Permit CITY OF TIGARD MECHANICAL PERMIT
m COMMUNITY DEVELOPMENT Permit #: MEC2012 -00159
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2012
Parcel: 2S 111 AD01900
Jurisdiction: Tigard
Site address: 14580 SW 88TH AV
Project: CHAMBERLIN Subdivision: PINEBROOK TERRACE Lot: 16
Project Description: Installing (1) electric residential boiler.
Contractor: THE HEATING SPECIALIST INC Owner: CHAMBERLIN, GENE H
9300 NE HALSEY ST EILEEN J
PORTLAND, OR 97220 14580 SW 88TH AVE
TIGARD, OR 97223
PHONE: 503 - 257 -7000 PHONE:
FAX: 503 - 257 -7702
FEES
Specifics: Description Date Amount
Residential Boiler (Radiator or Hydronic) 03/29/2012 $23.32
Type of Use: SF 12% State Surcharge - Mechanical 03/29/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/29/2012 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types: Electricity
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: � . J L � ermittee Signature:
AMP
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.
M a r . 29. 2 0 1 2 8:42AM Theci a l i s t s No. 0862 P. 1
Mechanical Permit A p plicx, cl
City of �1 and P� c p�ti �`�Q I Received NM FOR OFFICE ICE USE QNI,1'
Iii " 13125 SW Hall Blvd., Tigard, OR 97223 • % 'c \ `4k,)\' Date/By;
a Phone: 503.718.2439 Fax: 503.598.1960 r.c \I .�\ V e hew
Y Other Permit:
TI CARD Inspection Lino: 503.639.4175 Q \V BI See Page 2 for
I Date Ready/By: nternet; www.ligard- or ';6\
Dale Ready/By: Supplemental g
Intormntion
r - -
TYPE 01? 11'0121( • COMMERCIAL FEE" SC bUI,E USE CTTECICI,IST
Mechanical permit fees' are based on the value of the work
❑ New construction ® Addition /alleratitM/replaCetnent
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit. • —
CATEGORY OF CONSTRUCTION Value:3
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES'
® 1 - and 2 family dwelling C7 CommerciaVindustrial ❑ Accessory building Pot special InJbrmailar use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION • Heating/cooling:
88th Air conditioning
Job site address: 14580 SW 88 Ave.. (requires Bite plan showing plaoment) 46.75
City/State/ZIP: Tigard, OR 97224
Furnace 100,000 BTU(duotslvema) 46.75
Furnace 100,000+ BTU (duets/vents) 54.91
Suite/bldgiapL no.: Project name: - 32 r 3 ✓� 1 . _ 1 Heat pump —
�Lla1 (requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
13ydronic hot water system 23.32
• Residential boiler (radiator or
* NO A4f,21 r2) Nf c , q pe- hydronic) 1 23.32 23.32
It P / I' J Unit heaters (fuel -type, not electric),
-1-;
- /.�►4,1- / 1 ,T+-ee-t a I't f} /as / Ir l Q 7) in -wall, in -duct, suspended, etc. 46.75
Subdivision: P' `� Lot no.; Flue/vent for any of above 23.32
Other. 23.32
Tax map /parcel no.: Other fuel appliances; _
. DESCRIPTION OF WORK Water heater 2132
Install Electric Mini- Boiler/Radiant System Gas fireplace/insert 33.39
Flue vent for water heater or gas .
fireplace 23.32
Log lighter (pas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
❑ PROPERTY OWNER r la TENANT Chime /liner / luek 2 3.32
Name: Gene Chamberlain Other: - 2332
Environmental exhaust and ventilation:
Address: 14580 SW 88 Ave. Range hood/other kitchen
equipment 33.39
City /State/ZIP; Tigard, OR 97224 Clothes dryer exhaust 33.39
Phone: (503-)639-6897 g am: ( ) — Single -duct exhaust (bathrooms,
toilet wmpartmen[s, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic/crawispace fans
. 23.32 _ _
Business name: Other; 23.32 _
Fuel piping: _
Contact name: SI4.15 for That tour 54.03 for each additional
Address: Furnace. etc.
Gas h pump
City/Stale/ZIP:
ear WalUsuspended/unithcater
Phone: ( ) l Fax: : ( ) Water heater
E-mail: Fireplac
Range
•
CONTRACTOR. Barbecue
Business name: The Heating Specialist Clothes dryer (gas)
Other:
Address; 9300 NE Halsey St. MECHANICAL PERMIT FEES' .
City /State/ZIP: Portland, OR 97220 Subtotal
Phone; (503) 251-7000 Fax: (503) 257 -7702 Minimum permit fee (590.00) 90.00
- CCB lie.: 56628 _ Plan review (25% of permit fee)
State surcharge (12% of permit fee) 10.80
TOTAL PERMIT FEE 100.80
Authorized Signs i�, I ,� Thi pe rmit application expires if a permit Is nol obtained within 180
• days after it has been accepted as complete.
I Print name: Tracy Jones Date: 03/28/12 • Pee methodology set by Tri -Couery Building Industry Seeviee Board