Permit 1
1 CITY w,
OF TIGARD MECHANICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: MEC2011 -00041
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2011
Parcel: 1 S133AD14600
Jurisdiction: Tigard
Site address: 12712 SW SORREL DOCK CT
Project: SUMMERLAKE Subdivision: SUMMER LAKE Lot: 27
Project Description: Relocating gas meter.
Contractor: HEAT RELIEF CO Owner: MENDEZ, JAMES /DEBRA LYNN
13122 NE DAVID CIR # 800 12712 SW SORREL DOCK CT
PORTLAND, OR 97230 TIGARD, OR 97223
PHONE: 503 - 261 -9915 PHONE:
FAX: 503 - 261 -9814
FEES
Specifics: Description Date Amount
Fuel Piping 01/27/2011 $14.15
Type of Use: MF 12% State Surcharge - Mechanical 01/27/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 01/27/2011 $75.85
Occupancy Grp:
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 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.
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Issued By: Permittee Signature: _�
Call 503. . 75 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.
01/27/2011 THU 8:39 FAX 5032619814 faj002 /002
Mechanical Permit Application FOR OFFICE USE ONLY
City of Tigard ���a ..� Rece
III 4 13125 SW Hall Blvd., Tigard, OR 97223' p a �� Pla Review T .. Phone: 503.639.4171 Fax: 503.598.1 0 c„Cr 1\3 •
Date/By: Other Permit
Inspection Line: 503.639.4175
IGARD li \ :?� DateReadyBy: 0 SeePage2for
Internet: ww.hgardvcgov \V
9^ C.Notified/Method Supplemental Information
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\: �' Mechanical t fees* are based on the value of the work
El New construction ® Addition/alteration/rtplacement P
.... .... performed. Indicate the value.(rounded to the nearest dollar) of all
❑ Demolition ❑ Other. mechanical materials, equipment, labor, overhead, and profit.
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1:1 1- and 2- family dwelling ❑ Commercial/industrial El Accessory building -v< r ` '' t '' `. !F --�
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0 Multi family ❑ Master builder ❑ Other For special information use checklist.
Z �v�r , x x L Y * Description f Qty. I I Total
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` '..9, a� sy sr<ss" ` ::, �'.`1 .`�ei �rTITh Yq)a , i l fi t& c`. 7 . � ,� ; Heating/cooling
site address: Air conditioning or beat pump
- .!'. t f■ Or i. (requires site plan showing placement) 14.00
City/ State/ZIP:
0 ins Pomace •100,000 BTU (ducts/vents) 14.00
Suite/bldg./apt no.: Project name: _ / Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: Duct work 14.00
Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, induct, suspended, etc. 10.00
Subdivision (Lot no.: Flue/vent for any of above 10.00
Other: , 10.00
Tax map /parcel no.: ff� r Other fuel appliances
F . i �t9 i Ilia i ti�,`s .'kt� " q dS p ... n +. .li Z Water heater 10.00
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:'..�,.s�L� a-= �.�]v.- .- 1...,=,:....:�s. .. � ...n r i7!�....,.,,.�...... .0 1a_::�.. «..Y._..,. -,« .�e9...0 .�...'.a.
Gas fireplace 10.00
Flue vent for water heater or gas
1 ■ .- bit �' fireplace 10.00
v Log lighter (gas) 10.00
Wood/pellet stove 10.00
Wood fueplace/insert 10.00 ,
`' y °� --� r 1 ti .- u x� • g -, Chimney/liner/flue/vent 10.00
5 z { -- �.'x rt L tx E d. 1,�� „ . . T F - i , v_141 , ;? ,� ? i i .<.r
,v,,.�::- 1.,_v ., r' :ti._..:� ..:.. u.� r, n ._. 4;G »... :t:..v. ..�..,w.<,>t:1._ir.,� �...s an,.ai � l,.:. ,_ . :..t.:_.. ... , Other: 10.00
Name: S Ad 1 L� ter/ Environmental exhaust and ventilation
Address: Range hood/other kitchen
equipment 10.00
City/State/ZIP: Clothes dryer exhaust 10.00
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) g&}} toilet compartments, utility rooms) 6.80
t, s r ,.�` a `E ,� C`�VEis•Xs. . k :: 'E V y Y . -? . / T.EP � .} ."t) 5 ..1 Attic/crawlspacefans 10.00
Business name: HEAT RELIEF Other 10.00
Fuel piping
Contact name: MARK DEFRANCISCO $5.40 for first four; $1.00 for each additional
Address: 13122 NE DAVID CIR DR # 800 Furnace, etc.
Gas heat pump
City/State/ZIP: PORTLAND, OR 97230 Wall/suspended/unit beater
Phone: (503) 261 -9915 I Fax: : (503) 261 -9814 Water heater
Fireplace
E-mail: Range
`r. i x1'e _ �ti s _ 3sT rw- ras ,5 4 m L <tcr rbecue • er (gas)
k -.... :.... :.IA R aJ.w ... _:._k ; f. „ :.- �� 4 & 'y+`. i Wet s .e :S."?; ...,..:c x�
4. Clothes Ba
Business name: HEAT RELIEF r Other: t ,t. .i I_>•tttt�r7lt
Address: 13122 NE DAVID CIR DR # 800 ; . it : s,. E 4 s c,�5 ! 6 ri ++ g: 1 a
City/State/ZIP: PORTLAND, OR. 97230 Subtotal
Minimum permitfee�72t50' f() - (JO
Phone: (503) 261 -9915 Fax: (503) 261 -9814 Pl review (25% of permit fee)
CCB tic.: 122424 State surcharge (12% of permit fee) /)j p ^l
TOTAL PERMIT FEE /tom, O v
Authorized signature: This permit application expires if a permit is not obtained within 180
�� 2211 �[ � -- �a days after it has been accepted as complete.
I Print name: MARK DEFRANCISCO , Date: * Fee methodology set by Tri- County Building Industry Service Board