Permit y CITY OF TIGARD MECHANICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: MEC2011 -00012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2011
Parcel: 2S102BB00824
Jurisdiction: Tigard
Site address: 10375 SW JOHNSON ST
Project: MORONEY Subdivision: Lot: 0
Project Description: Wood stove installation.
Contractor: EVERGREEN GAS INC. Owner: MORONEY, STEVEN E
PO BOX 388 10375 SW JOHNSON ST
WEST LINN, OR 97068 TIGARD, OR 97223
PHONE: 503 -407 -9542 PHONE:
FAX: 503 - 344 -6345
FEES
Specifics: Description Date Amount
Wood /Pellet Stove 01/05/2011 $33.39
Type of Use: SF Chimney /Liner /FlueNent 01/05/2011 $33.39
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 01/05/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 01/05/2011 $23.22
Stories:
Fuel
Fuel Types:
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.
c
Issued By: � � r _ Permittee Signature:
Call 503. :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 USE ONLY
Ci of • Ti and Received PenditNo.:
h' g � Date/By: � �J/ p. - 3Z� 1' �� (�
:� q 13125 SW Hall Blvd., Tigard, OR 97223 r ,\ Plan Review
Phone: 503.639.4171 Fax: 503.598.196 O'� Date/By: Other Permit: -
Inspection Line: 503.639
T I G A R D 0 J
w \ Date Ready/By: rim See Page 2 for
Internet: www.tigard - or.gov JP \v G` ' , 'j. D a t �y� o d ; - Supplemental Information
TYPE OF WORK C S 4( \) COMMERCIAL FEE• SCHEDULE – USE CHECKLIST
• ❑ New construction . W Addition/alteration/t'ep .`'z :, Mechanical permit fees' are based on the value of the work .
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition Q Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF CONSTRUCTION Value: $
RESIDENTIAL EQUIPMENT / SYSTEMS FEES*
' l - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building .
❑ Multi - family ❑ Master builder ❑ Other: For special information use checklist.
Description I Qty. I " Ea. I Total
JOB SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning
Job site address: . /03 7 > S I/J .s 6 L S Z. n • ST (requires site plan showing placement) 46.75
City /State/ZIP: ' , fi r � � ', Furnace 100,000 BTU (ducts/vents) 46.75
Furnace 100,000+ BTU (ducts /vents) 54.91
Suite/bldg. /apt. no.: i Pro 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 -
Flue/vent for any of • above 23.32
Subdivision: , Lot no.: Other: 23.32
- Tax map /parcel'no. : - • . • Other fuel appliances
DESCRIPTION OF WORK - Water heater 23.32
_ �- . Gas fireplace ' 33.39
. c2L't5 I (> ii S/ Jt.; -- v(,t/L1( Flue vent for water heater or gas
fireplace - 23.32
. Log lighter (gas) 23.32
Wood/pellet stove • _ 33.39 r33 . d 1, :
Wood fireplace /insert 23.32 ,.
' Chimney/liner /flue /vent j '23.32 .- ?- ' `4)._.
[�]rPROPERTY OWNER ❑ TENANT Other 23.32
Name: // — J Poi o ( iAty - ' Environmental exhaust and ventilation'
•J C Range hood/other kitchen
7
Address: 1 0 \ p S / , r l 0 0 14 NS -.Cr--- equipment 33.39.
City/State /ZIP: - I , , �, f 0 -K q 7 i z 3 . Clothes s dryer exhaust . 33.39 -
' "tt " ""ll / Single-duct exhaust (b
Phone: ( D 7 0 .. L I J 1 2 � - Fax: ( ) toilet compartments, utility rooms) 23.32
❑ APPLICANT ❑CONTACT PERSON
Attic /crawlspace fans 23.32
. Other: 23.32
Business name: Fuel piping
Contact name: . $14.15 for first four; $4.03 for each additional
•
Address: Furnace, etc.
Gas heat pump -
City/ State/ZIP: Wall/suspended/unit heater
Phone: ( ) Fax,: ( ' ) Water heater
Fireplace V
E - mail: Range .
CONTRACTOR Barbecue . .
• Business name: / Clothes dryer (gas)
B
El v e_ i ci Beet 6 A5 . TNL - Other:
Address:. 7 .z �� ` P MECHANICAL PERMIT FEES*
City/State/ZIP: j A j C.c_ 1 t/LLA i ( ? 0 b6 subtotal
IA 1 M inimum permit fee ($90.00) 9 0
Phone: ( p t1 ` 7 t 'L Fax: ( )
Plan review (25% of pe»it fee)
CCB lie.:. } e p s ` / 7, g ikt ek' State surcharge (12% of permit fee) , /0 ; )
r TOTAL PERMIT FEE • 106 ,87)
Authorized signature: This permit days application
fter it has been accepted complete.
180
Print name:' - A . i 14 A A Da L. • Fee methodology set by Tri- County. Building. Industry Service Board
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