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Permit CITY OF TIGARD MECHANICAL PERMIT o COMMUNITY DEVELOPMENT Permit #: MEC2010 00559 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2010 Parcel: 1 S133DD07200 Jurisdiction: Tigard Site address: 12714 SW DANBUSH CT Subdivision: VILLAGE AT SUMMER LAKE NO. 3 Lot: 111 Project: Project Description: Gas fireplace insert with fuel piping to fireplace and range. Owner: FEES JARBEAUX, DON Description Date Amount 12714 SW DANBUSH CT Gas Fireplace 11/04/2010 $33.39 TIGARD, OR 97223 Fuel Piping 11/04/2010 $14.15 PHONE: 12% State Surcharge - Mechanical 11/04/2010 $10.80 Minimum Fee Adjustment - Mechanical 11/04/2010 $42.46 Contractor: GASPRO INC 7603 SE LOUNSBERRY LN PORTLAND, OR 972056 PHONE: 503 - 775 -7020 FAX: 503 - 775 -7019 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: ,9404 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. Mechanical Permit Appllcah E C E IVED 1 ul: of I l( 1. l,til_ c),,1.1 City of Tigard NOV 3 2010 tidy i 1 ,r Permit No.: _ _ , • 0 _ 13125 SW Hall Blvd., Tigard, OR 97223 plan Review Phone: 503.639.4171 Fax: 503.598,1983ITV OF TIGARD Date/13y: Other Permit: T I C A K L, inspection Lino; 503.639.4175 BUILDING DIVISION Dflie '''''''' F Sep Page 2 for Internet www.tigard- or.gov Notified/Method: Supplcmentat Information .:.. TYPE"QE.WORIC • , ., • .: . COMMEacIAL FEE* SCHEDULE.r. USE CHECKLIST Mechanical permit fees* tole 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. . • ' CATEORY. • CONS'T'RUCTION.. Value: RE.S1f7 NTW.. FQiTiPMENT / SYSTEMS FEES* gl... L- and 2- family dwelling I3 Contmerci e stmt El Accessory building For special t rt.P EN use / S checklist. Multi- family ❑Master builder r ❑ Other: . Description l Qty. Ea. j Total ::JOB:SITE`.INEORMATION •Alt4R. LOCA.TION.. . . • Heatinc/cooling Air conditioning Job site address: f ?Pi 5 id DAr' btl Srh L f (roquifeS site plan showinmpl tceme m) 46.75 City /State/Z>P: • V r CI t•umace 100,000 BTU (aucts/vents) 46.75 _ Furnace 100,000+BTU (duets/vents) 54.91 Suite/bldgiapL no.: Project name: )170v 1 t °A t,. j` _ Heat pump 61.06 Cross street/directions to job site: 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 rto.: Other fuet:appliances DESCIUY1ON OF WORK .. .. • Water heater 23.32 Q r fireplace / 33.39 �4 21 " Flue vent for water heater nr gas fa .lace 23.32 �A5 g s e. 2,1' Log lighter (pas) 23,32 Wood/pellet stove 33.39 _ Wood fireplace/insert 23.32 Chimney /liner /flue/vent 23.32 . 1'itOPER Y OWNER . I 0 TENANT _, Other: 1 23.32 Name: {, Environmental exhaust and ventilation Doll/ T ✓ R bpAV X Range hood/other kitchen Address: /a 7) 4 / 5 kJ 1)41h: C t e ui • rent 33.39 City /State/ZIP: M1 9 r� '� Clothes • exhaust 33.39 T ./� V . ". Single -duct exhaust (bathrooms, Phone: ( 03 5 y + / p 3b Fax: ( ) toilet compartments, utility rooms) 23.32 CONTACT.; PERSON Attic/crawlspacefaas 23.32 (] APPLICANT Other, 23.32 Business name: _ Fuel nip* _ Contact name: w 514.15 for first four; 54.03 for each additional ■ Furnace, ern. ■ Address: — Gas treat • um. City /State/ZIP: Wall/sus.. :ndcd /unit heater -. water nearer Phone. ( ) Fes:: ( ) — Fire .lace E -mail: Range MI - CONTRACTOR Barbecue Clothes dryer (gas) MI Business name: 6 4 V4 p Dv Other" __ . Address: • / 5 • M , . 4 . • MECHANIC AL PERMIT: FEES* / � subtotal City/State/ZIP: `°Q&2•�r © 9 �p �lmnmmltrn permit fee (390.00) Gltl UU Phone: ( 0. . J Fax: ( - 7 r — Plan review (25% of permit fee) CCB lic.: State surcharge (12% of permit fix) it) , jrp �� 71 � J� TOTAL PERMIT FEE itul _ Ibis permit application expires if a permit is not obtained within 160 Authorized signature: days after it bas been accepted as complete. / , • Fee mimet6odology sot by'l'ri.County Building Industry S��vtce Board Print name: Da / i _:,.it ter u4A.,ri t inaiI19 440-461"/I(II /02 /COMIWEB) Z O / Z0" 3..... E d OddSti9 6TOLGLLE0S 5i :0i 0i0Z /E0 /ii