Permit CITY OF TIGARD MECHANICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit MEC2010 -00446
T [C' A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/08/2010
Parcel: 1 S135DB02600
Jurisdiction: Tigard
Site address: 11405 SW 90TH AVE
Subdivision: TIGARDVILLE PARK Lot 0
Project: Powloski
Project Description: Fuel piping for range.
Owner: FEES
POWLOSKI, C KENT & LISA Description Date Amount
11405 SW 90TH
TIGARD, OR 97223 Fuel Piping 09/08/2010 $14.15
12% State Surcharge - Mechanical 09/08/2010 $10.80
PHONE: Minimum Fee Adjustment - Mechanical 09/08/2010 $75.85
Contractor:
NORTHWEST CENTRAL PLUMBING CO INC
2870 SE 75TH AVE # 206
HILLSBORO, OR 97123
PHONE: 503 - 642 -2067
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
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.
lir
Issued By: - Permittee Signature: /
CaII 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.
09/08/2010 08:32 15036425954 NWCENTRAL #1064 P.002/004
Mechanical Perm Appiic . J(EJVED FUR DEPICT: us ONLY
Received
Ifii City t f Flail Tigard OR 97� r � t }, s " , d '
Phone: 503. 639.4172 Fax 503.598 t960 0 8 Z010 Plan Review
DatdOr Other Permit"
TIGARu Inspection linc. 503.639.4173 Date Ready /By: B See Pic2for
Internet: www.tigard -or -goo C ITY OF TIGARD �ficd Supplemental Information
BUILDING DIVISION
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I:1 New construction Add ition/alteration/replaccmcnt Mechanical Permit fees* arc based (rounded th e value nearest work
perfotmcd. Indicate the value (rounde W The nearest dollar) of all
❑ Demolition ❑ Other- , mechanical materials, equipment, labor, overhead, and profit
v =:_ -: Y� ll "u __ �_ __ro •- _ -'. -. ..---,-,--,-.--• _ 4i - . - 4 :_.�. Value: $
i lf ° •1_ti �!t ' nv } � -.4550 .... J- - c T', i 2 50'. • Kr n, n: Y�'i ` . - - _: :N: ? „ 1 ' r 3 A " _,--, �:!L' -Pi i4 i vi i_., - - a .+. 1�____ _ - -_ • r =- - - --= I .i_"".L
I- and 2- family dwelling 0 CommereiaVindustna1 ❑ Accessory building 4 . ; �:
For special information use tecklisL
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty, I Ea. I Total •
1 �
rs. • : t : %• ii� „¢'ia _ ',-:;�;:: IIeatmg/cooti
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Air conditioning
Sob site address: A lib • ab\ • (requires site visa snowing placement) 46.75
City/Statc/ZIP: •
Furnace 100.000 BTU (ducts/vents) 46.75
: .Ale. Furnace 100.000+ BTU (doctsrvenrs) 54.9!
Suite/bldg /a}�t no.: Project name: C' �! �� t/J� !,. ' Heat pump 6I.06
Cross s stroet/direaions to job site: Dui work 2332
Flydronic 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
- Plue/vent for any of above 23.32
Subdivision: Lot no.:
, 23.32
Tax map/parcel no.: Other fuel appliances
„ P . • , . ,, __ -_. +:_= Water hcator 23.32
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y :
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Gas
e`°' fireplace 3339
1 ,.._a 1 . r . Y , ( • Flue vent for water heater or gas
fireplace 2332
Log lighter (gas) 2332
Wood/pellet stove 3339
Wood fireplace/insert 23.32
•
.� .. .__... .... .. .. 44__ -.... :-- ._....._
Y= yy L,. u .- -�-, Chimney/liner /flue/vent 2332
10.1 II 41 �^ .. :'I.'ll v ..�._ �...,vl,_.� - A-11JL'
�� "' iii`.'. tv � �I - .n ))�:
=: �� �� _ i a ,a t . .t rq >�1 u'�F._ =5pf r _ ..i' (�ker 2332
Name: ueN + , t- ��a r ( al ter Environmental exhaust and ventilation
V` Range hooc/other kitchen
Address: equipment 33.39
City/State/Z1P: Clothes dryer exhaust 33.39 •
Single -duct exhaust (bathrooms, •
Phone: ( • ) Fax: ( ) toilet compartments, utility rooms) 23.32
— .W- 1 * . t.” -_ -• i r. f _ - ' _: } 1:::1:'.;:: _ - ..�cv-Z Attse/ctawlspaoc fans 2332
Other: 23.32
Business name: Fuel pipes
Contact name: $10. first 15 for fou 1 $4.03 for each additional
— _ Furnace. etc.
Address: Gras heat pun
City/State/ZIP: Wall/suspended/unit heater —_
Fax: ( ) Water beater
Phone: ( ) Fireplace
E -mail: . . Range 1 14; Is
:,...
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:._, - =tea . #. _3>� • ; ..-- ax.- r ?;L? ` -,!,,;- =-.,,ri.4. i _ -, 1 04 - -.� Barbecue _
;
c:, -. F.a- +i "cL - ?.. .- ... - vl �-' ' � .. ,- - rinr:::r- - -._._.ubl.i;n _ --
Clothes dryer (gat)
ntune:
Business k. 1. _ • ■ • CO • - Other:
Address: "41 , s- - -\ L . ri = :4 : • - '_1:F d"�e: : y', `'.�' -= a M.: m ,, ,Y r riff _;
City/StatclZ e � a' rP: _ , r Sabtotal IS
Minimum permit fee ($90.00) 'i" f2 , -
Phone: (C ) , A Z . eitxpl Fax: �) 042. 91 54 Plan review (25% of permit fee)
- CCB Tic.: 17 3 State surcharge (12% of permit fcc) I p . $D
TOTAL PERMIT FEE IDD.$D
Authorized signature: / T permit days ft a expires ° a � p � within 180
Print name W. • Data () D • Fee methodolopa' se by Tri•Cawuy Building Industry Service Board
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