Permit
CITY OF TIGARD MECHANICAL PERMIT
a' COMMUNITY DEVELOPMENT Permit: MEC2009-00627
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11124/2009
Parcel: 2S111 CA07700
Jurisdiction: Tigard
Site address: 15286 SW 100TH AVE
Subdivision: GULF SIDE ESTATES NO. 2 Lot: 21
Project: Muller
Project Description: Install wood insert and venting.
Owner: FEES
MOLLER, PENNY Description Date Amount
15286 SW 100TH AVE Wood Fireplace/Insert 11/24/2009 $23.32
TIGARD, OR 97224
Chimney/Liner/FlueNent 11/24/2009 $33.39
PHONE: 12% State Surcharge - Mechanical 11/24/2009 $10.80
Minimum Fee Adjustment - Mechanical 11/24/2009 $33.29
Contractor:
ALL FUEL INSTALLATION & SERVICE LLC
PO BOX 69
TROUTDALE, OR 97060
PHONE: 503-674-2350
FAX: 503-674-2693
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Solid Fuel
Gas Pressue:
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 it 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.
Issued By: Permittee Signature:
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.
_. • .4
RECEIVED _
Mechanical Permit Application .FOR OFFICE i s •oil
-
City of Tigard NOV 2 4 2009 Received
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: ' !, . A i I
Plan Review
0 - Phone: 503.639.4171 Fax: 503.598.1aTy OF TIGA1D Date/By: Other Permit:
BUILDING
71 GARDr inspection Line: 503.639.4175 DIVISION � fi d/ ham: See Page 2 for
.- Internet www'.tigard -or.gov Sapptementnt Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
E] New construction ® Addition/alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $ 51,062.00
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessor building
❑ Multi- family ❑ Master builder ❑ Other:
For special information use checklist.
Description 1 Qty. Ea Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 15286 SW 100 Ave Air conditioning
(regllirm site plan showier; placement) 46.75
City /State/ZIP: Tigard, OR 97224 Fumacc 100,000 BTU (duets /vents) 46.75
Fumace 100,000+ BTU (duets/vents) 54.91
Suite/bldgJapt. no.: Project name:
Heat pump 6106
Cross street/directions to job site: Duct work A— 2332
1 Hydronic hot water system 23.32
Residential boiler (radiator or
hydrooic) 23.32
' Unit healers (fuel -type, not electric),
. in -wall, in -duct, suspended, etc. 46.75
Subdivision Lot no : Flue/vent for any of above 23.32 _
1 Other: 23.32
Tax map/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gm fireplace , 33.39 _
Install new wood insert and venting Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32 ,
Wood'pellet stove 33.39
Wood fireplace/insert 1 23.32 23.32
Ot h er ey/linerltluehent 1 23.32 23.32
® PROPERTY OWnER 1 ❑ TENANT
Other. 23.32
Name: Penny Muller Environmental exhaust and ventilation
Address: Same as above Range hood/other kitchen
equipment 33.39
CityiState/ZTP: Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (503)620 -1892 Fax ( ) toilet compartments, utility rooms) 2332
® APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans I 23.32
Other: 1 23.32
Business name: Sec Below
Fuel p ppittg
Contact name: 514.15 for first four; 54.03 for each additional
Address: Fumace, etc.
Gas heat pump
City /State/ZIP: Wallsuspended/unitheater
Phone: ( ) Fax: : ( ) Water heater
- - -- Fireplace
E -mail: Range
•
CONTRACTOR Barbecue j
Business name: All Fool Installation and Service Clothes dryer (gas) _
Other
Address: PO Box 69 MECHANICAL PERMIT FEES*
ey 1
City /State/ZIP: Troutdale, OR 97060 Subtotal 46.64
Minimum permit fee (590.00) 90.00
Phone: (503) 674 -2350 Fax: (503) 674 -2693 Plan review (25% of permit fee)
CCB lic.: 169503 State surcharge (12 %ofpermit fee) 10.80
_— TOTAL PERMIT FEE 100.80
Authorized signature. This permit applic attires ation ires if a permit is nor obtained within 180
1 days after it has teen accepted as complete.
Print name: Erie Camp Date: 11/20/09 1 • Fcc methodology set by Tri County Building Industry Service Board
I :03iletio0crrninNMEC- PermitApp.doc 11.001/09 ev 1C___ � 15617rt1 I tO.VCOMnvge)