Permit CITY OF TIGARD MECHANICAL PERMIT
It COMMUNITY DEVELOPMENT Permit #: MEC2011 -00181
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/27/2011
Parcel: 2S103DD05200
Jurisdiction: Tigard
Site address: 10645 SW GARDEN PARK PL
Project: Perry Subdivision: GAARDE PARK Lot: 35
Project Description: Installation of wood stove insert.
Contractor: NW GAS LINES Owner: PERRY, SCOTT
16731 NE WASCO ST 10645 SW GARDEN PARK PL
PORTLAND, OR 97230 TIGARD, OR 97223
PHONE: 503 - 256 -2436 PHONE:
FAX: 503 - 256 -2245
FEES
Specifics: Description Date Amount
Wood Fireplace /Insert 04/27/2011 $23.32
Type of Use: SF 12% State Surcharge - Mechanical 04/27 /2011 $10.80
Class of Work: ALT Type of Const: Minimum Fee Adjustment - Mechanical 04/27/2011 $66.68
Occupancy Grp:
Stories:
Fuel
Fuel Types: Solid Fuel
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 . tions to 0 '. C by -If • , 503.232.1987 or 1.800.332.2344.
e l: ex /-
Issued =y: ` I Oki , i / Permittee Signatu • '
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.
Apr 26 11 10:28a N.W. GAS LINES 5032562245 p.1
Mechanical Permit Application RECEIV i FOR OFFICE USE ONO
Received 7 I t/
City of Tigard c erB e ` P tN °: )`/e j. -ool8/
III e 13125 SW Hall Blvd., Tigard, OR 97223 APR 2 6 1 C 1Inn Review
ti Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
Date/By:
T 1 G A R u Inspection Line: 503.639 err' OF TIG Ready/By: Juris. 0 See Page 2 for
Internet: www.tigard- or.gov BUILDING DIV LtJI`I l od• Supplemental Inforroatien
TYPE OF WORK COMMERCIAL FEE* SCHEDULE - USE Ch ECKLIST
• Mechanical permit fees* are based on the value of the work
❑ New construction Addition /alteration /replacement performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other mechanical materials, equipment, labor, overhead, and profit
Value: S
CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT /SYSTEMS FEES*
'ig and 2- family dwelling ❑ Cotnmercialrndustrial ❑ Accessory building For speespecial iejonnadna use checklist. Multi-family ❑Master builder 0 Other Description Qty. I Ea I Total
ROB SITE INFORMATION AND LOCATION Healing/cooling:
Air conditioning
lob site address: /(96 95 r� y)l (requires site plan showing placement) 46.75
/` Furnace 100,000 BTU (ducts/vents) 46.75
City: StateeZIP: � 1-/ * lc, ‘)t"-/ Furnace 100.000+ BTU (duets/vents) 54.91
J
Suite/bldg./apt. no.: Project name: Se j� yyJ { Heat pump
� (requires site plan showing placement) , 61.06
Cross street/directions to jab site: /// Ductwork 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 heater _. 23.32
MA ii 'AVM' fireplace 33.39
/ 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 4 77 3• 3 !
*PROPERTY OWNER 0 TENANT Chimney/liner/flue/vent 23.32
Other: : 23.32
Name: 5 G f / 42 b y Environmental exhaust and ventilation:
�j� Range hood/other kitchen
Address: /06" V t��/AlG3��i tQ equipment 33.39
—
City/State/ZIP: (✓ .T� er f Clothes dryer exhaust 33.39
Single -duct exhaust (bathrooms,
Phone: ( ) Fax: ( ) toilet compartments, utility rooms) 23.32
APPLICANT — ❑ CONTACT PERSON Attic/crawlspacc fans 23.32
Business nature: / Other 23.32
r� ! / I �' S / i J I 1 , _ » ` Fuel piping:
Contact name: 1 r n ' j 1. / , ° � / i �j� j $14.15 for first loan $4.03 for each additional
Address: 7j // �i Furnace, etc.
�� / / /l� �r�` � Gas heat pump
City/State/ZIP: f / i-,_36. Wall /suspended+unit heater
Phone: (93) c254, -- ...2 7 , Fax: :03) c_,....54,...-020 J (� Water heater
p
E- mail: G� jl �S L i.--- grace
CONTRACTOR Barbecue
Business name: Clothes dryer (gas)
i/ Other: _
Address: 54/1/3/1,.e MECHANICAL PERMIT FEES*
City /State/ZIP: Subtotal
Minimum permit fee ($90.00) *_ D I?
Phone. ( � I Fax: ( ) I Plan review (25% of permit fee)
//iv,,/ /tea lie.: V /47/3 State surcharge (12% of permit fee) 7 c�
I TOTAL PERMIT FEE pO• o
Z � � This permit application expires if a permit is not obtained within MI 1,,
Authorized signature: � c days after It has been accepted as complete. yV
Print name: e y e7' F Date: f � - & // ' Fee methodology set by Tri County Budding Industry Service Board
nlluir:u PumitsoMEC- PemitAuo.coc 09/099 /1 i
t: '440 45 l7T (1 0t12 /CC)M/IVEB)