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Permit CITY OF TIGARD MECHANICAL PERMIT ''. • COMMUNITY DEVELOPMENT Permit #: MEC2011 -00222 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/20/2011 T1GAFkD Parcel: 25102DD00809 Jurisdiction: Tigard Site address: 13940 SW 87TH CT Project: Gardner Subdivision: FILBERT PARK Lot: 2 Project Description: Install gas piping, water heater and fireplace. Contractor: PIONEER GAS FURNACE Owner: GARDNER, RICHARD A 2636 NE SANDY BLVD 13940 SW 87TH CT PORTLAND, OR 97232 TIGARD, OR 97223 PHONE: 503 - 249 -5000 PHONE: 503 - 639 - 9307 FAX: 503 - 249 -8260 FEES Specifics: Description Date Amount f Water Heater 05/20/2011 $23.32 Type of Use: SF Gas Fireplace 05/20/2011 $33.39 Class of Work: ALT Type of Const: Flue Vent for Water Heater or Gas 05/20/2011 $46.64 Occupancy Grp: Fireplace Stories: Fuel Piping 05/20/2011 $14.15 12% State Surcharge - Mechanical 05/20/2011 $14.10 Fuel Fuel Types: Natural Gas Gas Pressure: Total $131.60 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: Permittee Signature: d ,O L.j (4 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. May 20 2011 10:15AM HP LASERJET FRX p.3 Mechanical Permit Application , /tali (H.-F ` . I. sr. (lwl.) ceived City of Tigard ‘��"� n - // Permit No 00 - do as 13125 SW Hall Blvd., Tigard, OR 97223 ° ��s Plan Review Phone: 503,639.4171 Fax: 503.598.1960' y O \ y Date/B Other Permit:: Inspection Line: 503.639.4175 j " 1 1 , •,� r.1 , P O Date Ready/By: ® See Page 2 for Internet: www.tigard or.gov \` P\ `1 6), -Q \ Notif , ed/Method: Supplemental Information OO . v -'t& : a,,x c x r + ` > " t +'rf ; "- ,.1 v. x zv.2a ar r"' a at _-.:F.,+n , +xt+4 `4 �"� 5 r(( r �Su .ifyin ' a ' 3�. v d . r g d .1 1, 7 ' i f' i : e.• - l 1 ; t 4i �4 .. l • - i . , r. x ,i�..- . "•a. � rle rt r .'�v � • � > � r4� Ld s t .. "t : _�:�wvCt`s!Pik°� �il:.Vk'vc'3,o . .. � ,s ..�'��.�''` \\ ao \� Mechanical permit fees* are based on the value of the work El New construction 6.11 Addition/alberatton/repp� \�lrive performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: s mechanical materials, equipment, labor, overhead, and profit • ;x� ` a ; r ��a T + i a s ��i r r a . :, . 'ti . , �?rk°^ �'f-P,};: �'i� 1 ; Value $ • _ ., n. t . - "- ...z ..1 f� N i ►1 1- and 2- family dwelling ❑ Commercial/industrial El Accessory building . , .L' li _ti . . "'' { Multi -famil For special information use checklist. El y ❑ Master builder ❑ O ther: Description 1 Qty. I Ea. I Total ;rc na:" sr` =t 1 li> p , t I �t t , 0 k i 3 it 7' n .:. t .; . ... * Heating/cooling �' ' j�,;;x,i,!''; _.. �.,a.« _ •,����. ..ua�� , s i.� xt �..