Permit � ', C ITY OF TIGARD MECHANICAL PERMIT
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1, F. COMMUNITY DEVELOPMENT I Permit #: MEC2010 00303
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07 /02/2010
T1CrARD' g Parcel: 1 S 125DA02300
Jurisdiction: Tigard
Site address: 9260 SW 69TH AVE
Subdivision: KINGS VIEW Lot: 8
Project: Champion
Project Description: Install gas line, venting and new gas fireplace insert.
Owner: FEES
CHAMPION, HEATHER Description Date Amount
9260 SW 69TH AVE
TIGARD, OR 97223 Gas Fireplace 07/02/2010 $33.39
Flue Vent for Water Heater or Gas 07/02/2010 $23.32
PHONE: 503 - 329 -2055 Fireplace
Fuel Piping 07/02/2010 $14.15
Contactor: 12% State Surcharge - Mechanical 07/02/2010 $10.80
ALL FUEL INSTALLATION & SERVICE LLC Minimum Fee Adjustment - Mechanical 07/02/2010 $19.14
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.
i
Issued By: 4 �/ � / Permittee Signature: O� 7,4_/)..o. , / i � `�7 % /Q /L
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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Mechanical Permit A lecati � � �
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Plan
• why D alelBy: Phone: 503.639.4171, Fax: 501598.1960 eTBy a Other'Permit:
TIGARDp Cnspectior7Line:503.639.41 CITY OF DateRead iB
A i; of , H ik .,� <: Internet www!tigard- or.goY p �/ CITY BUILDING Y' Y ®Sec Page 2 fur
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Sepplemental,Information
TYPE OF WORK � COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
Mechanical permit fees' arc based on the value of the work
❑ New construction ® Addition /alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: S
® 1- and 2- family dwelling ❑ Commercial/industrial RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
❑ Ac cessory building
❑ IVluiti- family ❑]blaster builder For special information use checklist.
❑ �' Description 1 Qty. I Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Job site address:.9260 SW' 69`6AVe Air conditioning
(requires site plan, showing placement) 46.75
City /State /ZIP: Tigard, OR 97223 Furnace 100,000 BTU (durtsivents) 46.75
Fumace 100,000+ BTU fducts/vents) . 54.91
Suite/bldg. /apt. no.: Project name: Heat pump 61.06
Cross street /directions to job site: Duct work 2332
1-1' ydronic 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.: '
Other: 1 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 23.32
Gas fireplace . I 33.34 33.39
Install gas line, venting and new gas insert Flue vent for water heater or gas
fireplace I 23.32 23.32
Log lighter (gas) i ' 23.32
Wood/pel]et stove 1 33.39
Wood fireplace/insert 23.32
® PROPERTY. OWNER El TENANT Chimnevlliner /flueivent 23.32
Other: _ 23.32
Name: Heather Champion Environmental exhaust and ventilation
Range, hood kitchen
Address: Same as Above equipment 33.39
City /State/ZIP: Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: (503)329 -2055 Fax: ( ) toilet compartments, utility rooms) 23.32
® APPLICANT ❑ CONTACT PERSON Attic /crawispace fans 23.32
Business name: See Below
Other: 23.32
Fuel piping
Contact name: 514.15 for first four; 54.03 for each additional
Address: Furnace, etc.
Gas heat pump
City /State/ZIP: Wall /suspended/unit heater •
Phone: ( ) Fax:: ( ) Water heater
Fireplace 1 14.15
E -mail: allfuel ta@comcast.net Range
CONTRACCOR Barbecue
Business name: All Fuel Installation and Service, LLC Clothes dryer (gas)
Other_
Address: PO Box 69 MECHANICAL PERMIT FEES'
City /State!ZIP: Troutdale, OR 97060 Subtotal 70.86
Minimum permit fee (590.00) 90.00
Phone: (503) 674 -2350 Fax: (503) 674 -2693 Plan review (25% of permit fee)
0 ,4 ' :CB Iic. :169563 r State surcharge(12 %ofpermitfee) 1 0.80 7
'.'77-' / TOTAL. PERMIT FEE 100.80
Authorized signature: / Ibis permit application expires ila permit is not obtained within 150
[[[� - days after it has been accepted as coin pkte.
Print name: Eric Camp Date: 7/1/10 ' Fee methodology set by Tri -County Building. Industry Service Board
. t:r BuildingWcrmits \MEC 70!01109 440 -1617T (17 /02/COM/WEB)
6 £69Z1 . uoiielie}sul land Ild dt79 :Zi 0 1.01nf