Permit 11 CITY OF TIGARD MEC PERM IT
COMMUNITY DEVELOPM Pe rmit # : MEC2 -007 HANICAL 57
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/12/2013
Parcel: 2S 103DD00427
Jurisdiction: Tigard
Site address: 10890 SW FAIRHAVEN WAY
Project: Scheckla Subdivision: FAIRHAVEN COURT Lot: 11
Project Description: Installation of new gas furnace
Contractor: ROBBEN & SONS HEATING INC Owner: SCHECKLA, KENNETH W & BIBIANNE L
2214 SE 8TH AVE 10890 SW FAIRHAVEN WAY
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 233 -5841 PHONE: 503 - 639 -5697
FAX: 503 - 238 -8849
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 12/12/2013 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/12/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/12/2013 $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
Utilit i ication 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 rect questions to OU by calling 503.232.1987 or 1.800.332.2344.
I sued By: I� I� /ill 0 ,/) k4 Permittee -ignature: ( /> r e�
Call 503.639.4175 by 7:00 a.m. for the next available ins • - tion 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.
Mechanical Permit Application 1.01:01.1 1( I. t I cl',l.l
City of Tigard Received pe rmit No.
5 11 1' LL Date/By: > n - m te j -� 75'7 13125 SW Hall Blvd., Tigard, OR 97223 : Plan Review
- 1�" - Phone: 503.718.2439 Fax: 503.598.1960 �� ,,- Dpie/gy. Other Permit:
II t ; A it n Inspection Line: 503.639.4175 Date Ready/By. Lek „Y See Pale 2 for
Internet: www.tigard- or.gov CITY C 1 2 r( 2 I � tiolifiaUMau+od. Supplemental Information
TYPE OF W O R K t /I � OF TI{at� COMMERCIAL FEE” SCHEDULE - USE CHECKLIST
�G UIVISKJ performed. apical permit fees' are based on the value of the work
❑ New construction ddilion /alteration l � perfo Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipment, labor. overhead, and profit.
❑ Demolition ❑ Other: value: S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
rand 2 family dwelling ❑ Commercial /industrial ❑ Accessory building Perspeciol Wu-motion use checklISJ.
❑ Multi - family ❑ Master builder ❑ Other: Des cription Qty I Ea. Total
JOB SITE INFORMATION AND LOCATION Htntin; /coolie ;:
Air conditiont3 46.75
Job site address. r11t1• Alb r _ (_ may± i Furnace 100,000 BTU (ducts /vents) \, 46.75
City/State/ZIP: Furnace 100.000+ BTU (ducts /vents) 54.91
Heat pump_ 61.06
Suite/bldg. /apt. no.: I - Project name: Duct work 23.32
Cross street/directions to, job site: jydronic hot water system 23.32
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel -type, not electric),
in-wall. in -duct, Sits_ended, etc. 46.75
Flue/vent for any of above 23.32
-- - Other: _ 23,32
Subdivision: Lot no,: Other 11te1 appliances:
Tax map /parcel no.: Water heater 23.32
DESCRIPTION OF WORK Gas fireplace /insert 33.39
Flue vent for water heater or gas
6» i a /_ : _ 0 ttA ►_a. I fir e p lace 23 32
li Log lighter (>tis) 23.32
Wood /pellet stove 33.39
Wood fireplace/insert 23.32
Chimney /liner /flue/vent 23.32
Other 23.32
[] PROPERTY OWNER 0 TENANT Environmental exhaust and ventilation:
Name: 5 /„'x�(,1 Range hood/othcr kitchen
t( 1L� \ f- r ya Range oo 33.39
Address: `t+� '1 ..ii 1. Clothes dryer exhaust 33.39
S ingle -d uct exhaust (bathrooms,
City /Slate /"ZIP. I AIL .F r toilet compartments, utility roomS) 23.32
� y t , Ca_ Q ► r dr
Phone: ( Attic /crawlspace fans 23.32
Ji �u ` �! y
❑ APPLICANT ❑ CONTACT PERSON
Other 23.32
Fuel piping:
Business name: SI4.IS for first four: $4.03 for each additional
Contact name: V V e Furnace, etc.
Gas heat puns _
Address: � Wall /suspended/unit heater ,
City /State/ZIP: r Water heater
F ireplace
Phone: tr 1 Z I� \ Fax:: 410 0 rE Range
E Air Barbecue
CONTRACTOR Clothes dryer (gas).
Other.
Business Warne MECHANICAL PERMIT FEES"
Address: A Subtotal
L Minimum permit fcc ($90.00) • dip .CD
6
City /State/ZIP: C
P lan review (25 % of permit fee) D -
Phone: ( )
lax: ( ) State surcharge (12% of permit fee) WF►Te,
CCB lie.: `T YT 1 TOTAL PERMIT FEE [,j
T his permit application expires if a permit it not Obitiined n /77
f ^
days attar it hes been accepted as complete. ^ c(J
Authorized signature: • No meniedology set by Tri- County Building Industy Service Hoard 40/ •
Print name: Date:
,, n,,.ieina , p /L . d termii�` 1 995 ' °N 'DUI 2ui 1 'eaH suos 12 uagq°a Ad9Z , Zl EL@ 'zl ')90