Permit a CITY OF TIGARD MECHANICAL PERMIT
a COMMUNITY DEVELOPMENT Permit #: MEC2010 -00569
TIGARD ' 13125 SW HaII Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/09/2010
Parcel: 2S104AB12400
Jurisdiction: Tigard
Site address: 13116 SW BENISH ST
Project: Hof Subdivision: MORNING HILL NO. 6 Lot: 153
Project Description: Installation of gas insert & venting. Gas line is existing.
Contractor: EVERGREEN GAS INC. Owner: HOF, DANIEL
PO BOX 388 13116 SW BENISH ST
WEST LINN, OR 97068 TIGARD, OR 97223
PHONE: 503 - 407 -9542 PHONE: 503 - 430 -7622
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Gas Fireplace 11/09/2010 $33.39
Type of Use: SF Chimney /Liner /FlueNent 11/09/2010 $33.39
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 11/09/2010 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 11/09/2010 $23.22
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressure:
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 ' cation e - . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir t questions to OUN • • cal g • :3.232.1987 or 1.800.332.2344.
0 1 I
Iss ed By: it CO r Permittee i nature:
fir
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 Application FOR OFFICE. tISIl ONLY
City of Tigard Received Permit No. • City DateBy: ' C.� „a, u 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' g C ' Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date/By:
T I G A R D Inspection Line: 503.639 Date Ready/By: June. H See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑ New construction Addition/alteration/replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
IADemolition Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
111- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description 1 Qty. 1 Ea. 1 Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
2 Air conditioning
Job site address:
31 1 _S t4 U .2 "v! LI (requires site plan showing placement) 46.75
City/State/ZIP: c2 (7 7 .L.1. . 7 Furnace 100,000 BTU ( ducts/vents) 46.75
i/ J Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: 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
Subdivision: Lot no.: Flue/vent for any of above 23.32
Other: 23.32
Tax map /parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water 23.32
J Gas fireplace 33.39
j /* 1 / 6~4'5 / 844 CR, f •- • f- Vli 417 ►�J 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
PROPERTY OWNER ❑ TENANT Chimney/liner/flue/vent 23.32
Other: 23.32
Name: ➢A3' " Environmental exhaust and ventilation
Address: Y � / / F ` Range hood/other kitchen
3 / / & .$ ii✓ gory is equipment 33.39
/ State/ZIP:
Ci L� Clothes dryer exhaust 33.39
City/State/ZIP: ' ' h ✓~ �� �, Single-duct exhaust (bathrooms,
Phone: (5 /./ t 0 .. 7 j L.. Fax: ( ) toilet compartments, utility rooms) 23.32
❑ lI AP J PLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32
Other: 23.32
Business name: Fuel piping
Contact name: $14.15 for first four; S4.03 for each additional
Address. Furnace, etc.
Gas heat pump
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax:: ( ) Water heater
Fireplace
E -mail: Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name:
✓{l it ri c. ..r.✓,c. Other:
Address: ? • 3- ft: 3.s MECHANICAL PERMIT FEES*
City/State/ZIP: , 5 4 �. Q„� `� 4 Subtotal 9o.
V" Minimum permit fee ($90.00) ---
Phone: ' y
)5) � 1�1' �� � (� Fax: ( ) Plan review (25% of permit fee)
CCB lic.: / 53 03 1 State surcharge (12% of permit fee) fC).9O
TOTAL PERMIT FEE /D O • ''C)
M
Authorized signature: . T, ,t{f�5mil,a.ml orkiruexpiceas a permit is not obtained within 180
44' . mid aftun Ut9es ikata amtepted as complete.
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