ��` a ' �� Other: 23.32 NM
Contact name. `� Fuel Tin
'� �'�"` 3 /II $14.15 for first four $4.03 for each additional
Address: � m �
4A. A
Wall/sus. ended/unit heater _ �Min
Phone: • 1 :0 .f . ell �' f, 4
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«wa w' es pj.`� Clothes d cr : as
• Address: � - � r 'ti _� ' j `r�1
f Other: ���
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Phone. • 420 � / e . ,.. � , �-�!�
>•� Istria h r II Minimum mum • ermit fee ($90.00) �'
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State surcharge (12% of permit fee
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Authorized signature: 41. � II TOTAL PERMIT FEE 1 "'
Thi permit application expires If a perwtt is not obtained within 180
�� :� :�� ,. bale iP! t days after it has been accepted as eompteta
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Ingaiid4Perm$ - rem ilApp doe romicei P ®e methodology oat by TFi •CoUnly Building industry gervice Board
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