�. . <ei°,i�`°'';�''° �;" 1 - ;t2` �<<<,: �. pry' a„ Job site address: / 3 q 4 10 1 Fit ' W. Air conditioning (requires site plan showing placement) 46.75 City / State/ZIP: To d t v 97 Y Furnace 100,000 BTU (ducts/vents) 46.75 �1 � , Furnace 100,000+ BTU (ducts/vente) 54.91 Suite/bldg./apt. no.: Proj ect name: /r 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 2332 Subdivision: . Lot no.: ether; 23.32 Tax map /parcel no.: Other fuel appliances ;�.` ;?' =vc; ' � �I1�Y ' ;y . . _ i��3:�� " " - .�' ;]iC%?Fc� �' - . 'r,7��" Water heater / 2332 � • 7 +j ,1 ',„. : ,-, . ( .p r; ;;;: S s `aiYQ j t .•..: • ,j �. . : . 4 , 1 % ,r.:i ,, �`i ' Y �:,;!H.- At � - r 44 M t` 4 f , r r. . „ .; � wy �� �;`��� ' ��� ` `�" � 33.3 �u� P, +' ` 1 ,..;. 1 >, }n'e �, ��t^'ili.'.iY: :, '.i:1 �::, � n /��/�� F:wrror. I n as (41 , w eT Y� j +l t/l /-�C-f Q ilo r fr `l lace 2. 23.32 121b-64/ a r Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace/insert 23.32 1: :,.ri :.r. , �.. x.,F , , 1 Mr '. aa �::t , „, r , „L a =: . . Chimney /liner /flue/vent 23.32 .r . '.;f " r d r I, ', A'� .d i '1� 0:" . . n , ' 1 3s Aa d� .i Y a L ! v r�, 4:4, .rs t, 7 . {, a.,.. .. ' . . 41 :1 2 r u lftl .:. » •� . s,.. Wl• r . V'''' , -. Other: 23.32 Name: R o`<h,�- gia r o y Environmental exhaust and ventilation Address: / () 5 ' t r`fi Range hood/other kitchen equipment 3339 City/State/ZIP: i acct., t 2 cr Clothes dryer exhaust , 33.39 Phone: (703) f Single -duct exhaust (bathrooms. ©7 1 es: ( ) toilet compartments, utility rooms) 23.32 VPho "rte L t)y '.T,p 4T `f x x ax : .•. : . : ' n ;tr, , .. Att :.µBa °. , ..., y � t 1 ..,- i :.A;- Attc /crawlace f s ans 23.32 ; >r: 1 ; r a. 9^ 3 yy . -+:, t fit' � ,,q ,V ::', .' s P y�: fi r. ?.,;� 7: :t . �. # � ' :�:,;�.. , Avla' �,.lr"f�, r ,T ,.,•_ , �,. ± :v%>'. rTr Other: , 23.32 Business name: Fuel pipin ( 2 , IIVPL I /• /qC. - Contact name: - 14.15 r first four; 54.03 for each additional Address: Furnace, c. Gas heat pump City /State/ZIP: Wall/suspended/unit heater Phone: ( ) 1 Fax: : ( ) Water heater i /X / 15 Fireplace I ' E -mail: Range � / .� y � • � : :� - sits 1EM ..y CTL: tsl`+<'a ' "" + ,a `,' L IM}; I X'ai:t Barbecue Business name: IF/ oNeele... a F d Q ll Clothes dryer (gas) Other: Address: ji j� �jr� a �) �•� /�/C� C.[ U6 -s'�f' c•. 30ei' =ti,r v : :;i'; :i;i t;..0 • . /San` sty n. x b c � tt•::.. ,c !-.., ' . ` „ City/State/Z1P: pi 4nd DA, 617230_ Subtotal • $ I Minimum permit fee ($90.00) Ph 45 '�L one: LCD ,.F o O Fax: 663) 2(4GJ .. ' z Plan review (25% of permit fee) L B lic.: ! --1 j / ! State surcharge (12% of permit fee) f 1/• / v ��v��vff CCC iii"'''' ! 1 TOTAL PERMIT FEE ^1 V , (it r ,, This permit / � / � j application expires if a permit is not obtained within 180 / Authorized SlgrlatuIe :� q u days after it has been accepted as complete. PrintnameHOity Li,tb,,,, '7 Date: 5 id) 2/ A _ I Fee methodology set b Tri County Building Industry Service Board t:\ Building \PermitelMEC- PemntApp.doe 20/01/'69 r 440-4517T I1 /02/COOM/WEU)