Permit ,, CITY OF TIGARD MECHANICAL PERMIT
III II 4 ' COMM UNITY DEVELOPMENT Pe rmit #: MEC2011 -00246
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/02/2011
Parcel: 25111 DD13700
Jurisdiction: Tigard
Site address: 8722 SW HAMLET ST
Project: MCCURDY Subdivision: MILLMONT PARK Lot: 14
Project Description: Gas piping for barbecue and fireplace.
Contractor: ROSE CITY REFRIGERATION HEATING & AIR LLC Owner: MCCURDY, WAYNE E & BETTE C
PO BOX 19207 8722 SW HAMLET ST
PORTLAND, OR 97280 TIGARD, OR 97224
PHONE: 503 - 636 -5371 PHONE:
FAX: 503 - 655 -4669
FEES
Specifics: Description Date Amount
Fuel Piping 06/02/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 06/02/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 06/02/2011 $75.85
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 By: i /��� / ermittee Signature: X� 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.
06/01/2011 14:25 5036554669 ROSECITY PAGE 01/02
Mechanical Permit Application FOR OFFICE - USE - ON Y' = -
Ci of Ti a DateiB Reeei�ed y
�3r g p'' Permit No.:
" 13125 SW Hall Blvd., Tigard, OR 97223 ° ` I l 6 ��� ,/ . ! �p — I
. �,� ` " Plan Review
Phone: 503,718.2439 Fax 503.59:. 6 Date/By:
Other Permit:
Inspection Line: 503.639.4175 i 11 Date Ready /By; El See Page 2 for
TIGARU Internet: www.ti and -or, ov •',
g g .\6 ' ‘1"\ NotificdiMcthod: Supplemental Information
0 t. " .
•v -kr. • O `a . . , - ...C FEE" , SCHEDULE USE CHECKLIST
'TYPE: OF. WORK-- [;cIS t \ct
t y r.r` v Mechanical permit fees' are based on the value of the work
ID New construction ®Ad dition /alteratro e pl c �e m �'tt performed. Indicate the value (rounded to the nearest dollar) of all
[2 Demolition ❑ Other: vv1` mechanical materials, equipment, labor, overhead, and profit.
Value: S
.CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
CO 1- and 2- family dwelling ❑ Commercial /industrial 0 Accessory building For special infprmalipn use checklist.
❑ Multi- family U Master builder ❑ Other: Description Qty. , Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Air conditioning
Job site address: 8722 SW Hamlet Street, (requires site plan showing placement) , 46.75
Furnace 100,000 BTU (ducts /vents) 46.75 -
City /State /ZIP: Tigard, OR 97224 Furnace 100,000+ BTU (ducts/vents) 54,91
Suite/bldg. /apt. no -: Project name: Heat pump
( requires site plan sho_winEplacernm t) 61.06
Cross street/directions to job site: Duct work 2332
Hydronic hot water system 23,32
.. . - -. Residential boiler (radiator or .
hydronic) 23.32
------ -^�— Unit heaters (fuel-type, not electric),
in - wall, in -duct, suspended, etc. 46.75 ,
Lo no.: Flue /vent for an of abo 23.32
Subdivision: .
— Other: 2
Tax map /parcel no.; Other fuel apQiianees: •
DESCRIPTION OF• WORK Water heater 23.32
• Run gas line to BBQ &fireplace Gas fireplace _ 33.39
Flue vent for water heater or gas
fireplace 23,32 _
Log lighter (gas) .. 23.32
Wood /pellet stove 33 -39
Wood fireplace /insert 23.32
0 PROPERTY OWNER Q TENANT Chimney /liner /flue /vent 23.32
Other: 23.32
Name: Environmental exhaust and ventilation:
Address: Range hood /other kitchen
equipment 3339
City /State /ZIP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility room 23.32
I, APPLICANT ' ® CONTACT PERSON Attiefcrawlspace fans 23.32
Business name: Rose City Heating & Air
Other: 23,32
Fuel piping:
Contact name: Jeff Pangborn $14.15 for first four;'$4.03 for each additional
Furnace, etc.
Address: -
Gas heat pump
City /State/ZIP: Wall /suspended/unit heater _
Phone: (503) 6365371 Fax:: (503) 6554669 Water heater
Fireplace x l 14.15
E -mail: jeff @rosecityheating.com Range
CONTRACTOR . Barbecue x 14.15
-
Business name: Rose City Beating & Air - CIothes dryeOzas) _
— Other;
Address: PO Box 19207 MECHANICAL PERMIT FEES"
City /State /ZIP: Portland, OR 97280 Subtotal 2830
Minimum permit fee ($90.00) 90.
Phone: (503) 6365371 Fax: (503) 6554669 Plan review (25% of permit fee)
CCBlie. :161325 _ State surcharge (12 %ofpertnit 10.8
TOTAL PERMIT FE 100,80
Authorized signature:
This p ermit application expires On permit is not obtained within 180
� days after it has been accepted an complete.
Print name: 7' fj / Q p 6 csl.") Date: ‘7 /r • Fee methodology set by To - Comnty 6uifding Industry Service Board
1' t BUIICISS IPermltuMEC- Perml[App.00c 09/099170 440 0 i /02