Permit II is CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Pe
COMMUNITY MEC2023-00003
Date Issued: 1/4/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S111BD00311
Jurisdiction: Tigard
Site address: 9970 SW PEMBROOK ST
Project: HUNGERFORD Subdivision: PEMBROOK HEIGHTS Lot: 1
Project Description: New gas piping for range.
Contractor: PDX GAS LINES LLC Owner: HUNGERFORD, DEBORAH L&
PO BOX 90516 JAMES L
PORTLAND, OR 97290 9970 SW PEMBROOK ST
TIGARD, OR 97224
PHONE: 503-995-8396 PHONE:
FAX:
FEES
Specifics: Description Date Amount
Fuel Piping 01/04/2023 $14.15
Type of Use: MF 12%State Surcharge-Mechanical 01/04/2023 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment-Mechanical 01/04/2023 $75.85
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
Issued By: Pormittee Signature:
AC1/ I
/
C J
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 FOR OFFICE USE ONLY
City of Tigard Received • / ) Permit No.:
14
• 13125 SW Hall Blvd..Tigard,OR 97223 Date By: t/`Y �3 /113LG�r123-[.Y1ik13
Pion Review
II Phone: 503.718.2439 Fax: 503.598.1 E Date/By: Other Permit: Pi Mh let_Lb d?
T I(7 A tt U Inspection Line: 503.639.4175 r Date Ready/By: runs: Se. � W
Internet: www.li and-or, ov. Supplemental See Page for
g g Notified/Method: Information
JANJ 4 O?37-_-,-.,
TYPE OF WCairt Cr=got COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
' Mechanical permit fees*are based on the value of the work
D New construction ZAddition/alteIMMAIR - performed.Indicate the value(rounded to the nearest dollar)of all
D Demolition ❑Other: mechanical materials,equipment.labor,overhead,and profit.
Value:S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT/SYSTEMS FEES*
❑ I-and 2-family dwelling 0 Commercial/industrial 0 Accessory building For special information use checklist.
er Multi-family ❑Master builder ❑Other: Description Qty. Ea. Total
JOB SITE INFORMATION AND LOCATION Heating/cooling:
Q[y Air conditioning 46.75
Job site address: 1"I .0 ,J w pem o aK
I"' Furnace I(0.0()0 BTU(duct.rcnis) 46.75
City/State ZIP: 'r' r, r d 6 r 91,1ae1 Furnace 100.000+BTU(ducts vents) 54.91
J f( Heat pump 61.06
Suilerbldg.rapl.no.: Project name:
Duct work 233.32
Cross street/directions to job site: 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
Flue/vent for any of above 23.32
Subdivision: Lot no.:
Other: 23.32
Other fuel appliances:
Tax map/parcel no.: Water heater 23.32
f, , DESCRIPTION OF WORK Gus fireplace/insert 33.39
,Wt be �hS tl e.d n.eu I�CS line e co r fi ee vent for water heater or gas
Y� �f fireplace 23.32
�� 3/-/ Wood/pellet
lighter(gas) 23.32
a Wood`pellet stove 33.39
Wood fireplace/insert 23.32
Chimney/liner/flue/vent 23.32
❑ PROPERTY OWNER ❑ TENANT Other: 23.32
Environmental exhaust and ventilation:
Name: 4 tv �� Range hood/other kitchen
Address: equipment 33.39
Clothes dryer exhaust 33.39
City(State/ZIP: Single-duct exhaust(bathrooms.
toilet compartments,utility rooms) 23.32
Phone:( ) Fax:( ) Attic/crawlspace fans 23.32
0 APPLICANT ❑ CONTACT PERSON Other: 23.32
Business name:111)X &its L ttui s, L.LC Fuel piping:
$14.15 for first four;$4.03 for each additional
Contact name: C�Vet.AI Gel 0 Sant_kez- Furnace.etc.
Address: ( b7- e J A ,� 1 _aL T2 Gas heat pump
56 5 E Dix n5 ? q �T /i t t -Ft U Wall/suspended/unit heater
City/Stale/Z1P: P 0 r 4-LCi1��1 or c(`-4,"3 3 Water heater
Phone:(50'D) qq 5-- 834‘ Fax:: ( ) Fireplace
Range
E-mail:Old_tow fly,5Pip't/ICI@CImai 1. eorvt Barbecue
001/11T1dCTOR Clothes dtyer(gas)
Business name: P'O t� ! Other:
+�X /�l®t L l N,t]fL C MECHANICAL PERMIT FEES*
Address: Po 3 X D5t Subtotal
CityState-ZIP: 'Por-i 4an� or q aqa Minimum permit fee(S90.00)
Phone:(503 )qq c 8 3-�I 6, Fax: l ) Plan surchargerevw(25%of permit fee)
V State (12%of permit fee)
CCB lie.: a'crisis- 3/I,v% TOTAL PERMIT FEE
This permit application expires if a permit Is not obtained within 180
�' days after it Ims been accepted as complete.
LU
Authorized signature: (1 a ter 0 6,0rc it .,u4c " Fee ntellnrdolory set h1 Tri-('oustr Building Insts.uv Service Board
Print name: 1<i e be Y -10 Gi n r c_ a 5. -lDate: 1- a_ a 023
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