Permit l
CITY OF TIGARD MECHANICAL PERMIT
=k' COMMUNITY DEVELOPMENT Permit #: MEC2009 -00095
Date Issued: 03/09/2009
`T',tGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
; Parcel: 2S103CB12200
Jurisdiction: Tigard
Site address: 12176 SW HOLLOW LN
Subdivision: Lot: 0
Project: Pacholl
Project Description: Install water heater, and (1) gas line.
Owner: FEES
PACHOLL, DIANNA & RICHARD Description Date Amount
12176 SW HOLLOW LN Water Heater 03/09/2009 $10.00
TIGARD, OR 97224
Flue Vent for Water Heater or Gas 03/09/2009 $10.00
PHONE: 503 - 579 -6880 Fireplace
Fuel Piping 03/09/2009 $5.40
Contractor: 12% State Surcharge - Mechanical 03/09/2009 $8.70
ROBBEN & SONS HEATING INC Minimum Fee Adjustment - Mechanical 03/09/2009 $47.10
2214 SE 8TH AVE
PORTLAND, OR 97214
PHONE 503- 233 -5841
FAX: 503 - 238 -8849
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue:
Total $81.20
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1 800 332 2344.
1 ' /�
Issued By: a , y n , u �\_/ \` p „ ^ 1� ,� n 41 , Permittee Signature: Aoplts kio I
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 App licaUCEIVED FOR OFIWK.USE ()Ni .V ' . ' • ' •
- 1 111 ' 1 7 ..,, City of Tigard Received
plIte/ 3.9. 09 -._1. 1:21123.
13125 SW Hall Blvd,. Tigard, OR 97223 t AR 0 9 2009 Plan Review
' n. Phone: 503.639.4171 Fax: 503.598.19611 Date/By: Other Parrott:
1'1010t.p . inspection Lin ' e 503 63 CITY OF T
9.4175 tap Dare Ready/By: NEll 0 Ste Page 2 for
: '
Internet: www.tigard-orgov BUILDING DINIbtv ■-TINN Notified/Method: Supplemental Information
'::TO. ' '':;iiii`::"OiPsikik***IgAIAI. q''.. L
Mechanical pormit fees are based on the value of thc work
0 New construction (Id+tion/alteration./replacement
performed. Indicate tht value (rounded to the nearest dollar) of all
0 Demolition I2 Other: mechanical materials, equipment, labor, overhead and profit.
Value; $
,02,,,Mt4,9.!„*q0.1.,g0.§,
- : - Frilly dwelling 0 Commercial/industrial D Accessory building Agt T4.t.W
For special information use checklist.
0 Multi-family ID Master builder 0 Other: . . Description I Qty. I Ea. Total
4li:; ' ,. R i
- . . .
. , . .
Air conditioning or heat pump
job site address; ) a )7(„ ,,..S4N) At q ( (.4.$11-e_, (requires site plan showing placement) 14,00
City/State/ZIP: . • - . i • e . C4rN. - . Furnace 100,000 BTU (ducts/vents)
Furnace 100,000+ BTU (duels/vents) 14.00
17.90
Suite/bldg./apt. no.: Project name: Fi ( Ix Gas heat pump 14.00
• 10.00
Cross street/directions to job site: Duct work
14 hot water system 14.00
Residential boiler (radiator or
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: i0.00
Tax map/parcel no.: Other fuel appliances
.,,,,,,,: , ,, , • , • • ( 4 ., , N.1..,,1„;7477.:4, Water heater
'' ,L.INV1F4M447,5064kieiVi50041C0 .,VkA&.T.O.",-1',Akiak44 . I 10.00 1 0
44,-;,%,0,4.14.4....,- oe,t, : .„ . . ..r.; . A .. •,- ■ • .. •:, .'. ,./...,!,!.•,,, ' , ,.,.c,.. ,,, ' oa • ,• - c :....41.0.. , c Gas fireplace
10.00
-
t. -. A A . A , -.I 1 ..ik-■ - II: Flue vent for water heater or gas
;-, - • fireplace I moo 1 0
,-, arvA t . Log liOrtetigas) 10.00
Woodlpelletsze 10.00
.,
Wood fireplace/insert 10.00
• ,...2 ufrjr4mtra.. ?atar.7.1.mg
' Chimney/liner/flue/vent 10.00
Ki , `•ipfigNi ‘■ 1 fife* 'ffakini'7 Kirsl„Wrx.^.7.q.k"'" 10.00
Name: allirlftli 6\ \ Environmental exhaust and ventilation
Range hood/other kitchen
Address: 1. ,),,‘ •11 .W - \ j 3 La
equipment 10.00
City/State/ZIP: a ..a.: Ail: , tA----N-- Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
hone.' w 3) atiii/ORMAIIIS ) 2o _
toilet compartments, utility rooms) 6.80
Attic/crawlspacc fans 10.00
Other: 10.00
-
Business name: I o .ik /6, ■ 0 MM.., - NY . elL1 A - Fuel piping
Contact name: .\ hy r \ P---,. • $5.40 for first four; $1.00 for each additional
Furnace, etc.
Address: 44 1 -.
Gas heat pump
City/State/ZIP: . 1 t 1/44 , Wall/suspended/unit heater
Phone: Ei); 0 1_ 3--sigt.4( I Fax: : g).-3) ) M"..- 2 NI Water heater I 5
Fireplace
E-mail: . b a is , 6 a ... , . 0 ...■ • , ( AA Range
r4:1y. .t
::m;: ); , „, 1 . :' Ai :. Millkii: t Barbecue
-_,.. 4T!14sfn.,.,. oxtz..... „..,..,,.....),..,„')nin.,...,4, • ..... , ,.., (., ., - -, -!. - :0 ,
Clothes dryer (gas) ,
Business name: i .. &.0.' - _.A. .
..■ 'NW 40.11 A Other:
Address : at:4 A. k " L c,.._ • ,,-:*,,,, ..vr 7 • --''''''.' ' dAy3 lfiri114it.i1tg;04':..,)?,./,;3
City/State/ZIP: . 1;',i I : '
CY' Subtotal
A A Al AIL -
Minimum perrnit fee ($72.50) 1?..- so
Phone: iSib ) - Fax: (
Plan review (25% of perrnit fbe)
CCB lie.: ! g 0 • 1 '10 . State surcharge (12% of permit fee)
TOTAL PERMIT FEE ‘ L 6
This permit application mires if a permit Is not obtained within 180
Authorized signature: A 1/4 4 4r i k r\ t ,,,..._, , (
Th dap after it has been accepted aa complete.
Print name: . Date: -j . Fee methodology set by Tri-County Building Industry Service Board
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