Permit CITY OF TIGARD MECHANICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit #: MEC2010 -00471
T i G :\ R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/29/2010
Parcel: 1S133 DC08400
Jurisdiction: Tigard
Site address: 11730 SW 134TH TER
Subdivision: WINTER LAKE Lot: 14
Project: Debartola
Project Description: Installation of 15 of gas piping to range.
Owner: FEES
DEBARTOLA, YVONNE Description Date Amount
11730 SW 134TH TER
TIGARD, OR 97223 Fuel Piping 09/29/2010 $14.15
12% State Surcharge - Mechanical 09/29/2010 $10.80
PHONE: 503 - 310 -7624 Minimum Fee Adjustment - Mechanical 09/29/2010 $75.85
Contractor:
FAST WATER HEATER COMPANY
12601 132ND AVE NE
KIRKLAND, WA 98034
PHONE: 425 - 636 -7054
FAX: 425 - 636 -7055
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 N " ation a er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir questions to O ?„,
calling 503.246.6699 or 1.800.332.2344. ��
Issue By: � Permitte Signature: ` , ' � J ,(
CaII 503.639.4175 by 7:00 a.m. for an inspection that b - ness day.
This permit card shall be kept in a conspicuous place on the job -' : until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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From: 09/29/2010 08:24 #308 P.003/004
o V9 20
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Mechanical Permit Application a y of Tigard ,, F01( OFFICE USF ON1.1
Cit V' N XSP.' Received
CI CI 0 Al M . /
11211:1ri -T-..6 109 ?4
• 13125 SW Hll Bh/d., Ti , Plan gaml OR ' . A u
• LO - Date/By:
Review
I II 1 Phone: 503.639.4171 Fax: 503.59.'. •C 1 DatelBy: Other Permit:
Inspection Line: 503.639.4175
- 1 - Ic■ARID Date ReadyiBy: Avis: Fa See Page 2 tor
Internet: www.tig,ard Notified:Method: Supplemental Information
'.":::'`.P':i TZ:A.2. t 4,4:::*W: . .i'-:;
Mechanical permit fees* are based on the value of the work
0 New construction 64-Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other. mechanical materials, equipment, labor, overhead, and profit
Value: S
LI and 2 dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist
El Multi-family 0 Master builder 0 Other: Description 1 Qty. f Ea. I Total
, 10•04* - 00cf c ****** * 0* - : - .*OKie - i , raft6Pli : Beatimile?olin it
Job site address: In ?...)) 1/ if)( Air conditioning
(requires site plan showing placement) 46.75
City/State/ZIP: ,,e„,, 0,, 7-zz Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg./apt. no.: 1 Project name:
Heat pump 61.06
Cross street/directions to job site: ":. kA3 ‘G Mct , Duct work 23.32
Hydronic 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 23.32
Tax map/parcel no.: Other fuel appliances
1 . ' . 0::**iti - if . 4* : .:*0 - w,.s , ! .. : ; Z : ..:.-,....:W " :":"V.4t1:& . - 3 .). GWasaterfurphealaterce 2332
33.39
ThsAfx,v1 k ' OS i , p% %/No) - Ai) farne , Flue vent for water heater or gas
fireplace 23.32
Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
.. Chinmey/liner/flue/vent 23.32
4ft7.00?..:tt.J other 2332
Name: ‘'i \)CW\Y\ P - Environmental exhaust and ventilation
ki
Address: \ VIS S VO \'4 vex- Range hood/other kitchen
33.39
City/State/ZIP: - T\G‘cxc l ok t OIL CV( II'S Clothes dryer exhaust 33.39
F 4,„ --11/4 Fax: ( ) ,..
Single-duct exhaust (bathrooms,
Phone: -
toilet compartments, utility rooms) , 23.32
MISittAttOit.M.gtA :. g-Vt01 AttickmwisPace fans 2332
Othr: 23.32
Business name: e
SO-Yr kX) Ctif X kielf)* Fuel piping
Contact name: (0,__ L S14.15 for first four; S4.03 for each additional
Address: k'LU 0 \ -- \ ( 2 ..... 1\3G_ Furnace, etc.
Gas heat pump
City/State/ZIP: 1<,..\ { t, V O yka w\P‘ mua-1 Wall/suspended/unit heater
Phone: U15') tp319 7 b9 1 Fax: : (1-1/c) USU , 70S-S Water heater
Fireplace
E-mail: t CCAA ( / kASA" IN) kb tfeetiQf • CON Ran i ii - I .1 tii.15
.'a.`,25 .Y Barbecue
Business name: f b i-veDfi Clothes dlyer (gas)
Address: 1 2- 1 t i I.; E-: . c. -, P,F,:- -- .'t. - -':',:tixtgaiti*O4:4*Rsoloto. , ..v=.t40:: - v::
City/State/ZIP: K% .. V.Aa t.1
* i
- ViAl 4g Subtotal . -
Minimum permt fee ($90.00) ' D . 0 b 90
Phone: (Li t5) 1W -1O'34 Fax: (14 i6j 1 -
Plan review (25% of pennit fee)
CCB lic.: \ 1/4,0 ( 6 0 01 State surcharge (12% of pennit fee) 4.1.-eila- 0• °
TOTAL PERMIT FEE 4,0.40,5'
11 This permit
Authorized signature: application t:ras Pelmaceeptl is not as ob within 180
com
Print name: ,. QSS.\ C C4. A ,, )Y ,, (4, Date: C I 1 7,c( 1' 0 . Fee methodology set by Tri-County Building Industry Service Board/op 8.0
1 ABuildingWermits \ MEC-PermitApp doc 10 440-4617T (11/02/COMN/EB)
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