Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2010 -00192
Date Issued: 04/29/2010
T1G'ARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S125DA00200
Jurisdiction: Tigard
Site address: 9070 SW 66TH AVE
Subdivision: Lot: 0
Project: Whalen
Project Description: Gas piping for fireplace.
Owner: FEES
WHALEN, VALERIE L Description Date Amount
9070 SW 66TH AVE Fuel Piping 04/29/2010 $14.15
TIGARD, OR 97223 12% State Surcharge - Mechanical 04/29/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 04/29/2010 $75.85
Contractor:
3 MOUNTAINS PLUMBING
PO BOX 230051
PORTLAND, OR 97281
PHONE: 503 - 670 -1342
FAX: 503 - 670 -9104
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 to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: r
Permittee Signature: /V ,'/' L / e E9
,t6 /)/17-
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.
04 -27 -2010 08:19 3 MTNS PLUMBING 5039259104 PAGE1 (6
Mechanical Permit Application i p : t , I (,;1 i ' � 1 '.; "''
$1 Reeeival
- n , City o Tigard � q, y + rm, N, t
� ; CEIv� yozod �I�CaO /t9 -0079
I
�/ V 13125 SW Hall Blvd.,'figard, 1.1R L •1 Non kevie
a # Phonc: 503,639,4171 Hax: '503.598.19M I htte /ply: Other Per tit:
" r' +I Inspection Line: 503.639.4175 ^ p p 2 7 Date Ready/By: Jnti 121 See Page 2 fur
tt 3se ? Internet: www.tigard- or.gov Notified/Method: i Supplemental Information
111 1FTIGA
-__ 'rvPi. sr:�'ll�t GDWISI()N COMMERCIAL FEE* SCHEDULE - USE CHF.CKLiST
❑ New construction 71 Addition /alteration /replacement Mechanical permit fees* are based on the value of thc work
performed. Indicate thc value (roundcd to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and protit.
- CATEGORY OF CONSTRUCTION Value: $
�- - RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
1Z] 1 - and 2 ! dwelling ❑ Commercial/industrial ❑ Accessory building
For special inf'ornration tvse; checklist.
0 Multi - family ❑ Master builder ❑ Other:
DesGTipliMt �clty_ 1 h:a, lotal
JOB si'rF: INFORMATION AND LOCATION , Heating/cooling
Job site address: /` r Air conditioning
5t.,.. b !T (requires rile plan showing placement) 46.75
City /Stall: /7iP: `-- ! ad ?7,22.3 Fumacc 100.000 BTU (ducts/vents) 46.75
J Furnace 100.000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no_: Project name: Cite) L. ..,_ I kat pump 61,06
Cross street/directions to job site: Duct work 23,32
Ilydronic hot water system 23,32
Residential boiler (radiator or
jydronic) 23.32
I )nit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 46.75
Subdivision: I ul nut.: Flue/vent for any of above 23.32
_ _ _. __ Other: 23.32 •
Tax map /parcel nu.: Other fuel appllaaces
DESCRIPTION OF WORK Water heater 23.32
-- - "' ' Gus fireplace _�. 33.39
Flue vent for water heater or gas
fireplace -. 23.32
Log lighter (gas) 23,32
Wood/pellet stove 31.39
- - • Wood fireplace/insert 23,32
__. PRUPF:R'1'Y OWNER Chimncy/liner /fluGvcnt 23.32
❑ 'TENANT
Other: • 23.32
Name: 14 )/7 1 9 LCN (/ L E AJ r Environmental exhaust and ventilation
Mange hood/other kitchen
Address:
S7)'/1 etluipme.E..,..,.... 33.39 ,
City /State/ZIP: Clothes dryer exhaust 33.39
- - Single -duct exhaust (bathrooms.
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑ CONTACT PERSON Attic /crawlspacc fans 23.32
Business name: - Other: , 23,32
Fuel.ripin;z
(intact name: 511.15 for first four: S4.03 for each additional
Address: - Furnace, etc.
- -. , Gas heat pump
City /State/ZIP: Wa1I /suspended/tmitheater _ —„
Phone: ( ) [Fax: ( ) Water healer
Fireplace 1.... / y./6
E - mail: ; / le s ` auf / r _ lt�n
CONT CTOR Barbecue
r Clothes dryer (gas)
Business name: T/ " y r .(W C' 0174 �, O thcr: i __.__._
Address: 0 � yX 07 ; , $ / - 77 ✓ Z -- MECHANICAL PERMIT FEES*
,_. / rc Subtotal _ 1�.�
City /Start /ZIP; and v'` g/ S
Minimum permit fee ($90.00 l Q
Phone: (y193) 6 / 34'.2 1 Fax: ( 3 ) 6j ? • - <f" Y Plan review (25% of permit fee) q>
CCB lic.: /‘ ✓ State surcharge (12% of permit tee) j0,
TOTAL PERMIT FEE /670,.
Authorized signature. days permit application expire!. if a permit is nut obtained within 180
•L days after it his been accepted as complete_
Print name: //1.4 / / /17:1.-:P 'v Date: V-. ..,,i) r Pee methodology set by Tri•Coutdy liuihling Industry Servtcc Board
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