Permit CITY OF TIGARD
MECHANICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: MEC2012 -00489
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/25/2012
Parcel: 2S 111 CA11800
Jurisdiction: Tigard
Site address: 9765 SW OAKS LN
Project: Klein Subdivision: SATTLER PARK Lot: 3
Project Description: (1) furnace replacement
Contractor: RUMBOLD HEATING & AIR COND INC Owner: KLEIN, DAVID A &
PO BOX 397 KLEIN, CINDY A
BEAVERCREEK, OR 97004 9765 SW OAKS LN
TIGARD, OR 97224
PHONE: 503 - 656 -0475 PHONE:
FAX: 503 - 632 -8669
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 09/25/2012 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 09/25/2012 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 09/25/2012 $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: el ( 4 PPu` O/Q.
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.
FROM : R FAX NO. : 656 4572 Sep. 25 2012 09:03AM P1
.
'
Mechanical Permit ApplicationRE 1. 1
C'm74VE:1----' Fortorricr lltil:. ONLY
City of Tigard . - Received
: ,..- 13125 SW Ilan Blvd., Tigard, OR 97223
Ill et le<b>• So(
Plan Revi Permit No. m ge. abla
Other Permit:
- l . Phone: 503.639.4 17 I Fax: 503.598.1960 SEP 2 2012
ew
Date/By:
inspection Line: • 503.639.4175 CITY •
,-„;," Date Itcady/By: uris: El See Page 2 for
Internet www.tigard-or.gov
BUILDING OfinsiOu Nowi.,x,: '....0c, 1 Supplemental InfurmnSiOn
-"
4;2 ,.::..0.010
e
0 New construction 2rAddition/altcration/replacement Mechanical permit fees* arbased on the value of the work
performed. indicate thc value (rounded to the nearest dollar) of all
1:1 Demolition ID Other: mechanical materials. equipment, labor, overhead, and profit.
3...0 tAIFS*:1:ii:1..':::7:-...:t!,.......-t2:::.:?.-. Value: $
`'.....; AZO:4
grl- and 2-family dwelling 0 COmmerciallindustrial 0 Acces.sory building
Fur special information use checklist.
1: Multi-family 0 Mater builder 0 Other;
Des cript ------- 1 .-- 1 - ‘ Qty. Ea. I Total
4. .00.f$OV. - 0, -6 7* . gtgf 61 ! " ;..0 .7 j.Wit : i i tiiit,=.:1;:::F.'g7Pr Heatii/e0Oling
__________
Job site address: J7j7 510 /IS tA) . Air conditioning or heat pump
(recpares site_plan showing placement) 14.00
City/State/ZIP: ri 5i ebe_ r i 0 , e f-.?Z Furnace 100,000 BTU ((in i , 14.00
-
--- Furnace 100,000+ BTU (ducts/vent%) 17.90
Suite/bldg./apt. no.: Project name:
Gas heat pump 14.00
—
Cross street/directions to job site: Duct work . 10.00
$.* 21-?-#4 Ilydronie hot water system . 14.00 —
Residential boiler (radiator or
hydrnnic) 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
t.: Water heater 10.00
—
Gas fireplace 10.00
.,•,/ _ ' . . 7,9-c e- Flue vent for water heater or gas —
fireplace 10.00
Log lighter (.gas) 10,00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
;
Chimney/liner/flue/vent /liner/flue/vent 10.00 .._
10.00
Name: L /V Environmental exhaust and ventilation
Range hood/other kitchen
Address: SA-m-e---- equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
• . - Single-duet exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 6.80
7 :77 1.24 • ; • : .f : 7 : •: " ..r.":) . . : 7 i .0•Wil i gOtite'l.. 3: „A i :•;;.:.5.•;1E•itt;:.:,1,06/Nxe . ..Eitii$0* . .. : ,,: , _: - : AttiJcrnwls 1000
Other: 10,00
Business name: —
- Fuel piping .
Contact name:
$5.40 for first four; $1.00 for each additional —
Furnace, etc. .
Address:
Gas heat pump
City/State/ZIP:
Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) Water heater
- , Fireplace
E e(ikilboklik.4 P.) 0 . co rvN Range ., .
'..:i n5... Barbecue 1 —
.
I' Clothes dryer (gas)
Business name: , i /7, 0 0 , apl A; . • :41 ' •
Other:
Address: 10 i „, '9 ',...;•.:'.'.-:••Pg::••.::,.:OfttitilitdAtitiiiiintoss.,:::::".:!::..;i:::::::::: -
City/State/ZIP: /11,4t.'Iezeeek;,,7, "
. Subtotal
Phone: (:)3 )„09.75— Fax: ( .5-2,..0 6 32— e--4., L,. Minimum pc= it fee ($72.50)
Plan review (25% of permit fcc)
—
•
CCB lic.: / 7s9 7
State surcharge (12% of permit fee)
TOTAL PERMIT FEE --
Authorized signature: This pe
This I 60 - gb
rmit applicnti:D expires if a permit is nOt ohtnincd within 180
days after it bas been aocepted as complete_
Print nun.: k .A . _ . 4, 7 t i, ,e,/c, eez,_ - Date: ,-zs I . Fee methodology set by Tri-County Building Industry Service noard
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