Permit , CITY OF TIGARD MECHANICAL PERMIT
II C COMMUNITY DEVELOPMENT Permit #: MEC2010 -00427
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2010
TIGARD Parcel: 1 S 135DCO5200
Jurisdiction: Tigard
Site address: 11830 SW 95TH AVE
Subdivision: TANGELA Lot: 7
Project: Smith
Project Description: Install tankless water heater and gas line
Owner: FEES
SMITH, MAHLON Description Date Amount
11830 SW 95TH AVE Water Heater 08/25/2010 $23.32
TIGARD, OR 97223 Flue Vent for Water Heater or Gas 08/25/2010 $23.32
PHONE: 503 - 603 -1875 Fireplace
12% State Surcharge - Mechanical 08/25/2010 $10.80
Contractor: Minimum Fee Adjustment - Mechanical 08/25/2010 $43.36
T & K MECHANICAL
PO BOX 116
FOREST GROVE, OR 97116
PHONE: 503 - 844 -9173
FAX: 503 - 846 -0195
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: Permittee Signature: /N / of-70,4 / e ' - /7(1/x' ,
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.
Aug 25 10 03:59p Aline wynne 503-846-0195 p.1
Mechanical Permit Application VS) !..' . , ., ' ifsbiNtv,
: : : City of Tigard 1 1 6P 1 Date/By: t ZS a 42 Pcri" No 6 a - 0 Ya2
- 13125 SW Hall Blvd., Tigard, OR 9 it
I
el.° Plan Revie I
i
Phone: 501639.4171 Fax 501598.1' . 1 c ‘0 Date/y. Other Permit:
-- C ,,,,,, Inspection Line: 503.639A175 0 '3 ,_ , ,i,V,9 Date Ready/fly: Iwis: El See Page 2 for ■
L.......,.,:-........:: Internet www.tigard-or.gov ,.. c ‘43 otified/Method:
f i g Stipplemattal Information
0 0 /-A ■C-
TYPE OF .WO ot .\
• 0 New construction ' --- lakddition/alterationtplacement
0 Demolition _
0 Other: COMMERCIAL. FEE* SCHIEDULE - USE CHECKLIST I
Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
mechanical materials, equipmej t. labor, overhead, and profit
, CATEGORY OF CONSTRUCTION Value: $
RESIDDITIAL EQUIPMENT / SYSTEMS FEES*
Lw. I- and 2-family dwelling 0 Conunercialfmdustrial 0 Accessory building
0 Multi-family 0 Master builder 0 Other: For Jpecial information use checkfix
Description 1 Qty. - 1, Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site address: i ‘ S3' 3 (--) .‘:.- (,,...) q c. - i....tiN
omakes sitc plan showing placement) 46.75
City/State/ZIP: ---1 t ' c e , ,,-- c, () 4 / Z (-1-? )a. 3 Furnace 100,000 BTU (ductslvents) 46.75
Furnar-e 100,000+ B'TU (ducts/vents) 54 91
•
Suite/Mg/apt no.: rProject nazne: S ' ..1. -
i .s. k ,.. - . Heat PaMP 6L06
Cross street/directions to job site:
_ - - - _Duct wodr__ _ . 23.32
Hydronic hot water system 2332
Residential boiler (radiator or
hydronic) 23.32
Unit heaters (reset-type, not electric),
in-wall, in-duct, suspended, etc. 46_75
Subdivision: Lot no.: Flue/vent for any of above 23.32
1
Other 23.32
Tax map/parcel no.:
Other fuel apptiauces
DESCRIPTION OF WORK Water heater ) 2332 <;,I, 3 - 3 - A,
Gas fireplace 33.39
'i a vN Ic__131_,S S c- 6, 1-Q. , / h uN--IP V Flue vent fax water heater or gas
) fireplace ) 73.32 ..) 3 ...i.„
T y, i n ci v 1 c,,10Q I --c"scry rilivy.,.„1-,5 Log lighter (gas) 23.32
Wood/pellet stove 3339
- Wood fireplacefinsert 23.32
Cbanneyneriihretvent
Q PROPERTY OWNER 1 0 TKNANT - 2332
Other:
2332
Name: .‘k ( ■ .Ai\ \crY\ Environmental exhaust and ventilation
Address: 3 0 i kce - F--, L.3 q '-..
—4._ ir, Range bood/other kitchen
enuipment 33.39
iC ty/Statr-/ZIP: -- ‘. c. r,',, 'C/ 9- C- 1 --- ?ika t Clothes dryer exhaust 3339
--)CN Single-duct estisaust (bathrooms.
Phone: ( ;rt.>) ISs'' --) LT Fax: (: )
i
toilet compartments, utility rooms) 2332
a
1:1 APPLICANT 0 CONTACT PERSON Attic/erawtspace fns 23_32
__.-.
Other: 2132
BusinesS Y, 1711 si. 0/1 cl, vl, 1 ( c., • FUei Piving
Contact name: S,( ....,
S14.15 for first Cour; 54.03 f or each additional
Address Furnace, Address .2 e\ -,?,c, >: II t_i) etc. 1
Gas beat pump
City/State/ZIP: ..(7 ( , - 1 - C3 e ( 2_ 9 70( Wall/suspended/anit heater
Phone: ( 4:r) #,... i t--I - CI 1 ' '' 1 FeL : ( C 9 . 1- 1 ( t) • (-3 i Lr Water heater 1 1 ti IC
Fireplace
E-mail:
Range _
• CONTRACTOR Barbecue
Clothes dtmleas)
Business name: -- 1 / .. Y cv-c1/4„-1*, r
011itr:
itddrcss: ? 0 r 1 1 ( _, i ,
NIECHANICAL PERMIT FEES*
Subtotal 616 - 2 ci
:Ity/State/ZIP: - c (-1% .1? (-:-A Opcfni•-l) (1),(' () l 7 t Lo
Minimum getout fee ($90.00) .1 6 : -0
'hone: ses.) fs I_ 04 - ci i -)..., ce9 (... 4C49 - 0 i ct ic
Plan review (25% of permit fee)
sit ic -
il • - 1 k Lc ( -3 - State surcharge (12% of permit fee) )0 • 7r (::
TOTAL PERMIT FEE : ';5-
luthorized signature: rK,
_.S•J' ----\/.'-- This permit approcation espiFeS if a permit is not obtained Irithin tso
days after it has been accepted as complete.
'rint Date: 5 ,...... a „,,.., ) 0 1 • Fee methodology sz.- hy re-County Building Indarry Sc'" Etozat
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