Permit CITY OF TIGARD MECHANICAL PERMIT
;' COMMUNITY DEVELOPMENT Permit #: MEC2011 00023
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/12/2011
Parcel: 2S1148B16600
Jurisdiction: Tigard
Site address: 16292 SW 103RD AVE
Project: Whisler Subdivision: RIVERVIEW ESTATES Lot: 12
Project Description: Install gas fireplace, vent and gas piping
Contractor: G P & W SYSTEMS INC Owner: WHISLER, SUZANNE F
732 MARBLE RD 16292 SW 103RD AVE
WASHOUGAL, WA 98671 TIGARD, OR 97224
PHONE: 360- 772 -6331 PHONE: 503 - 460 -7832
FAX: 360 - 835 -5716
FEES
Specifics: Description Date Amount
Gas Fireplace 01/12/2011 $33.39
Type of Use: SF Flue Vent for Water Heater or Gas 01/12/2011 $23.32
Class of Work: ALT Type of Const: Fireplace
Occupancy Grp: Fuel Piping 01/12/2011 $14.15
Stories: 12% State Surcharge - Mechanical 01/12/2011 $10.80
Minimum Fee Adjustment - Mechanical 01/12/2011 $19.14
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 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 1.800.332.2344.
�
Issued By: I r/ - Permittee Signature: c" '/ /f'/'L/
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.
'r 1 V �V
Mechanical Permit Ap $ l%ca 'lsim FOR OFFICE USE ONLY
Cl Of Tigard JAN 2 2011 Received /02. // ;�� Permit No /1r 0610a3
`J Date /By:
" 13125 SW Hall Blvd. - Tigard. OR 97223 Plan Revie ti
Other Permit: rai Phone: 503.639.4171 Fax: 5�3 0• Date /By:
TIGARD kJI Date Ready /By: �� TIGARD
Inspection Line: 503.639.4175 0 See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: 11 Supplemental Information
ii$1 r 4" e TYPE OF 1Y ORIh x FitC017NIERCIAL; FCE SGHED 11SE GHCChLISi
Mechanical permit fees* are based on the value of the work
❑ New construction X Addition /alteration /replacement
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
CATEGORY OF'CO Value $ /TO
. « = '• ".. " , `, RESIDENTIAL EQUiIPA4 SY FEES * ....
rg I -and 2 - family dwelling ❑ Commercial /industrial El Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total
M ' JOB SITE INFORMATION AND LOC9IION Hea ting /cooling
Air conditioning
Job site address: /( a ? !J 5 /0 3 r -� 40-e.., (requires site plan showing placement) 46.75
City /State /ZIP: -1-∎ l #4-rL{ U 0 1 -7 a a ti Furnace 100,000 BTU (ducts /veins) 46.75
r /� Furnace 100,000+ BTU (ducts /vents) 54.91
Suite /bldg. /apt. no.: Project name:5 u VI l/v t'L I SI P/- 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
i l DESCRIPTION OFs WORK N � 9 ` 4
Water heater 23.32
^ " 1 Gas fireplace / 33.39 3 3,
e ; P i t la p 1. Flue vent for water heater or gas
fireplace. I 23.32 P3 • 3Z
,- T •i-y F Yyep !a'c---e_ Log lighter (gas) 23.32
Wood /pellet stove 33.39
Wood fireplace /insert 23.32
'° PROPERTY OWNER / `. _ TENANT Chimney/liner/flue/vent 2 23.3
CI'
�t�.,. ,.. Other: 23.32
Name: C K - $. (--)11 1 s I e r - Environmental exhaust and ventilation
J r Range hood /other kitchen
Address:
/ '1 9 2_ 5 GO / Q 3 ,- -fit -4 -__ equipment 33.39
City /State /ZIP: rd_ 0 - Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: (5/ ) 4/6,6 _ 783 2 Fax: ( ) toilet compartments, utility rooms) 23.32
't"YPPLI' ANT 5 CONTACT PERSON 'P Attic /crawlspace fans 23.32
,,, . „. Will.
Other: 23.32 _
Business name: G P4- (..6 s c, S , Fuel piping
Contact name: e- 514.15 for first four; 54.03 for each additional
Address: 7 3 yn q-v- f 14f Furnace, etc.
Gas heat pump
City /State /ZIP: C [44 i / /,� 9 7I Wall /suspended /unit heater
Phone: (�A6 77) _ &,33 / / Fax: : (3(,d) 835 -57/( Water heater
L mail: /�v`"' (iA L 1 iv $ 5 4 -5 , C b /'Y.- T Range ace ( �u.� • " IM Barbecue
',� . +' e, . .. ` . I CON Ti2ACT�OR , • Clothes dryer (gas)
Business name:
Other:
S �4
Address: • - f TEES t , , " ''
City /State /ZIP: Subtotal //
Minimum permit fee ($90.00) 9o. d O
Phone: ( ) l Fax: ( ) Plan review (25% of permit fee)
4,,e B lie.: /(y g / 7 t (MI .^ ?s ) State surcharge(12 %of permit fee) /0 -$0
/ " , C �� r ' TOTAL PERMIT FEE / , 'WO 4 :7
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
Print name: A .,, 0_ G re C•A— Date: ( — i i — ( 1 $ Fee methodology set by Tri- County Building Industry Service Board
I:ABu ilding \ Permits \MEC- Permitdpp.doc IO /01 /09 440.4617T (11 /0JCOAIM'E R)