Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: MEC2013-00669
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/07/2013
Parcel: 2S103BA00105
Jurisdiction: Tigard
Site address: 11830 SW ANN ST
Project: PROCTOR Subdivision: LERON HEIGHTS Lot: 5
Project Description: Furnace installation.
Contractor: ROBBEN&SONS HEATING INC Owner: PROCTOR,TIFFANY A&PATRICK E
2214 SE 8TH AVE 11830 SW ANN ST
PORTLAND,OR 97214 TIGARD,OR 97223
PHONE: 503-233-5841 PHONE:
FAX: 503-238-8849
FEES
Specifics: Description Date Amount
Furnaces<100K BTU 11/07/2013 $46.75
Type of Use: SF 12%State Surcharge-Mechanical 11/07/2013 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 11/07/2013 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
/- Mechanical Permit Applica C IV VU)It O►�Fl( I: l!tit:()NIA
Received
CI of Tigard Date/By: I� � i :ffi IIMIFFAMEM 13125 SW Hall Blvd,.Tigard,OR 97223J NQV 5 2013 Plan Review
i e • Phone: 503.7112439 Fax: 503.598.196 Other Permit:
Date/By:i fid:
T I G A It p Inspection Line: 503.639.4175 CITY TIGARD Date Ready/By. see Page 2 In for
Internet tvtvw.tigard or.gov Notified/Method Supplemental Infmmalia,
-k. BUILDING DIVISION•3 TYPE OF WORK'. � � ::, •.. COMMERCIAL FEE""SCHEDULE.-'USE CHECKLIST
Mechanical permit fees"are based on the value of the wore:
❑Ncw construction Addition/alteration/replacement performed.Indicate the value(rounded to the nearest dollar)of all
13 DCIIIUIitiot1 u Other; mechanical materials,equipment,labor,overhead.and profit.
Value:$
' CATEGORY,,OF CONSTRUCTION '
- RSSIDENTIAL'EQUIPMENT:7 SYSTEMS FEES*I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building ForspeciMrdJDnnnGon use checklist
41
,q Multi-family r] Master builder ❑Other Description Qty I Ea. I Total
J Heating/cooling:
I JOB'SITE INFORMATION AND LOCATION•.
` Air conditioning 46.75 )1
vJob site address: \\ l Furnace 100,000 BTU(ducts/vents) i 46.75 —1(p• 7
City/State/ZIP` C( rb Furnace 100,000+sru1ductsrveni,) 54.91
..k Heat pump 61.06
Suite/bldg./apt.no.: Project name: 1Q —fay Duct work 23.32
Cross StreeUdirections to job site: Hy-dronic 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
Flue/vent for any of above 23.32
FSubdivision: Lot no.: Other. 23.32
Other fuel appliances:
v Tax map/parcel no.: Water heater 23.32
fe■ DESCRIPTION:.OF WORK . Gas fireplace/insert 33.39
■
Flue vent for water heater or as
r + ,^ fireplace 23 32
• Log lighter(gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
r Chinmey/liner/flue/vent 23.32'
- - . . Other 23.32
Q PROPERTY OWNER. TENANT:. Environmental exhaust and ventilation::
ame: ( Range hood/other kitchen .
\\`` "`-�' ` equipment 33.39
Address: O. • i__ A AI A ` Clothes dryer exhaust 33.39
City/State/ZIP: s t T Single-duct exhaust ent5,(bathrooms.
` ,tom: �_. ��r toilet eomparttnenis,utility rooms) 23.32
IPhone• 4,1', _ a •Ort Fax:( ) Attic/crawlspace fans 23.32
.t. Other: 23.32•❑ APPLICANT ' D CONTACT:PERSON
.
_ _ Fuel piping:
Business name: �`���/\� 514.15 for lint four;54.03 for each additional
Contact name: ,.k, Furnace.etc.
m.m
ta
Address: 7 Gas heat pump
1� Wall/suspended/unitheater
V City/State/21 :• '* \,, Water heater I
• Phone: , - - t, Fax::(alb BR"l Fireplace . .. .
'� � iA.+ " Range
I E-mail: n%aU!\_k•. • `1 A \.� A 4k,soc_a_ .tt.--sju .t` Barbecue
:CONTRA 1R
Clothes dryer(gas)
me
Other:
• Business name:
p\4'\\PC__:, ...-'•- ''.:.'‘ :1 •MECHANICAL 14RMIT.FEES'' ' •.
Address: Subtotal
City/State/ZIP: Minimum permit fee($9000) Q,
Plan review(25%0f permit fee)
Phone:( ) Fax:( ) State surcharge(12%of permit fee)
No'gib •
CCB lie.: \991,k TOTAL
l 1,k TOTAL PERMIT FEE i •
This permit application expires if a permit is not obtained within 1: .
days after it has becn accepted as complete.
Authorized signature: • Fee methodology set by Tri-County Building Industry Service Board
Print name: Date: ///5L1/3
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