Permit d CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00098
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/09/2011
Parcel: 2S111AD03600
Jurisdiction: Tigard
Site address: 9000 SW PINEBROOK CT
Project: ROSE Subdivision: PINEBROOK TERRACE Lot: 33
Project Description: Gas furnace replacement.
Contractor: MILWAUKIE HEATING & COOLING Owner: ROSE, KEITH E
PO BOX 220216 9000 SW PINEBROOK CT
MILWAUKIE, OR 97222 TIGARD, OR 97224
PHONE: 503 - 557 -5562 PHONE:
FAX: 503 - 557 -0790
FEES
Specifics: Description Date Amount
Furnaces < 100K BTU 03/09/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/09/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 03/09/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
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 B �_ ` Permittee Signature: s _ , / `
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.
Mechanical Permit Application .
1, OR OFFICE USE O,NEI
City of Tigard A x R ece iv e d
• 1312S SW Hall Blvd., Tigard, OR 97223 Date/By. NAM Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960
Plan Review I — let ��
T I G A k n Inspection Line: 503.639.4175 % tiO��
Date/By: Other Permit
Internet: ►vww.tiga[d- Or.gov P� Date Ready /By: runs: ® See Page 2 for
M ..),i0 Notified/Method:
�� -� 77 � Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
y
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition /alteration/replacement
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: $
® I - and 2 family dwelling ❑ Commercial /industrial El Accessory building RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
JOB SITE INFORMATION AND LOCATION Description I Qty. I Ea. ' Total
Hcating/COding
,
Air conditioning or heat pump
Job site address: _
CitylStatelZlF: tt ` � J F j n 4,, �� k 2 C , 7 (requires site plan sliowin q placement) 14.00
A ore. q 44 Furnace 100,000 BTIJ (ducts,'venls) ' q6 7
Suite/bldg. /apt. no.: I Project name: p �� e . `
y \* }J` Furnace 100,000+ BTU (ducts/vents) 17.90
Cross street/directions to job site: Gas heat pump 14.00
Duct work 10.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 14.00
Subdivision: Flue/vent for any of above
1 Lot no.: 6 80
Tax map /parcel no.: Other 10.00
Other fuel appliances
DESCRIPTION OF WORK Water heater
10.00
C.-.1? .5 i Ur VA k. e Gas fireplace 10.00
Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
Er-PROPERTY Wood fireplace/insert 10.00
OWNER I ❑ TENANT Chimney/liner /flue/vent 10.00
Name: K� { p D S‹.. Other: 10.00
et t~ Environmental exhaust and ventilation
Address: (� l)CC ` Range hood/other kitchen
_ J P f$1 4 h me k C..t equipment
City/State/ZIP: ' i F 0 (1721. , ( 10.00
`� T Clothes dryer exhaust 10.00
Phone; (��) t?� p t Fes: ( )
Single-duct exhaust (bathrooms,
f q J - C} 1 toilet compartments, utility rooms) 6.80
® APPLICANT El CONTACT PERSON Atticicrawlspace fans 10.00
Business name: Milwaukee Heating & Cooling Inc. Other: 10.00
Contact name: Terry Klink Furl piping
55.40 for first four, $1.00 for each a_ dditional
Address: P.O. Box 220216 Furnace, etc. T
City/State21P: Milwaukee OR, 97222 Gas heat pump
Wall/suspertded/unit heater
Phone: (503) 557 -5562 m
i Fax:: (503) 557 -0790 Water heater
E -mail: milwaukicheating @msn.co Fireplace
Range
CONTRACTOR Barbecue
Business name: Milwauket Heating & Cooling Inc. - Clothes dryer (gas)
Address: P.O. Box 220216 Other: r
City/State/ZIP: Milwuakie OR, 97222 MECHANICAL PERMIT FEES*
Subtotal li (
Phone: (503) 557 -5562 I Fax: (503) 557 -0790 Minimum permit fee ($72.50)
cid•Lk)
CCB ]ic :104102 Plan review (25% of permit fee) --
State surcharge (12% of permit fee) 1() ,g i
Authorized signature . f TOTAL PERMIT FEE Il1tl
2411 1 — / This permit application expires if a permit is not obtained withi n 180
I n .^ crt mo days after it has been accepted as complete.
I = Fu, methrvinin m set by Tri.rnunty %nib - line tndnetry Grvir Roe ni
6 �0 ) 8 61H eNnemPlAl eL9:0l, U. 60 leiN
Z'd 06L0- L99-E09