Permit CITY OF TIGARD MECHANICAL PERMIT
C COMMUNITY DEVELOPMENT Permit #: MEC2010 00113
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/17/2010
Parcel: 2S103DB04500
Jurisdiction: Tigard
Site address: 11140 SW NOVARE PL
Subdivision: GENESIS NO. 2 Lot: 43
Project: Darland
Project Description: Install Woodstove insert.
Owner: FEES
DARLAND, JEFF Description Date Amount
PO BOX 4017
BEAVERTON, OR 97076 Wood Fireplace /Insert 03/17/2010 $23.32
12% State Surcharge - Mechanical 03/17/2010 $10.80
PHONE: 503 - 929 -2880 Minimum Fee Adjustment - Mechanical 03/17/2010 $66.68
Contractor:
CASCADE CHIMNEY CARE
P.O. BOX 775
ESTACADA, OR 97023
PHONE: 503 - 630 -3846
FAX: 503 -982 -1603
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types:
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 o OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: )72 � /( V/ /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 Applicatiolt' F :- - , OFFICE ONLY
FCik OFFiCF l F
City of Tigard MAR 1 7 2013 Received
• 13125 SW Hall Blvd., Tigard, OR 97223 ate/By ` I'ermirNo.: 11 i `, Co ` '2
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 C;' fY L ; i ;,` Mri Date/By: f •
T I G A It D Inspection Line: 503.639 1; I �. , r C ° i . : 1; i L`!r g , p Ready/By: li ae P apt 3 bar
Internet: www.tigard- or.gov 1 '" - ' ' �' ' - d Notified/Method: fin Supplemental Information
TYPE OF WORK COMMERCIAL FEE' SCHEDULE — USE CHECKLIST
❑ 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
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For . ntuiiall iir Artattatlitaaarae ektallart.
❑ Multi- family ❑ Master builder ❑ Other: Description (Qtt '. _ Eat. _ 'Real
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address: 1 1 L 0 .1 s . u . ) • N �` V f l td e P r , A� c res site p ing )
(requires site Ian shosim placement 46.75
City/State /ZIP: ,� Q0..cd Furnace 100,000 BTU ( ducts/vents) 46.75
11 J Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: r Project name: Heat pump 61.06
Cross street/directions to job site: Duct work 23.32
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.:
er: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 2-312
l `' c Gas fireplace 31339 I l
r \s + " Q I " u ) O Ocl S J e f nse i- eentfor water heater or gas
fireplace i B32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplacelmseQt I 1 1 23..32 t: 3. dD
Chinmey/l ner flued.eral I ; 2332 0
L PROPERTY OWNER ' ❑ TENANT
Other: 2332
Name: S e Dor I O ` v
.n d (� 1 O V ` I ct n t� P Env"ironmened calmed and s— teatie
Address: I I I y O 5. W . 1 1 I' a hood/other kitchen
n ecpri}xireud 33.39
City/State/ZIP:
T Qy ( ��.yy l t 0 • Clothe diyer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (SO) 9 dq- ,i3B0 Fax: ( ) toilet compartments, utility rooms) 23.32
EZI APPLICANT ❑ CONTACT PERSON Attic/crawlspace fans i 2332
, 1 1 Other: 1 23.32 _
Business name: C 1 10,6 e, Chu ern CI e y (\ f e w . w • Fuel i in
PP g
Contact name: I ' 1 L-7 ( 11 Pr $14.15 for first four; $4.03 for each additional
• , Furnace, etc.
Address: p, 0. n x 1 -is
Gas heat pump
City /State /ZIP: Es---c a i d , a i O R, q f 0'),3 Wal /suspended/unit heater
Phone: ( 53 ) b3 C)- 3f„34/ Fax: :(503) qba -Ib Water heater
/- Fireplace
E - mail: m m I Ier Doi Q,„, • C OYr\ Range
CONTRACTOR �y ,� p , Barbecue
Business name: e a S ec tvt 1 t ( Y /� e O 1 1 I m n e r carp: tP I V• 4 Clothes dryer (gas)
Other:
Address: P. O. - 60x '71 5 I MECHANICAL PERMIT FEES'
City/State/ZIP: ES -A (`Goat 0 R. 9 7 O3 Subtotal
( S03 (0 3 3 J (S0 q ga -1 e p3 Minimum (25% fee r $ it fee
Phone: ) Q- 9 Fax: Plan review (25% of permit fee)
CCB lic.: 1 1 5 \ \ 0 State surcharge (12% of permit fee)
TOTAL PERMIT FEE
s 1
Authorized signature: This permit application expires if a permit is not obtain been within 180
1 m ��� days after it has en accepted as complete_
Print name: rn err ir� ' 11 e r Date: - 3.- 17-10 Fee methodology set by Tri -County Building Industry Service Board
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