Permit " ,� CITY OF TIGARD MECHANICAL PERMIT
' °'� I COMMUNITY DEVELOPMENT Permit #: MEC2011 -00596
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/21/2011
Parcel: 2S104BB06500
Jurisdiction: Tigard
Site address: 14161 SW STARDUST LN
Project: GOBEL Subdivision: CASTLE HILL Lot: 2
Project Description: Furnace installation.
Contractor: RA SCHWARZ HEATING & COOLING INC Owner: GOBEL, DEREK K & JENNIFER L
15078 SE BRIGHTWOOD AVE 14161 SW STARDUST LN
PORTLAND, OR 97015 TIGARD, OR 97223
PHONE: 503 - 668 -3399 PHONE:
FAX: 503 - 344 -4900
FEES
Specifics: Description _ Date Amount
Furnaces < 100K BTU 12/21/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 12/21/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 12/21/2011 $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: — _ — 11111111%
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Call 1' •.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.
12/21/2011 09 :06 p T0: +1 (503) 5981960 FROM:5033444900 Page: 2
Mechanical Per it ApplicatiftECEIVED FOR OFFICE (SE ONLY
City of Ti I and Received
lla[cl6 � , G
° 13 125 SW Hall . }vd., Tigard, OR 97223 0 E C 21 2011 Plan Review / �_, r
Phone: 503.718 2439 Fax: 503.598.1960 Date /By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: !?I SeePage2for
Internet: www. igard ur.gov CITY OF TIGARD Notified/Method. Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
- Mechanical permit tees* arc based on the value of the work
❑ New construction dition /alteration /replaceinee performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ter: mechanical materials, equipment, labor, overhead, and profit.
Value: $
_____ ATECORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT I SYSI EMS FEES"
I- and 2- family dwellin_ a Commercial /industrial ❑ Accessory building For special information use checklist.
I.1 1- amily El Master builder ❑ Other: Description Qty. Ea. Total
JOB ITE INFORMATION AND LOCATION
J7eating/cooling:
( Air conditioning
Job site address: ( i `, 4)1 S ( ) (requires site plan showing placement) 46.75
City /State /ZIP: ( t om L. �- �. I 7 Furnace 100,000 B TU (ducts/vents) 46.75 94
! --, c- ( y
_ i i V L� _> ` Furnace l00,0001 BTU (ducts /vents) 54.91
—
Suite/bldg. /apt. no.: Project name: • C`12 ( Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydronic hot water system 2332
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (fuel - type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: 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 23.32
V 1 !` v �.� Gas fireplace 33.39
I -E r P' C=( r ^l t C'_i It ft.S`! G , C t J�0C."7` -r ' N7 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
[PROPERTY / WNER ' ❑ TENANT Chimney/liner /flue/vent 23.32
Other: 23.32
Name: le k a . fr 4.1" l (c ./ Environmental exhaust and ventilation: _
Address: , 1 + I (p 1 , L _j S=¢- / - c. ., Range huud/other kitchen
equipment 33.39
City /Slate /"LIP: (i a f r M C `� 2.2_,--
. - ' Clothes dryer exhaust 33.39
�' Single -duct exhaust (bathrooms,
Phone:
, ) ' 2/- �L Fax: ) toilet compartments, utility rooms) 23.32
❑ APPLIC • CONTACT PERSON Attic /crawlspace fans 2332
Business name: I l ,l `.) p ar. Z j) !! ` �` C C ,.r Fuel 2332
f 1 1' I l J c tr v L� �t i l�
Contact name: k c c l. • v-- LAC Fuel piping:
- - � C., + 1 1 q v - 514.15 for first four; 54.03 for each additional
Furnace, etc.
Address:
1 5G s -. e' - 17- ' 1 iot. toce.1' F10) -e-- Gas heat pump
City /State /ZIP: \ I Lz),L.J'1.„.i -. X L -. - -7 Wall/suspended/unit heater
Phone: Fax: : �` Water heater
Fireplace
E -mail: r e ( C ( 4 . 6 7 1 r 4 3 4 / Z. 1 1 to F ✓ (9 • CP 77 1 Range
CONTRACTOR Barbecue
r n l o_ /. Clothes der as
Business name: iK A, � GU- 2. .ti ed..,, as Wv( ,s. e-. ry (g )
Other.
d
Address: 9 w ,_ ' it{ w ,c), r� ( t" 1V v a MECHANICAL PERMIT FEES*
City /State /ZIP: M t ), „-- y r Subtotal Mil
Minimum permit fee (590.00) ' (7, E,)G.
Phone: (503 )1.., 4' 7 Fax: (50 1 -{-q6,0
r Plan review (25% of permit fee)
CCB lie.: 19 Millfrallirarrip - State surcharge (12% of permit fee)
TOTAL PERMIT FEE 7 i r _
Authorized si natu v II.i \ � A �`.1 1k '� This permit application expires if a permit is not obtained within 180
g • � I P ' ��C—liil•r... x days after it has been accepted as complete.
Print name: l ` - L r i ' V t , (j i / ' 7 ' ' 2 1 j I " Fee methodology set by Tri- County Building Industry Service Board
I\ 6uildin� \PermitAMEC,- Per.tApp.dx )9/09/10 44 4617T (11)02 /COM /win)