Permit a CITY OF TIGARD
MECHANICAL PERMIT
14 a :F, COMMUNITY DEVELOPMENT Permit #: MEC2009 00592
T t GAR Lj 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11!05/2009
Parcel: 2S112CD07300
Jurisdiction: Tigard
Site address: 15838 SW 76TH AVE
Subdivision: PP1994 -100 Lot: 1
Project: Smith
Project Description: Relocate gas line for range.
Owner: FEES
SMITH, ROBERT W & JUDITH C TRUST Description Date Amount
15838 SW 76TH AVE
TIGARD, OR 97224 Fuel Piping 11/05/2009 $14.15
12% State Surcharge - Mechanical 11/05/2009 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 11/05/2009 $75.85
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062
PHONE: 503 - 691 -6166
FAX:
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
issuanc : ■• • uspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit otification Center. hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or • rect questions to OUN . cal • 03.246.6699 or 1.800.332.2344.
Iss ed By: — _A A i/� L Permittee Sig .ture: ..)d:` _�-A���i ,W, d~-6-
r
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.
- Nov, 4. 2009 4:51PNarA Mod ern PislipINiiIQJNIQ'IICI' No. 6573 P. ? F3
City of Tigard
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