Permit CITY OF TIGARD MECHANICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: MEC2009 -00116
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/20/2009
Parcel: 1 S 125DD08300
Jurisdiction: Tigard
Site address: 6925 SW BARBARA LN
Subdivision: WASHINGTON SQUARE ESTATES NO.3 Lot: 91
Project: Nudelman
Project Description: Install gas insert, and (1) gas pipe.
Owner: FEES
NUDELMAN, AARON & CELESTE Description Date Amount
6925 SW BARBARA LN Gas Fireplace 03/20/2009 $10.00
TIGARD, OR 97223 12% State Surcharge - Mechanical 03/20/2009 $8.70
PHONE: Minimum Fee Adjustment - Mechanical 03/20/2009 $62.50
Contractor:
G P & W SYSTEMS INC
732 MARBLE RD
WASHOUGAL, WA 98671
PHONE: 360- 835 -3516
FAX: 360- 835 -5716
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Fuel
Fuel Types: Natural Gas
Gas Pressue
Total $81.20
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 -0100. You may obtain a copy of the rules
Issued By: a/ t A r p� Q ` n J n ,►\ Permittee Signature:
1 J` 3.
Call 503. 7:00 a.m. for an inspection that business day.
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.
f.
MAR -19 -2009 06:26 FROM:GP &4 SYSTEMS 3608355716 T0:15035981960 P.1'2
-T Mechani1cal Permit Application �` I OI + it I ii 1 1 `.I CO i 1 . d 1312 SW f ran Bhd �' d. • ,t �n��? AJ� °'�lBy: r ' ` . 6 , ) Permit No.. 111/ , r • • ,, a • •
• ?boom 503.639.4171 Fax: I,;i /I7 '. , � Other Permit
Inspection ina 503.639�f l7 ` Ic Z % 156 s. i er"andaa NetireValubact V/
TYPE 01 i SX COMMERCIAL FEE' sciwoUL.E — USE gfCICLISI'
0 New construction {gi .. .:: Adel , . 1 . w , t — Mechanical permit foes' are hosed cn the value of the wore
Q Demolition ❑ Other: B \ performed. bulimia the value (tuunded to the must dollar) of all
mechanical materials equ ipotmtl, labor overhead. and profit
CATEGORY OF value $
al- and 2- family dwelling ❑ C ial/iindustrial RESIDENTIAL EQUIPMENT (SYSTEMS FEES
El Y building - For special V frni tion ore darei isr.
❑ Multi-family 0 Master bu 0 Other. Description Qty. Ea. Total
JOB SITE INFORMATIIIN AND LOCATION Heat /coolleg
Job site address: ( q „2,5 S w 3,m c lo Ara LA nip �uditi ri m h r No pimp Furnace City/Stadn/ZIP: `r q r 4 4 lg A A 3 _ Femme 100:0004 BTU (th l ) 17.90
Suite/bldg /am no.: J Project name: Ow We pump 14
Cross street /directions to job Bite: Dori w arts 10.00
-
— Hlatrorric hat matter rya vy% — 14 (10
Boid:mid (miler (radiator or
hydrOn
14,00
it heaters (foeMype, not electric),
in- wafl -d mded dc. 14.00
Subdivision LA W.: Fluervent for any of above 6.80
-
Other 10.00
Tau map/parcel no.: Other Tad shy.
DIFI Or wORK Water heater 10.00
Gait Ample= h eplw 10.00
,rte
N 1'14 • , 4,-, Yh) .` . Flue vent far wwlra Leafs or gas
- Flo pea ce n d J J'k Jt � Log l li lo,ao
�i'�a, �A �l�l �. ' Col{1O iF Ws) y . 10.00
Wood/pellet stove 10.00
Wood fireplace /truest 19 i) J 10.00 ^ 1 0
a PROP£RT'Y OWNER I 0 TENANT chitrumv/l;rrQ/AtaJvent 10.00
// Q11>r r _ 10.00
Name;
' Fp v 4!- Joel _ hytiI Di Environmental rxksest and ventilation_
- Range
Arkin ' Co 4a s' 51A/ genii, a lh hood/other kitchen
�"'L °"�'t 10.00
crZ>I*
Ar t __ Clothesr4vercalmed 10.00
1 I Single - duet =beast (hathraeras,
Phut ( ) S al $ - 90- Fox: ( ) miter eommarma:ntr„ utility rooms) 610
AP1PLICANT 0 CO P/rAGT PERSON Attidcrawls a Cana 10.00
. 134asi»ess mmnt Ha" $ - ea4 $ — _ Other 10.00 __C i(f Contact none �. M f^' S&4S Ihr Brit four, SLIM tar eneb Imedlitowtl
Aed, 735 /}1�r'f r `� T
Om heat pump
p
City/5latts2lP .. _ '`1 walv►raiit 6�r
2.174"3: ( rp) $ 3 ,574 `( Fireplace r.�
�) 85F- - 7/ 6 WEAN heater
4rratil: S.Yo
CONTRACTOR Hartle :
- 13rmuremg minim
(ZQ Q Siskt•f' % 1 '� . _ c (gm)
Other Address: - ? 3 new A MECHANICAL !PE FOES- /3" -to
Cily t tWZIP! Subtotal •
Pt$ ( , Feu )_ 5.7s - 7I Mkimu permit foe (57230)
_ Pl m Plan review (259L of permit fee)
CCB ti : , O 7 �le 3,�!I, State surch (12%ofpermit fee) L1O
T(YrAI. PERMIT FEE 5<
Authorized signature: w / . — Th ter y hem accepted as complete. *kilned a *teiu TM
►, - Z. Date: , 4 - • Foe weahodobcP set by Tri- County Beadles ladrtrtry, Service Board
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