Permit 11 CITY OF TIGARD MECHANICAL PERMIT
2' COMMUNITY DEVELOPMENT Permit #: MEC2011 -00383
T A D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2011
Parcel: 2S111AD01000
Jurisdiction: Tigard
Site address: 14565 SW 87TH AVE
Project: HOWELL Subdivision: PINEBROOK TERRACE Lot: 7
Project Description: Venting for water heater.
Contractor: BULL MOUNTAIN MECHANICAL Owner: POLENSEK, DAVID & HOWELL, SAMARA
13580 SW RHETT CT. 14565 SW 87TH AVE
TIGARD, OR 97224 TIGARD, OR 97224
PHONE: 503 - 612 -6677 PHONE: 503 - 598 -2255
FAX: 503 - 692 -3084
FEES
Specifics: Description Date Amount
Flue Vent for Water Heater or Gas 08/30/2011 $23.32
Type of Use: SF Fireplace
Class of Work: ALT Type of Const: 12% State Surcharge - Mechanical 08/30/2011 $10.80
Occupancy Grp: Minimum Fee Adjustment - Mechanical 08/30/2011 $66.68
Stories:
Fuel
Fuel Types:
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.
Issued By:, / Permittee Signature: • ,, Ad •
411110P; -
Call 503.6 1 5 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.
From: 08/30/2011 09:27 #358 P.002/002
Mechanical Permit Applica in 12 01 1 1CI. USL 0 L..) •
City of Tigard 11 �� Received
11111 I t ' • 13125 SW Hall Blvd., Tigard, OR19 , O 1.%\1\ Date/By: lji i byl t11. .e j
Plan Review
Phone: 503.718.2439 Fax: 503.548.1'960 r. Permit:
V Date/By:
Other Permi
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gard or.gov \ V ufied/Meth Supplementallnformahon
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g K�'' . a''s ,''''''5 TYPE : OF, WO K *_. ,.. ;'''''''''�' u','''''' ' ''''. }' •n M permit f T
v Mechanical permit fees* are based on the value of wo
❑ 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.
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Value: $
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® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other: Description I Qty. I Ea. I Total
•"�" c;, - ;�r `�"' :�. =$AT�� .� _.� /� }/��{ �:..:,• r., , �; �c ��' HeanpJcoollnR:
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Job site address: 14565 SW 87 Avenue . . (requires site plan showing placement) 46.75
Furnace 100,000 BTU (ducts/vents) 46.75
City / State/ZIP: Tigard, OR 97224 Furnace 100,000+ BTU (ducts/vents) 54.91
Suite/bldg. /apt. no.: Project name: 001184 - Howell Heat pump
(requires site plan showing placement) 61.06
Cross street/directions to job site: Duct work 23.32
Hydmnic 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:
ni f l' ''1! !• 1 TION 01:**K ., , " ' z `� :41, Water heater 23.32
Gas fireplace 33.39
Venting for Navien Tankless Water Heater 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
Chimney/liner /flue/vent 1 23,32 23.32
Other: 23,32
Name: Samara Howell & David Polensek . . Environmental exhaust and ventilation:
Address: 14565 SW 87 Avenue Range hood/other kitchen
equipment 33.39
City /State/ZIP: Tigard, OR 97224 Clothes dryer exhaust 33.39
Single-duct exhaust (bathrooms,
Phone: (503)598 -2255 Fax: ( ) toilet compartments, utility Moms) 23.32
Ati t ' .< ; ,. y' 10 $ON Attkc%lawlspace fans 2332
Other:
Business name: Bull Mountain Heating 23.32
Fuel piping:
Contact name:. Jack Hansen $14.15 for first four; $4.03 for each additional
Address: 6520 Rosewood Street Furnace, etc.
Gas heat pump
City /State/ZIP: Lake Oswego, OR 97035 Wall/suspended/unit heater
Phone: (503) 612 -6677 Fax: : (503) 692.3084 Water heater
Fireplace
E -mail: info @bullmountainmcch.com Range
-A�y� ' 'R �M1' ti �'yp ��fp°Y'��` p X ry, a�j., Barbecue
'�/ Fy3F,3A.�'".H» � Y;�„ �aumN»,a� �� -,�: ��X+,� �2�J.�i :,r. Y� 1)LI UeCitre
Business name: * SAME AS ABOVE * Clothes. dryer (gas)
Address:
Other:
,0¢
City/State/ZIP: Subtotal 23.32
Minimum permit fee ($90.00) 90.00
Phone: ( ) Fax: ( ) Plan review (25% of permit fee) _
CCB lic.: 157814 .. ' :' ' ' ' State surcharge (12% of permit fee) 100.80
TOTAL PERMIT FEE 100.80
T his permit ap plication expires if a permit Is not obtained within 180
Authorized signatu days after It bas been accepted as complete.
I Print name: Jack • ansen ' Date: 08 - 2011 • Fee methodology set by Tri-County Building Industry Service Board
I:\ Building \Permits \MEC-PermitApp.doc 09/09/10 440-4617T (I 1/02/COM/WEB)
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