Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2011 -00140
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/01/2011
Parcel: 1 S 134CA05000
Jurisdiction: Tigard
Site address: 11715 SW BURLCREST DR
Project: MONTGOMERY Subdivision: BURLWOOD NO.2 Lot: 23
Project Description: Gas piping for range.
Contractor: MIKE HAMILTON CONSTRUCTION Owner: MONTGOMERY, TERI J
3741 SE 134TH AVE 11715 SW BURLCREST DR
PORTLAND, OR 97236 TIGARD, OR 97223
PHONE: 503 - 388 -0347 PHONE:
FAX: 888 - 874 -5660
FEES
Specifics: Description Date Amount
Fuel Piping 04/01/2011 $14.15
Type of Use: SF 12% State Surcharge - Mechanical 04/01/2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/01/2011 $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 1.800.3
7
Issued By: ` � 0M Permittee Signature:
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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.
Fm:MyFax - Mike Hamilton Construction To:Mechanical permit app:) (15035981960) 13:30 04/01111GMT -05 Pg 02 -
Mechanical Permit Application FOR of i ti F I SI•: ()N1.1
6 1312 S W Tigard 2 ��
5 V. Hall Blvd., Tigard, OR 971_3
11 1
It Phone: 503.718.2439 Fax: 503.598.1 ' ' Plan Review Other Perna; d .` ' c. r: DatoBy:
T 1( L..,-,;;;,;. L1 Inspection Line: 503.639.4175 Dote Bendy. y^ See Page 2 for
Internet www.tigard-or.gov 1 rLL Notifies Method _ Supplemental Information
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Mechanical permit fees' are based on the value of the work
❑ New construction ® Addition/ alteration /replacement performed. Indicate the value (roundel to the nearest dollar) of all
0 Demolition 0 Other; mechanical materials, equipment, labor, overhead, and pmfit.
Value: $ 500.00
C OF CO N= O1i •
El 1- and 2 -family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist
❑ Multi- family ❑ Master builder ❑ Other: Description I Qty. 1 Ea. Total
JOB SITE:'INFORMkT.JON ;,Alm L A.TION Heating/cooling:
Air conditioning
Job site address: 11715 sw buricrest dr (requires site plan showing placement) 46.75
City /State/ZIP: tigard or 97223 Furnace 100 BTU (delta veers) 46.75 _______
Furnace 100,000+ BTU (ducts/vents) 54.91
Suite /bldg. /apt. no.: Project name: Heat pump
Cross street/directions to job site: (requires site plan strewing placement) 61.06
J 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: j Lot no.: Flue/ve t for any of above 23.32
I Other: 23.32 I
Tax map /parcel no.: Other fuel appliances:
- -_
. I3ES.GRIII?'T1O :OF Wt _- W at er heater 23.32
gas line install for kitchen range Gas fireplace 33.39
Floe vent for water heater or gas
approx. 251f of line fireplace 23.32
— — Log lighter (gas) 23.32
Wood/pellet stove 33.39 __
Wood fiteeplaceTmsen _ 23.32 ..
met /4ue/vent
i• d ' PRt ?1�R'!'3f IJtii't!!i�R. 1 .,..: � T.IP,IiI�►iH'I` ;
fh;mnet.n: 23.32
Other: 23.32
Name: Ted Montgomery Environmental exhaust and ventilation:
Address: 11715 sw Burkrest Dr. Range hood/other kitchen
equipment 33.39
City /State/ZIP: Tigard OR 97223 Clothes dryer exhaust 3339
Phone: (503)5909515 Fax: ( ) Single - duct exhaust (bathrooms,
r o0 ms}
.. - toilet compartments, utility 23.32 , ..... .._-
AP'PL'It ArNT : ' r 00NT',AC1 P ON " . Attic /erawlspace fans 23.32
Business name: Mike Hamilton Construction Other: 23.32
Fuel piping:
Contact name: Susan or Mike 514.15 for first four; 54.03 for each additional
Address: 3741 se 134 ave Furnace, etc.
Gas heat pump
City /State/ZIP: portland or 97236 _ ��— Wall/suspendedhmit heater
Phone: (503 ) 388 0347 Fax: : (888) 8745660 Water heater
Fireplace
E mhconstruction()comcastmet
Range 1 /4 C CT .: Barbecue y {
Business name: Mike Hamilton Construction Clothes dryer (gas)
Other:
Address: 3741 se 134 ave _ A
,1l11Cl~ t; 4LOt1t111itEF1 lGfi' _.
City/State/ZIP: Portland or 97236 _ .._ .._ Subtotal _ _ 14.60 I
Minimum pcatnii fte ($90.00 7 k)70 - 45 - 1
Phone: (503) 388 0347 / Fax: (888) 8745660 Plan review (25% of permit tt e)
CCB lie.: 18891 1 J� /4- r State surcharge (12% of permit fee) 10. ir
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TOTAL PERMIT FEE i/ ij.kr)
This permit application expires if a permit is not obtained within 180
Authorized signature: days after it has been accepted as complete.
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Print name: Michael Hamilton Date: 3 - - * Fee methodology set by Tri- County Building Industry Service Board
F∎AoigdateennelA 2c- Peruntapp.do: OW 09;10 440.4617T (1 t //02 COM',V1tB)
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