Permit z MECHANICAL PERMIT
I CITY OF TIGARD
�' r ,, COMMUNITY DEVELOPMENT Permit #: MEC2010 -00108
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/12/2010
Parcel: 2S103CA00400
Jurisdiction: Tigard
Site address: 13270 SW 121ST AVE
Subdivision: Lot: 0
Project: Cartwright
Project Description: Install new gas fireplace with associated gas line and venting.
Owner: FEES
CARTWRIGHT, HANK Description Date Amount
13270 SW 121ST AVE Gas Fireplace 03/12/2010 $33.39
TIGARD, OR 97223 Fuel Piping 03/12/2010 $14.15
PHONE: 503 - 284 -4250 12% State Surcharge - Mechanical 03/12/2010 $10.80
Minimum Fee Adjustment - Mechanical 03/12/2010 $42.46
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: Natural Gas
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 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.
Issued By: lei \ a A Ls'W Permittee Signature:
9-0 AID)c)
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.
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rF Received `
City of Tigard � Permit No.: ( • t>> O ' 6 . •
" ' 13125 SW Hall Blvd., Tigard, OR 97223 MAR 1 2 2013 Plan Review
Zt Date/By:
4 Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
reRi Inspection Line: 503.639.4175 DatetBy:
G'.1'RsD, p CITY OF i !GAI�D DateReadyBy: � / El See Page for .
^'"
ur - qd Internet: www.tigard or.gov Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees* are based on the value of the work
❑ New construction ® Addition /alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
J Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION
i Value: $ S656.00
RESIDENTIAL EQUIPMIEN F / SYSTEMS FEES'
® 1- and 2- family dwelling El Commercial/industrial ❑ Accessory building
E] Multi family ❑ Master builder For special information. use checklist
O ther: Description I Qty- I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 13270 SW 121st Air conditioning
Irequires site plan showing placement) 46.75
City /State /ZIP: Tigard, OR Furnace 100,000 BTU (ducts /veats) 46.75 1
-- Furnace 100,000+ BTU (ducosfventc) 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
I Cross street/directions to job site: Duct work 23.32
I Hydrunic hot water system 23.32
Residential boiler (radiator or
hydronicj 23.32
Unit heaters (fuel -type, not electric), -
in -wall. in -duct. suspended, etc. 46.75
Flue /ventfor of above 23.32
Subdivision: Lot no.:
Other: 23.32
Tax map /parcel no.. Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace 1 33.39 33.39
Install gas line, vent and new gas stove Flue cent for water heater or gas
fireplace 1 1 23.32 23.32
---- -- Log lighter (gas) [ 23.32
1 Wood/pellet stove 33.39
Wood fireplace/insert pp 2332
® PROPERTY OWNER ❑ TENANT Chimney /liner /flue/vent 23.32
Other 1 2332
Name: Hank Cartwright Environmental exhaust and ventilation ■
Range hood /other kitchen
.Address: Same as Above equipment 3339
City/State// IP: Clothes dryer exhaust [ 33.39
Single -duct exhaust (bathrooms.
Phone: (503)284 -4250 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Altic/crawlspe.ce farts I 23.32
Other: 1- 23.32
Business name: See Below _- .__.--- .- -_ - - - -__ _ ---
Fuel piping
Contact name: Eric Camp S14.15 for first four; 54.03 for each additional
Furnace, etc.
Address:
.- Gas heat pump
City /Statc /ZIP: i Wall/suspended/unit heater
Phone: ( ) Fax: : ( ) i Water heater
4 Fireplace 1 1 14.15
E - mail: ecamp_allfuel verizon, net : Range
CON'TR.4CTOR Barbecue
Business name: All Fuel Installation and Service, LLC Clothes dryer (gas)
_Other__
Address: PO Box 69 MECHANICAL PERMIIT FEES*
City/State /ZIP: Troutdale, OR 97060 Subtotal t 70.86
Phone: (503) 674 -2350 I Fax: (503) 674 -2693 Minimum permit fee (90.00) 90.00
Plan review (25% of permit fee) 1
CCB lic.: 169503 State surcharge (12% of permit fee) 10.80
____IL. TOTAL. PERMIT FEE 100.80
This permit application expires if a permit is not obtained within 180
Authorized signature: . C . ______.. - i ff
days after it has been accepted as complete.
Print name: Eric Camp Date: 3/12/10 * Fee rnethodolou set by Tri- County Budding Industry Service Board
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